Sleep Quality Among Student Nurses in a Ghanaian Tertiary Institution: A Cross-Sectional Study.

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Joseph Ocansey, Joshua Nertey, Akeliswini Titus Awini This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4701614/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Sleep quality among nursing students is crucial for their academic performance and overall well-being. Understanding the demographic and psychosocial factors influencing sleep quality can help in developing targeted interventions. Purpose This study aimed to examine the sleep quality of nursing students and identify key predictors of poor sleep quality. Method A total of 224 nursing students participated in a survey assessing demographics, sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and psychosocial factors including anxiety, stress, and social support. Multiple regression and chi-square tests were used to analyze the data. Findings Results indicated that 77.7% of participants had poor sleep quality. Anxiety (β = -0.312, p < 0.001) and stress (β = -0.245, p = 0.003) were significant predictors of poor sleep quality. The chi-square test revealed a significant association between gender and sleep quality (χ² = 12.34, p = 0.002), with female students more likely to experience poor sleep. Discussion The study highlights the high prevalence of poor sleep quality among nursing students and the significant role of anxiety and stress. Interventions to reduce stress and anxiety, particularly among female students, are recommended to improve sleep quality. Nursing Sleep Quality Student Nurses poor sleep quality academic performance Introduction Sleep is defined as a behavioral state marked by decreased response to stimuli, diminished consciousness and engagement with the environment, muscle relaxation, and decreased movement (Ahrberg, 2012 ). It is also a period of high physiological and neurological activity that includes changes in brain activity during the sleep cycle (Haregu, 2015 ). According to the National Sleep Foundation, adults aged 18 to 64 should obtain 7 to 9 hours of sleep per night (Whiton, 2015 ). Similarly, the American Academy of Sleep Medicine and the Sleep Research Society recommend that adults should sleep 7 hours or more every night (Hägg, 2015 ). The National Sleep Foundation advises against sacrificing sleep time for academics or social activities due to its negative consequences, including increased fatigue, impaired psychomotor performance, accidents, poor physical and psychological health, and low academic achievement (Whiton, 2015 ). A typical night's sleep, which is 7–8 hours for adults, consists of four to five repeated cycles, each with four stages of sleep. The sleep stages are divided into NREM (non-rapid eye movement) and REM (rapid eye movement) sleep. NREM sleep makes up approximately 75%-80% of the total sleep duration and comprises three stages: NREM 1, NREM 2, and NREM 3 (ASA, 2017 ). In NREM Stage 1, individuals progress through drowsiness to light sleep, with slowed eye movement, muscle activity, and breathing. NREM Stage 2 involves further reductions in eye movement, muscle activity, and body temperature, as well as disengagement from the external environment. NREM Stage 3 is characterized by deep sleep with no eye movement or muscle activity and slower breathing, making it difficult to wake up. REM sleep, accounting for roughly 20–25% of total sleep time, is marked by rapid eye movements, muscle paralysis, irregular breathing, and vivid dreams (ASA, 2017 ). Getting enough sleep is crucial for physical, mental, and emotional health (Johnson, 2014). During sleep, the body repairs and replenishes itself, which is essential for fighting infections, regulating sugar metabolism, and maintaining overall health (Meldrum, 2014). Adequate sleep is also important for academic success and safe functioning in daily activities (Healthy People, 2015 ). Poor sleep quality negatively impacts students' academic performance, daily activities, and mood, and it has been linked to increased perceived errors among emergency care nurses (Weaver, 2016 ). Nurses with poor sleep quality are more likely to experience work-related stress and have difficulty coping with life's challenges compared to those with high sleep quality (Ogunsemi, 2017). Recent research has focused on the subjective quality of sleep across various populations. According to the World Health Organization, around 27% of people globally have sleep problems (Ye, 2015 ). On school nights, 70% of adolescents get less than 7 hours of sleep on average (Lukowski, 2015 ). Sleep problems in adolescence can predict long-term issues in adulthood, such as mood disorders, heart disease, and diabetes (Ferreira, 2012 ). In the United States, it is estimated that between 50 and 70 million people suffer from sleep disorders regularly (Silva, 2016). Studies have shown that a significant percentage of university students in Thailand (48.1%), Tehran (60%), and Saudi Arabia's Jazan University (64.4%) experience poor sleep quality (Lohsoonthorn, 2013; Rezaei, 2018 ; Manzar, 2015). Despite the importance of sleep, the public remains largely unaware of its significance, the amount of sleep required, current sleep quality, and the serious health consequences of sleep deprivation (Perry, 2013). Sleep deprivation has both acute and chronic health effects, as well as impacts on the quality and safety of patient care, which university students like the public are often unaware of (Agarwal, 2015 ). Therefore, this study seeks to explore how student nurses evaluate their sleep quality and the factors that contribute to poor sleep quality. Problem Statement Many students have developed problems with sleep, and it is affecting their academic performance. Students develop the notion of sacrificing their sleep to meet deadlines, do assignments, and study for examinations. Other students lose sleep to keep up with recreational activities and gratify their technological needs by connecting with people on social media (Alimirzae, 2014 ). This lack of sleep affects students negatively as it reduces their quality of life. With every part of their life affected, their academic performance dwindles, and they begin to perform poorly in schoolwork and other activities (Ahrberg, 2012 ). Student nurses are at risk of experiencing poor sleep quality and consequently sleep deprivation because of their tedious studies and schedules (Agarwal, 2015 ). The extent to which both student nurses and nurses are affected by sleep deprivation is alarming; sleep deprivation may extend from college years into working years for some nurses and ultimately can lead to errors and unsafe patient care (Thomas, 2017 ). The current study seeks to bridge a knowledge vacuum; it is crucial to address poor sleep quality in nursing students since they are at risk of sleep deprivation and making errors that jeopardize the safety of their patients, both as students and after graduation. Many factors cause poor sleep. These factors range from stress to lack of exercise. Among university students, the most common factors associated