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ORIGINAL ARTICLE
Year : 2021  |  Volume : 30  |  Issue : 1  |  Page : 136-140  Table of Contents     

Effect of four weeks of integrated yoga intervention on perceived stress and sleep quality among female nursing professionals working at a tertiary care hospital: A pilot study


1 Centre for Integrative Medicine and Research, AIIMS, New Delhi, India
2 Division of Yoga and Humanities, SVYASA, Bengaluru, Karnataka, India

Date of Submission15-Jan-2021
Date of Acceptance30-Apr-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Balaram Pradhan
SVYASA Yoga University, # No-19, Eknath Bhavan, Gavipuram Circle, KG Nagar City, Bengaluru - 560 019, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_11_21

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   Abstract 


Background: Studies have reported that significant nursing professionals experience tremendous stress which often affects their sleep quality leading to poor well-being. Yoga being a mind body intervention reported to improve sleep quality and reduce stress. Aim: The present pilot study was designed to assess the effect of yoga on perceived stress and sleep quality of the female nursing professionals working at tertiary care hospital. Materials and Methods: Thirty-three apparently healthy nursing staffs in the age range of 30–60 years (mean age 40.60 ± 10.26) were recruited as participants of the study, from a tertiary care hospital in Delhi. Participants were administered perceived stress scale (PSS) and Pittsburgh sleep quality index (PSQI) before and after the yoga intervention. Participants received 4 week of yoga intervention for 45 min/day for 5 days a week. Results: There was a significant reduction on the postscores of PSS (t = 5.86, P < 0.0001, paired t-test) and PSQI (z = −4.38, P < 0.0001, Wilcoxon signed-ranks test) in comparison to prescores. After the yoga intervention, perceived stress reduced by 27.01% and the sleep quality improved by 38.68%. Conclusion: The finding of the study suggests effectiveness of yoga in reduction of the perceived stress and improvement of the quality of sleep of the nursing professional. However, the present findings need to be confirmed with further studies with larger sample size and robust research design.

Keywords: Nursing profession, sleep quality, stress, yoga


How to cite this article:
Parajuli N, Pradhan B, Jat M. Effect of four weeks of integrated yoga intervention on perceived stress and sleep quality among female nursing professionals working at a tertiary care hospital: A pilot study. Ind Psychiatry J 2021;30:136-40

How to cite this URL:
Parajuli N, Pradhan B, Jat M. Effect of four weeks of integrated yoga intervention on perceived stress and sleep quality among female nursing professionals working at a tertiary care hospital: A pilot study. Ind Psychiatry J [serial online] 2021 [cited 2021 Aug 1];30:136-40. Available from: https://www.industrialpsychiatry.org/text.asp?2021/30/1/136/320351



Nursing professionals in India as well as throughout the world experience high stress[1],[2],[3] and poor sleep quality.[4],[5],[6],[7] Negative consequences of stress and poor sleep quality in the health of nursing professionals are well established. Studies showed that stress and poor sleep quality are positively associated with anxiety, depression, fatigue, and confusion, and negatively associated with attention, memory, and concentration of professional nurses.[8],[9],[10],[11] High level of stress and poor sleep quality are also correlated with increased physical health complications such as hypertension, obesity, cardiovascular diseases, and low quality of life.[12],[13] Stress and poor sleep quality in nurses' even increases patient care errors.[14],[15]

The findings of scientific studies showed excessive workload, professional conflicts, poor leadership management style, inadequate pay, work shift pattern, and emotional cost of caring are some of the causes of stress and poor sleep quality in nursing professionals.[16],[17],[18],[19] In addition, nurses are found neglecting their self-care needs when they are devoted to patient care.[20] Abandonment of self-care increases stress, reduces quality of life, deteriorates physical and psychological health of nurses as well as increases the health care cost.[21] It also compromises the patients care quality.[21] The present study also showed that stress negatively affects self-care in nurses.[22] Therefore, hospital managements are required to improve nurses' working environment and promote practices that nurture self-care in nurses, reduce their stress and improve sleep quality. Fostering self-care, improving sleep quality and helping to manage stress can enhance nurses' physical and psychological health, can minimize patient care errors and health-care cost of an institution.