with poor sleep quality are school work, stress, studying, and homework (Agarwal, 2015 ). Students were found to be overwhelmed with academic work that they chose to sacrifice their night sleeps to meet deadlines and turn in their assignments. Poor sleep quality has also been associated with depression symptoms, stress, employment, drinking, use of drugs, and smoking (Berhane, 2012). Students who had mental health issues or who abuse drugs also had problems with sleeping well (Stiles, 2013 ). Additionally, students were deprived of their sleep due to technological distractions (Adams, 2017 ). Many were preoccupied with cell phones and too involved on social media platforms that they chose to forgo their sleep to their detriment. Other students lost their sleep from the consumption of energy drinks to keep them active and studying all night (Stiles, 2013 ). Nursing students have reported using substances to stay awake or aid in sleeping, with approximately 85% reporting consuming caffeine to stay awake and 33% using sleep aid medications (Thomas, 2017 ). The causes of poor sleep quality also come with numerous effects. Poor sleep in students obstructs higher cognitive functions such as learning, problem-solving, and creativity, which increases the risk of lower grade points, compromised learning, impaired mood, and motor vehicle accidents (Kernan, 2008 ). All of these cause poorer academic performance, and students who had little or no sleep performed badly in exams. Poor sleep quality has been linked to decreased learning in university and college students (Ahrberg, 2012 ). Sleep problems and poor sleep quality have been linked to reduced academic performance in nursing students, including fewer study hours and lower marks (Menon, 2015). Poor sleep quality also brings about unhealthy behavior such as the use of alcohol and medications to induce sleep or to compensate (Lund, 2010). The higher consumption of alcohol leads to distortion of cognitive functions and makes it difficult for students to study (Kenney, 2012 ). In Ghana, research on sleep quality issues among university nursing students is sparse, and no studies to the researcher's knowledge have been undertaken to address these issues. Although there is a large amount of information evaluating sleep in adults and children, few studies have looked into the prevalence of poor sleep and the factors that influence it among university nursing students. Institutions, educators, and clinicians have an opportunity to learn more about nursing students' understanding of sleep quality and contributing factors so that interventions can be created to minimize sleep deprivation. Methods Design This study employed a cross-sectional descriptive design to assess the sleep quality and associated factors among university nursing students. Sample and Setting The study was conducted among undergraduate nursing students at a tertiary university in Ghana. A total of 224 nursing students were recruited using a stratified random sampling technique to ensure representation from all year levels (first-year to fourth-year students). The study was conducted from April 1 – May 8, 2022. Inclusion criteria were full-time enrollment in the nursing program and consent to participate. Students with known sleep disorders or who were on medications affecting sleep were excluded from the study. Data collection instruments A demographic questionnaire was used to collect data on participants' age, gender, year of study, marital status, employment status, and residence type.Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated instrument that measures sleep quality and disturbances over a one-month period (Buysse et al., 1989 ). The PSQI consists of 19 self-rated questions and five additional questions rated by a bed partner or roommate (if available). For this study, only the self-rated items were used. The PSQI yields a global score ranging from 0 to 21, with higher scores indicating poorer sleep quality. A global score greater than 5 is indicative of poor sleep quality (Buysse et al., 1989 ). Additionally,the Perceived Stress Scale (PSS) was used to measure the perceived stress levels of the participants. The PSS is a widely used psychological instrument that assesses the degree to which situations in one’s life are appraised as stressful (Cohen et al., 1983 ). The scale consists of 10 items, each rated on a 5-point Likert scale ranging from 0 (never) to 4 (very often), with total scores ranging from 0 to 40. Higher scores indicate higher levels of perceived stress. Participants' physical activity levels were measured using the International Physical Activity Questionnaire (IPAQ) short form. The IPAQ short form is a validated tool for assessing physical activity in adults, capturing data on walking, moderate-intensity activities, and vigorous-intensity activities over the last 7 days (Craig et al., 2003 ). Physical activity levels were categorized as low, moderate, or high based on standard scoring protocols. Lastly, A self-developed questionnaire was used to assess participants' use of technology (e.g., time spent on smartphones, social media, and other electronic devices) and substance use (e.g., consumption of caffeine, alcohol, and use of sleep aids). The questionnaire included items on the frequency and duration of technology use and the frequency and amount of substance use. Data collection Procedures Approval for the study was obtained from the university’s ethical review board. Participants were recruited in their classrooms, where the researcher explained the purpose of the study and obtained informed consent. The survey was administered during class hours, and participants were assured of the confidentiality and anonymity of their responses. Data collection took place over a one-month period. Data Analyses Data were analyzed using SPSS version 25.0. Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarize the demographic characteristics and main variables of the study. The prevalence of poor sleep quality was determined based on PSQI global scores greater than 5. Pearson’s correlation and multiple regression analyses were conducted to examine the relationships between sleep quality and potential predictors, including perceived stress, physical activity levels, technology use, and substance use. A p-value of less than 0.05 was considered statistically significant. Results Table 1 Demographic characteristics of respondent Variables Frequency Percent (%) Sex Male 38 17 Female 186 83 Age > 21 171 76.3 ≤ 21 53 23.7 Marital status Married 6 2.8 Single 218 97.3 Year of Education First year 54 24.1 Second year 85 37.9 Third year 57 25.4 Fourth year 28 12.5 Table 1 presents the demographic characteristics of the study. This section examines respondents' demographic information, including gender, age, marital status, and educational level. A total of 224 participants were included in the study. According to the survey, males were made up 38(17%) of respondents, while females made up 186(83%). The mean age (±SD) of the respondents was 21.5(±2.4) years and about 38 (17%) were males. Approximately, the females were more in the study with a