Yoga is a practice to enhance self-care, coping strategies and sleep quality, and to reduce work stress of nurses.[23],[24],[25] A randomized, control, pilot-study conducted in 40 nurses showed that yoga significantly improves self-care and mindfulness, and significantly reduces emotional exhaustion.[26] Another randomized control study conducted in nurses with chronic low back pain showed that yoga is an efficient intervention to improve their physical, psychological, and social health spheres of quality of life compared to physical exercise.[27] Even a systematic review reported yoga as an effective technique to manage the stress of health workers.[28] Yoga also improves nurses' problem-solving ability and ability to focus on patients' needs.[29] In addition, mindfulness meditation and mindfulness-based stress reduction techniques were found effective in improving general health, sense of coherence, coping ability, life satisfaction, relaxation, mental well-being and job satisfaction as well as reducing stress, anxiety, depression, burnout of professional nurses.[30],[31],[32],[33]

Studies to assess the effect of yoga on stress and sleep quality of nursing professionals are rare, one study conducted in Chinese nurses reported 6 months of yoga intervention improves nurses sleep quality and reduces work stress.[24] Further studies are required to support the effect of yoga on stress and sleep quality of nursing professionals. Literature review showed no study to assess the effect of yoga on perceived stress and sleep quality in India. Therefore, the present pilot study was designed to assess the effectiveness of 4 weeks of yoga on perceived stress and sleep quality among the nursing professionals working at a tertiary care hospital.


   Materials and Methods Top


Convenient sample of 33 apparently healthy female nursing professionals within the age range of 30–60 years (mean age 40.60 ± 10.26), working at a tertiary care hospital in New Delhi were recruited as the participants for the present study. Registered Direct Care Giving nursing professionals' and those who were willing to participate were included in the study. Whereas those nursing professionals who were diagnosed with severe musculoskeletal, neurological or psychiatric illness, those who had recent surgical intervention and those who were practicing yoga on a regular basis were excluded from the study. The design of the study was a single group pre-post. Patients were assessed on baseline and after the 4 weeks of intervention. The study was approved by a project Evaluation Committee of Directorate of Distance Education, SVYASA deemed to be University, Bengaluru, Karnataka, India. Verbal informed consent was obtained from the nursing professionals before the study, after explanations of the nature of the study in detail.

Intervention

45 min of group yoga was given for 6 days a week for 4 weeks. 45 min of yoga intervention includes Sukshma Vyayama (Joints loosening) breathing exercise, asanas (postures), pranayamas and deep relaxation technique. Yoga intervention was given by an academically trained yoga therapist. Practices mentioned in [Table 1] were repeated throughout the intervention period.
Table 1: Yoga module for professional nurses

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Assessments

Perceived stress

Perceived stress was assessed using the perceived stress scale (PSS). PSS is a self-reported 10-item questionnaire to assess perception of stress in one's day-to-day life.[34] PSS is easy-to-use questionnaire with well-established psychometric property.[35] Each item of PSS is rated on 5 points scales from 0 (never) to 4 (very often). Each item of PSS is rated on 5-point scale from 0 (never) to 4 (very often). The possible score ranges from 0 to 40. The total score is obtained by reversing the responses for the positively state items (4, 5, 7, and 8) and summing scores across all the scales items.[34] PSS score ranging from 0 to 13 would be considered low stress; score ranging from 14 to 26 would be considered to be moderate stress; and score ranging from 27 to 40 would be considered to be high stress.[36]