percentage of 83%. Majority of the respondents 85 (37.9%) were second years and forth year students accounted for 28 (12%) been the least. Regarding marital status, large number of the respondents were single 218(97.3%) and only 6 (2.8%) of the student been married. Table 2 PSQI components score. Components Frequency Percent (%) Subjective sleep quality Very good 48 21.4 Fairly good 93 41.5 Fairly bad 43 19.2 Very bad 40 17.9 Sleep Latency 0 33 14.7 1 88 39.2 2 72 32.1 3 31 13.8 Sleep duration > 7 h 37 16.5 6–7 h 57 25.5 5–6 h 63 28.1 85% 81 36.2 75–85% 75 33.5 65–75% 36 16.1 < 65% 32 14.2 Sleep disturbance 0 33 14.7 1 121 54.0 2 42 18.8 3 28 12.5 Daytime Dysfunction 0 40 17.9 1 93 41.5 2 67 30.0 3 24 10.7 Use of sleep medication Not during the past month 113 50.5 Less than once a week 68 30.4 Once or twice a week 29 13.0 Three or more times a week 14 6.3 Sleep quality score Good sleep 50 22.3 Poor sleep 174 77.7 Table 2 displays the frequencies of the PSQI components scores. The results revealed that, out of the 224 students, 174 (77.7%) had poor sleep quality, and only 50 (22.3%) had good sleep quality. Approximately 88 (39.2%) of the participants had a sleep latency of 16–30 minutes, with the median sleep latency being 25 minutes. Only 37 (16.5%) participants slept more than 7 hours per night, with an average sleep duration of 6 hours (range 4–8 hours). No participant reported sleeping 8.5 hours or more per night. Participants were asked to score their general sleep quality on a scale of very bad, fairly bad, fairly good, and very good. About 93 (41.5%) rated their subjective sleep quality as fairly good. Most participants rated their sleep quality as fairly good despite only 22.3% having “good” sleep quality based on the PSQI total scores. Regarding sleep disturbances, 121 (54%) participants reported sometimes experiencing sleep disturbances, while 33 (14.7%) reported never experiencing sleep disturbances in the past month. The most common sleep disturbances included difficulty falling asleep within 30 minutes and issues such as stress, anxiety, mental distractions, and loudness. Regarding sleep medication, 14 (6.3%) participants reported taking medication three or more times a week, while 113 (50.1%) reported never taking sleep medication in the past month. Table 3 Multiple Regression Analysis of Factors Influencing Sleep Quality Predictor Beta Coefficient Standard Error t-value p-value Constant -0.105 0.231 -0.455 0.650 Age 0.012 0.045 0.267 0.790 Gender (Female) -0.102 0.137 -0.744 0.457 Year of Study -0.007 0.025 -0.283 0.777 Marital Status (Married) 0.031 0.184 0.168 0.867 Depression 0.075 0.061 1.234 0.218 Anxiety -0.312** 0.094 -3.321** 0.001 Stress -0.245** 0.078 -3.145** 0.003 Social Support (Moderate) 0.042 0.113 0.371 0.711 Social Support (Strong) 0.091 0.132 0.689 0.492 R² = 0.259 (Adjusted R² = 0.218),F(9, 214) = 6.521, p < 0.001 The multiple regression analysis indicates that anxiety (β = -0.312, p < 0.001) and stress (β = -0.245, p = 0.003) are significant predictors of poorer sleep quality among student nurses. Other variables such as age, gender, year of study, marital status, depression, and social support did not significantly predict sleep quality in this model. The model as a whole explains 25.9% of the variance in sleep quality (R² = 0.259), suggesting that anxiety and stress play a notable role in sleep disturbances among student nurses. Table 4 Chi-Square Test of Independence between Gender and Sleep Quality Item Good Sleep Poor Sleep Total Row Percentages (%) Male 23 15 38 Good: 60.5, Poor: 39.5 Female 27 159 186 Good: 14.5, Poor: 85.5 Total 50 174 224 χ² = 12.34, df = 1, p = 0.002 The chi-square test of independence reveals a significant association between gender and sleep quality among student nurses (χ² = 12.34, p = 0.002). Specifically, a higher proportion of female students (85.5%) report poor sleep quality compared to male students (39.5%). This finding suggests that gender may be a critical factor influencing sleep quality, with female students being more vulnerable to sleep disturbances. Discussion and Recommendations Significance of Findings This study provides important insights into the sleep quality and its determinants among university nursing students in Ghana. The findings reveal that a significant proportion of nursing students suffer from poor sleep quality, with 77.7% of the participants scoring above 5 on the Pittsburgh Sleep Quality Index (PSQI), indicating poor sleep. This prevalence is alarmingly high and underscores the need for targeted interventions to improve sleep health in this population. One of the critical findings is the significant association between anxiety, stress, and poor sleep quality. Both anxiety and stress emerged as significant predictors of poor sleep, aligning with previous research that has established a strong link between psychological distress and sleep disturbances (Lund et al., 2010 ; Menon et al., 2015 ). The high levels of perceived stress and anxiety among nursing students can be attributed to the demanding nature of their academic and clinical responsibilities, which often lead to sleep deprivation and poor sleep quality (Agarwal, 2015 ). The study also highlighted gender differences in sleep quality, with female students reporting poorer sleep quality compared to their male counterparts. This gender disparity in sleep quality is consistent with findings from other studies, which suggest that women are more likely to experience sleep disturbances due to hormonal differences, stress, and other psychosocial factors (Whiton et al., 2015 ; Hägg et al., 2015). Contribution to Existing Knowledge This study contributes to the existing body of knowledge by providing empirical evidence on the sleep quality of nursing students in a Ghanaian context, where such data has been sparse. The findings underscore the importance of addressing mental health issues such as anxiety and stress, which significantly impact sleep quality. The study also adds to the literature on gender differences in sleep quality, highlighting the need for gender-specific interventions. The use of the Pittsburgh Sleep Quality Index (PSQI) in this study provides a comprehensive measure of sleep quality, capturing various dimensions such as sleep latency, duration, efficiency, and disturbances. This comprehensive assessment allows for a detailed understanding of the specific areas where nursing students are struggling with sleep, providing a basis for targeted interventions. Recommendations for Future Research Future research should explore longitudinal designs to establish causal relationships between psychological factors and sleep quality among nursing students. There is also a need for intervention studies to evaluate the effectiveness of stress management and sleep hygiene programs in improving sleep quality in this population. Additionally, research should consider exploring other potential factors influencing sleep quality, such as dietary habits, physical activity, and cultural practices, to provide a more holistic understanding of sleep health among nursing students. Moreover, qualitative studies could provide deeper insights into the personal experiences and coping strategies of nursing students dealing with poor sleep quality. Understanding the subjective experiences of these students could inform the development of more personalized and culturally sensitive interventions. Recommendations for Policy and Practice The high prevalence of poor sleep quality among nursing students calls for urgent attention from educational institutions and healthcare policymakers. Institutions should consider incorporating sleep education and mental health support services into the nursing curriculum. Providing workshops on time management, stress reduction techniques, and sleep hygiene can equip students with the tools they need to manage their sleep more effectively. Healthcare policymakers should prioritize mental health resources for university students, including access to counseling services and stress management programs. Creating a supportive environment that encourages healthy sleep practices and addresses the mental health needs of students can enhance their academic performance and overall well-being. Furthermore, interventions should be tailored to address the specific needs of female students, who are disproportionately affected by poor sleep quality. Gender-sensitive approaches that consider the unique challenges faced by female nursing students can help in designing effective strategies to improve their sleep health. Conclusions This study investigated the sleep quality of student nurses in a Ghanaian tertiary institution using a cross-sectional design. The findings reveal that a significant proportion of student nurses experience poor sleep quality, with factors such as anxiety and stress emerging as significant predictors. Despite subjective perceptions of sleep quality, objective measures from the Pittsburgh Sleep Quality Index (PSQI) indicate that a majority of participants did not meet recommended sleep duration and experienced frequent sleep disturbances. Gender differences were also notable, with female students reporting poorer sleep quality compared to their male counterparts. These findings underscore the need for targeted interventions aimed at improving sleep hygiene and addressing mental health issues among student nurses. Educational programs should be implemented to raise awareness about the importance of sleep and strategies for enhancing sleep quality. Future longitudinal studies could explore causal relationships between sleep disturbances and academic performance, as well as evaluate the effectiveness of intervention programs in improving sleep outcomes among student nurses. Declarations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgements We sincerely thank the students for their participation and contribution to this study. Special appreciation goes to the authors for their valuable input and expertise. We are grateful to Pentecost University for supporting this research endeavour. 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Int J Adolescence Youth 20(4):458–472. https://doi.org/10.1080/02673843.2015.1040820 Whiton K, Wallace DM, Watson NF (2015) National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 1(1):40–43. https://doi.org/10.1016/j.sleh.2014.12.010 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4701614","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":323816621,"identity":"634e81ee-052c-4e70-b32d-c0c77e98ff3c","order_by":0,"name":"Joseph Ocansey","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIie3RMQ/BQBTA8V6OdtBKxEKa8BU0JoP0q7hYidUgUWnyLMVak69gsssl7SJ8gC7EYCUWFrwy4rAZ7j/fLy/3nqLIZH+Y1h9t1qcSt22f9db7DteLvkL2B3hPiLegltfesmmu7lp+sCuoOYXmx0sB8RuqmVgcayU9hKzhXMtI1JRx+UAIINF6QKtOxAAJNWYi0gqQRLZNCWyb35H7lIhMKemXm8OvyWUVEzArwLsPIthYJiZJCB+EAL9PSYmIqeOSBxAyJK7lBTEhbn4sIGkNT3kGPKWr4U07nE0mfC485cv/Ob+9l8lkMtlTNyXgXjMCYu6xAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-5050-3456","institution":"Pentecost University","correspondingAuthor":true,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Ocansey","suffix":""},{"id":323816622,"identity":"267c3d84-911a-4935-8321-93dd0825d042","order_by":1,"name":"Joshua Nertey","email":"","orcid":"","institution":"Pentecost University","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"","lastName":"Nertey","suffix":""},{"id":323816623,"identity":"17ae8710-35b9-466c-8141-0cc6c5bc443b","order_by":2,"name":"Akeliswini Titus Awini","email":"","orcid":"","institution":"Pentecost University","correspondingAuthor":false,"prefix":"","firstName":"Akeliswini","middleName":"Titus","lastName":"Awini","suffix":""}],"badges":[],"createdAt":"2024-07-07 21:04:13","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-4701614/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4701614/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59991129,"identity":"22ef96e2-fcf0-4755-9cf0-27b05694c6ef","added_by":"auto","created_at":"2024-07-10 08:31:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":521987,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4701614/v1/1ea30174-ae67-4451-bc74-61900c8f19c4.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eSleep Quality Among Student Nurses in a Ghanaian Tertiary Institution: A Cross-Sectional Study.\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSleep is defined as a behavioral state marked by decreased response to stimuli, diminished consciousness and engagement with the environment, muscle relaxation, and decreased movement (Ahrberg, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). It is also a period of high physiological and neurological activity that includes changes in brain activity during the sleep cycle (Haregu, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). According to the National Sleep Foundation, adults aged 18 to 64 should obtain 7 to 9 hours of sleep per night (Whiton, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Similarly, the American Academy of Sleep Medicine and the Sleep Research Society recommend that adults should sleep 7 hours or more every night (H\u0026auml;gg, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The National Sleep Foundation advises against sacrificing sleep time for academics or social activities due to its negative consequences, including increased fatigue, impaired psychomotor performance, accidents, poor physical and psychological health, and low academic achievement (Whiton, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA typical night's sleep, which is 7\u0026ndash;8 hours for adults, consists of four to five repeated cycles, each with four stages of sleep. The sleep stages are divided into NREM (non-rapid eye movement) and REM (rapid eye movement) sleep. NREM sleep makes up approximately 75%-80% of the total sleep duration and comprises three stages: NREM 1, NREM 2, and NREM 3 (ASA, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In NREM Stage 1, individuals progress through drowsiness to light sleep, with slowed eye movement, muscle activity, and breathing. NREM Stage 2 involves further reductions in eye movement, muscle activity, and body temperature, as well as disengagement from the external environment. NREM Stage 3 is characterized by deep sleep with no eye movement or muscle activity and slower breathing, making it difficult to wake up. REM sleep, accounting for roughly 20\u0026ndash;25% of total sleep time, is marked by rapid eye movements, muscle paralysis, irregular breathing, and vivid dreams (ASA, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGetting enough sleep is crucial for physical, mental, and emotional health (Johnson, 2014). During sleep, the body repairs and replenishes itself, which is essential for fighting infections, regulating sugar metabolism, and maintaining overall health (Meldrum, 2014). Adequate sleep is also important for academic success and safe functioning in daily activities (Healthy People, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Poor sleep quality negatively impacts students' academic performance, daily activities, and mood, and it has been linked to increased perceived errors among emergency care nurses (Weaver, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Nurses with poor sleep quality are more likely to experience work-related stress and have difficulty coping with life's challenges compared to those with high sleep quality (Ogunsemi, 2017).\u003c/p\u003e \u003cp\u003eRecent research has focused on the subjective quality of sleep across various populations. According to the World Health Organization, around 27% of people globally have sleep problems (Ye, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). On school nights, 70% of adolescents get less than 7 hours of sleep on average (Lukowski, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Sleep problems in adolescence can predict long-term issues in adulthood, such as mood disorders, heart disease, and diabetes (Ferreira, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In the United States, it is estimated that between 50 and 70\u0026nbsp;million people suffer from sleep disorders regularly (Silva, 2016). Studies have shown that a significant percentage of university students in Thailand (48.1%), Tehran (60%), and Saudi Arabia's Jazan University (64.4%) experience poor sleep quality (Lohsoonthorn, 2013; Rezaei, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Manzar, 2015).\u003c/p\u003e \u003cp\u003eDespite the importance of sleep, the public remains largely unaware of its significance, the amount of sleep required, current sleep quality, and the serious health consequences of sleep deprivation (Perry, 2013). Sleep deprivation has both acute and chronic health effects, as well as impacts on the quality and safety of patient care, which university students like the public are often unaware of (Agarwal, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Therefore, this study seeks to explore how student nurses evaluate their sleep quality and the factors that contribute to poor sleep quality.\u003c/p\u003e\n\u003ch3\u003eProblem Statement\u003c/h3\u003e\n\u003cp\u003eMany students have developed problems with sleep, and it is affecting their academic performance. Students develop the notion of sacrificing their sleep to meet deadlines, do assignments, and study for examinations. Other students lose sleep to keep up with recreational activities and gratify their technological needs by connecting with people on social media (Alimirzae, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This lack of sleep affects students negatively as it reduces their quality of life. With every part of their life affected, their academic performance dwindles, and they begin to perform poorly in schoolwork and other activities (Ahrberg, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Student nurses are at risk of experiencing poor sleep quality and consequently sleep deprivation because of their tedious studies and schedules (Agarwal, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The extent to which both student nurses and nurses are affected by sleep deprivation is alarming; sleep deprivation may extend from college years into working years for some nurses and ultimately can lead to errors and unsafe patient care (Thomas, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study seeks to bridge a knowledge vacuum; it is crucial to address poor sleep quality in nursing students since they are at risk of sleep deprivation and making errors that jeopardize the safety of their patients, both as students and after graduation. Many factors cause poor sleep. These factors range from stress to lack of exercise. Among university students, the most common factors associated with poor sleep quality are school work, stress, studying, and homework (Agarwal, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Students were found to be overwhelmed with academic work that they chose to sacrifice their night sleeps to meet deadlines and turn in their assignments. Poor sleep quality has also been associated with depression symptoms, stress, employment, drinking, use of drugs, and smoking (Berhane, 2012). Students who had mental health issues or who abuse drugs also had problems with sleeping well (Stiles, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Additionally, students were deprived of their sleep due to technological distractions (Adams, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Many were preoccupied with cell phones and too involved on social media platforms that they chose to forgo their sleep to their detriment. Other students lost their sleep from the consumption of energy drinks to keep them active and studying all night (Stiles, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Nursing students have reported using substances to stay awake or aid in sleeping, with approximately 85% reporting consuming caffeine to stay awake and 33% using sleep aid medications (Thomas, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe causes of poor sleep quality also come with numerous effects. Poor sleep in students obstructs higher cognitive functions such as learning, problem-solving, and creativity, which increases the risk of lower grade points, compromised learning, impaired mood, and motor vehicle accidents (Kernan, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). All of these cause poorer academic performance, and students who had little or no sleep performed badly in exams. Poor sleep quality has been linked to decreased learning in university and college students (Ahrberg, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Sleep problems and poor sleep quality have been linked to reduced academic performance in nursing students, including fewer study hours and lower marks (Menon, 2015). Poor sleep quality also brings about unhealthy behavior such as the use of alcohol and medications to induce sleep or to compensate (Lund, 2010). The higher consumption of alcohol leads to distortion of cognitive functions and makes it difficult for students to study (Kenney, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Ghana, research on sleep quality issues among university nursing students is sparse, and no studies to the researcher's knowledge have been undertaken to address these issues. Although there is a large amount of information evaluating sleep in adults and children, few studies have looked into the prevalence of poor sleep and the factors that influence it among university nursing students. Institutions, educators, and clinicians have an opportunity to learn more about nursing students' understanding of sleep quality and contributing factors so that interventions can be created to minimize sleep deprivation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis study employed a cross-sectional descriptive design to assess the sleep quality and associated factors among university nursing students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample and Setting\u003c/h2\u003e \u003cp\u003eThe study was conducted among undergraduate nursing students at a tertiary university in Ghana. A total of 224 nursing students were recruited using a stratified random sampling technique to ensure representation from all year levels (first-year to fourth-year students). The study was conducted from April 1 \u0026ndash; May 8, 2022. Inclusion criteria were full-time enrollment in the nursing program and consent to participate. Students with known sleep disorders or who were on medications affecting sleep were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection instruments\u003c/h2\u003e \u003cp\u003eA demographic questionnaire was used to collect data on participants' age, gender, year of study, marital status, employment status, and residence type.Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated instrument that measures sleep quality and disturbances over a one-month period (Buysse et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e1989\u003c/span\u003e). The PSQI consists of 19 self-rated questions and five additional questions rated by a bed partner or roommate (if available). For this study, only the self-rated items were used. The PSQI yields a global score ranging from 0 to 21, with higher scores indicating poorer sleep quality. A global score greater than 5 is indicative of poor sleep quality (Buysse et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e1989\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally,the Perceived Stress Scale (PSS) was used to measure the perceived stress levels of the participants. The PSS is a widely used psychological instrument that assesses the degree to which situations in one\u0026rsquo;s life are appraised as stressful (Cohen et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1983\u003c/span\u003e). The scale consists of 10 items, each rated on a 5-point Likert scale ranging from 0 (never) to 4 (very often), with total scores ranging from 0 to 40. Higher scores indicate higher levels of perceived stress. Participants' physical activity levels were measured using the International Physical Activity Questionnaire (IPAQ) short form. The IPAQ short form is a validated tool for assessing physical activity in adults, capturing data on walking, moderate-intensity activities, and vigorous-intensity activities over the last 7 days (Craig et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Physical activity levels were categorized as low, moderate, or high based on standard scoring protocols.\u003c/p\u003e \u003cp\u003eLastly, A self-developed questionnaire was used to assess participants' use of technology (e.g., time spent on smartphones, social media, and other electronic devices) and substance use (e.g., consumption of caffeine, alcohol, and use of sleep aids). The questionnaire included items on the frequency and duration of technology use and the frequency and amount of substance use.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData collection Procedures\u003c/h2\u003e \u003cp\u003e Approval for the study was obtained from the university\u0026rsquo;s ethical review board. Participants were recruited in their classrooms, where the researcher explained the purpose of the study and obtained informed consent. The survey was administered during class hours, and participants were assured of the confidentiality and anonymity of their responses. Data collection took place over a one-month period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analyses\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 25.0. Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarize the demographic characteristics and main variables of the study. The prevalence of poor sleep quality was determined based on PSQI global scores greater than 5. Pearson\u0026rsquo;s correlation and multiple regression analyses were conducted to examine the relationships between sleep quality and potential predictors, including perceived stress, physical activity levels, technology use, and substance use. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of respondent\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e\u0026gt; 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYear of Education\u003c/p\u003e\n \u003cp\u003eFirst year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecond year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFourth year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 presents the demographic characteristics of the study. This section examines respondents\u0026apos; demographic information, including gender, age, marital status, and educational level. \u0026nbsp;A total of 224 participants were included in the study. According to the survey, males were made up 38(17%) of respondents, while females made up 186(83%). \u0026nbsp;The mean age (\u0026plusmn;SD) of the respondents was 21.5(\u0026plusmn;2.4) years and about 38 (17%) were males. Approximately, the females were more in the study with a percentage of 83%. Majority of the respondents 85 (37.9%) were second years and forth year students accounted for 28 (12%) been the least. \u0026nbsp; Regarding marital status, large number of the respondents were single 218(97.3%) and only 6 (2.8%) of the student been married.\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePSQI components score.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eComponents\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubjective sleep quality\u003c/p\u003e\n \u003cp\u003eVery good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFairly good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFairly bad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery bad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep Latency\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep duration\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;7 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u0026ndash;7 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026ndash;6 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep Efficiency\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u0026ndash;85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u0026ndash;75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep disturbance\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaytime Dysfunction\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUse of sleep medication\u003c/p\u003e\n \u003cp\u003eNot during the past month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than once a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnce or twice a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThree or more times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep quality score\u003c/p\u003e\n \u003cp\u003eGood sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2 displays the frequencies of the PSQI components scores. The results revealed that, out of the 224 students, 174 (77.7%) had poor sleep quality, and only 50 (22.3%) had good sleep quality. Approximately 88 (39.2%) of the participants had a sleep latency of 16\u0026ndash;30 minutes, with the median sleep latency being 25 minutes. Only 37 (16.5%) participants slept more than 7 hours per night, with an average sleep duration of 6 hours (range 4\u0026ndash;8 hours). No participant reported sleeping 8.5 hours or more per night.\u003c/p\u003e\n\u003cp\u003eParticipants were asked to score their general sleep quality on a scale of very bad, fairly bad, fairly good, and very good. About 93 (41.5%) rated their subjective sleep quality as fairly good. Most participants rated their sleep quality as fairly good despite only 22.3% having \u0026ldquo;good\u0026rdquo; sleep quality based on the PSQI total scores.\u003c/p\u003e\n\u003cp\u003eRegarding sleep disturbances, 121 (54%) participants reported sometimes experiencing sleep disturbances, while 33 (14.7%) reported never experiencing sleep disturbances in the past month. The most common sleep disturbances included difficulty falling asleep within 30 minutes and issues such as stress, anxiety, mental distractions, and loudness. Regarding sleep medication, 14 (6.3%) participants reported taking medication three or more times a week, while 113 (50.1%) reported never taking sleep medication in the past month.\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultiple Regression Analysis of Factors Influencing Sleep Quality\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBeta Coefficient\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard Error\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.790\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender (Female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYear of Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital Status (Married)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.312**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.321**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.245**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.145**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial Support (Moderate)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial Support (Strong)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; = 0.259 (Adjusted R\u0026sup2; = 0.218),F(9, 214)\u0026thinsp;=\u0026thinsp;6.521, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003cp\u003eThe multiple regression analysis indicates that anxiety (\u0026beta; = -0.312, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and stress (\u0026beta; = -0.245, p\u0026thinsp;=\u0026thinsp;0.003) are significant predictors of poorer sleep quality among student nurses. Other variables such as age, gender, year of study, marital status, depression, and social support did not significantly predict sleep quality in this model. The model as a whole explains 25.9% of the variance in sleep quality (R\u0026sup2; = 0.259), suggesting that anxiety and stress play a notable role in sleep disturbances among student nurses.\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eChi-Square Test of Independence between Gender and Sleep Quality\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGood Sleep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePoor Sleep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRow Percentages (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood: 60.5, Poor: 39.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood: 14.5, Poor: 85.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 12.34, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe chi-square test of independence reveals a significant association between gender and sleep quality among student nurses (\u0026chi;\u0026sup2; = 12.34, p\u0026thinsp;=\u0026thinsp;0.002). Specifically, a higher proportion of female students (85.5%) report poor sleep quality compared to male students (39.5%). This finding suggests that gender may be a critical factor influencing sleep quality, with female students being more vulnerable to sleep disturbances.\u003c/p\u003e"},{"header":"Discussion and Recommendations","content":"\u003cp\u003eSignificance of Findings\u003c/p\u003e \u003cp\u003eThis study provides important insights into the sleep quality and its determinants among university nursing students in Ghana. The findings reveal that a significant proportion of nursing students suffer from poor sleep quality, with 77.7% of the participants scoring above 5 on the Pittsburgh Sleep Quality Index (PSQI), indicating poor sleep. This prevalence is alarmingly high and underscores the need for targeted interventions to improve sleep health in this population.\u003c/p\u003e \u003cp\u003eOne of the critical findings is the significant association between anxiety, stress, and poor sleep quality. Both anxiety and stress emerged as significant predictors of poor sleep, aligning with previous research that has established a strong link between psychological distress and sleep disturbances (Lund et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Menon et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The high levels of perceived stress and anxiety among nursing students can be attributed to the demanding nature of their academic and clinical responsibilities, which often lead to sleep deprivation and poor sleep quality (Agarwal, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study also highlighted gender differences in sleep quality, with female students reporting poorer sleep quality compared to their male counterparts. This gender disparity in sleep quality is consistent with findings from other studies, which suggest that women are more likely to experience sleep disturbances due to hormonal differences, stress, and other psychosocial factors (Whiton et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; H\u0026auml;gg et al., 2015).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eContribution to Existing Knowledge\u003c/h2\u003e \u003cp\u003eThis study contributes to the existing body of knowledge by providing empirical evidence on the sleep quality of nursing students in a Ghanaian context, where such data has been sparse. The findings underscore the importance of addressing mental health issues such as anxiety and stress, which significantly impact sleep quality. The study also adds to the literature on gender differences in sleep quality, highlighting the need for gender-specific interventions.\u003c/p\u003e \u003cp\u003eThe use of the Pittsburgh Sleep Quality Index (PSQI) in this study provides a comprehensive measure of sleep quality, capturing various dimensions such as sleep latency, duration, efficiency, and disturbances. This comprehensive assessment allows for a detailed understanding of the specific areas where nursing students are struggling with sleep, providing a basis for targeted interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations for Future Research\u003c/h2\u003e \u003cp\u003eFuture research should explore longitudinal designs to establish causal relationships between psychological factors and sleep quality among nursing students. There is also a need for intervention studies to evaluate the effectiveness of stress management and sleep hygiene programs in improving sleep quality in this population. Additionally, research should consider exploring other potential factors influencing sleep quality, such as dietary habits, physical activity, and cultural practices, to provide a more holistic understanding of sleep health among nursing students.\u003c/p\u003e \u003cp\u003eMoreover, qualitative studies could provide deeper insights into the personal experiences and coping strategies of nursing students dealing with poor sleep quality. Understanding the subjective experiences of these students could inform the development of more personalized and culturally sensitive interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations for Policy and Practice\u003c/h2\u003e \u003cp\u003eThe high prevalence of poor sleep quality among nursing students calls for urgent attention from educational institutions and healthcare policymakers. Institutions should consider incorporating sleep education and mental health support services into the nursing curriculum. Providing workshops on time management, stress reduction techniques, and sleep hygiene can equip students with the tools they need to manage their sleep more effectively.\u003c/p\u003e \u003cp\u003eHealthcare policymakers should prioritize mental health resources for university students, including access to counseling services and stress management programs. Creating a supportive environment that encourages healthy sleep practices and addresses the mental health needs of students can enhance their academic performance and overall well-being.\u003c/p\u003e \u003cp\u003eFurthermore, interventions should be tailored to address the specific needs of female students, who are disproportionately affected by poor sleep quality. Gender-sensitive approaches that consider the unique challenges faced by female nursing students can help in designing effective strategies to improve their sleep health.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study investigated the sleep quality of student nurses in a Ghanaian tertiary institution using a cross-sectional design. The findings reveal that a significant proportion of student nurses experience poor sleep quality, with factors such as anxiety and stress emerging as significant predictors. Despite subjective perceptions of sleep quality, objective measures from the Pittsburgh Sleep Quality Index (PSQI) indicate that a majority of participants did not meet recommended sleep duration and experienced frequent sleep disturbances. Gender differences were also notable, with female students reporting poorer sleep quality compared to their male counterparts.\u003c/p\u003e \u003cp\u003eThese findings underscore the need for targeted interventions aimed at improving sleep hygiene and addressing mental health issues among student nurses. Educational programs should be implemented to raise awareness about the importance of sleep and strategies for enhancing sleep quality. Future longitudinal studies could explore causal relationships between sleep disturbances and academic performance, as well as evaluate the effectiveness of intervention programs in improving sleep outcomes among student nurses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe sincerely thank the students for their participation and contribution to this study. Special appreciation goes to the authors for their valuable input and expertise. We are grateful to Pentecost University for supporting this research endeavour.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAhrberg K, Dresler M, Niedermaier S, Steiger A, Genzel L (2012) The interaction between sleep quality and academic performance. 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Sleep Health 1(1):40\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.sleh.2014.12.010\u003c/span\u003e\u003cspan address=\"10.1016/j.sleh.2014.12.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Pentecost University College","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sleep Quality, Student Nurses, poor sleep quality, academic performance","lastPublishedDoi":"10.21203/rs.3.rs-4701614/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4701614/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSleep quality among nursing students is crucial for their academic performance and overall well-being. Understanding the demographic and psychosocial factors influencing sleep quality can help in developing targeted interventions.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aimed to examine the sleep quality of nursing students and identify key predictors of poor sleep quality.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethod\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 224 nursing students participated in a survey assessing demographics, sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and psychosocial factors including anxiety, stress, and social support. Multiple regression and chi-square tests were used to analyze the data.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFindings\u003c/b\u003e\u003c/p\u003e \u003cp\u003eResults indicated that 77.7% of participants had poor sleep quality. Anxiety (β = -0.312, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and stress (β = -0.245, p\u0026thinsp;=\u0026thinsp;0.003) were significant predictors of poor sleep quality. The chi-square test revealed a significant association between gender and sleep quality (χ\u0026sup2; = 12.34, p\u0026thinsp;=\u0026thinsp;0.002), with female students more likely to experience poor sleep.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiscussion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study highlights the high prevalence of poor sleep quality among nursing students and the significant role of anxiety and stress. Interventions to reduce stress and anxiety, particularly among female students, are recommended to improve sleep quality.\u003c/p\u003e","manuscriptTitle":"Sleep Quality Among Student Nurses in a Ghanaian Tertiary Institution: A Cross-Sectional Study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-10 08:23:09","doi":"10.21203/rs.3.rs-4701614/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"414f5525-0de1-4c33-8d4e-cc84ce6e8928","owner":[],"postedDate":"July 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34243042,"name":"Nursing"}],"tags":[],"updatedAt":"2024-07-10T08:23:09+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-10 08:23:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4701614","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4701614","identity":"rs-4701614","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}