Sleep quality

Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) is a self-rated questionnaire to measure the quality of sleep and sleep disturbance over 1 month. PSQI contains 19 items and generates scores of seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction.[37] PSQI has internal consistency and reliability coefficient (Cronbach's alpha) 0.83 and test-retest reliability 0.87.[38] PSQI has diagnostic sensitivity of 89.6% and specificity of 86.5%.[37] Each item is rated in four point scales: 0 (not during the past month), to 3 (three or more times a week) for items 1–8 and 0 (very good) to 3 (very bad) for item number 9. The seven component scores are added to obtain a global score ranging from 0 to 21 and global score 5 or greater indicates worse sleep quality.[39]

Statistical analysis

Statistical analysis was performed using IBM statistics Statistical Package for the Social Sciences (SPSS) using Version 19.0., (Armonk, NY: IBM Corp.). Data were found to be normally distributed for PSS and were not found to be normally distributed for PSQI when tested with Shapiro–Wilk test. Hence, paired t-test was used to analyze PSS scores and Wilcoxon signed-ranks test was used to analyze the PSQI scores, respectively. All statistical analysis was computed with two-tailed.


   Results Top


There was a significant reduction on the postscores of PSS (t = 5.86, P < 0.0001, paired t-test) and PSQI (z = ‒4.38, P < 0.0001, Wilcoxon signed-ranks test) in comparison with prescores. Cohen's d for PSS is 0.69 and for PSQI is 0.63 which indicates moderate effect size. Yoga reduces the perceived stress by 27.01% and improves the quality of sleep by 38.68%. The study suggests yoga helps to reduce the perceived stress and improve the sleep quality of the nursing professionals. Mean pre- and post-scores of PSS and PSQI, Cohen's d as well as t score and z scores are illustrated in [Table 2].
Table 2: Mean±standard deviation, t score and Z score of perceived stress scale and Pittsburg sleep quality index before and after yoga intervention, and Cohen's d

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   Discussion Top


The present study was designed to assess the effect of the integrated yoga module in the perceived stress and sleep quality among nursing professionals working at a tertiary care hospital. The finding of the study indicated the significant reduction in the perceived stress and improvement in the sleep quality of the nursing professionals after integrative yoga intervention.

This finding of the present study was supported by the outcomes of previous studies which demonstrated yoga intervention significantly reduced work stress, anxiety, muscle fatigue and emotional exhaustion, and enhanced the quality of sleep, self-care, coping skills, and sense of well-being of nursing professionals.[24],[40],[41] However, the possible mechanism of reduction of stress and improvement in the quality of sleep after yoga intervention is not yet understood clearly. A previous study had shown that yoga reduced the sympathetic nerves activities, increases parasympathetic activities and balances autonomic nervous system reactivity.[42] Another study showed that yoga increased the secretion of a neurotransmitter called gamma-amino butyric acid (GABA).[43] Thus, increase in parasympathetic nerve activities, reduction of sympathetic nerve activities, and secretion of the inhibitory neurotransmitters such as GABA after yoga practice could be the possible mechanism for reduction of the perceived stress and improvement of the sleep quality. Increase in positive affect and self-compassion as well as inhibition of the posterior hypothalamus and salivary cortisol after yoga practice can also play an important role in reduction of stress.[44]

The finding of the present study advocated yoga module is effective in reducing perceived stress and improving sleep quality of nursing professionals; however, further study is required to conform to the present finding. Based on the present finding, health agencies and hospital managements can design the integrated yoga program for nursing professionals to improve their overall well-being and enhance patients care. In addition, based on the current research outcome, medical professionals can encourage patients at risk of getting stress-related disorders to practice yoga on a regular basis to minimize the stress, improve the sleep quality and prevent serious physiological and psychological complications. Furthermore, corporations and other organizations also can incorporate yoga on their daily schedule to enhance employees' psychological health and to minimize health care burden.

The limitations of the present study are small sample size, lack of control group, and use of self-report measures to assess stress and sleep quality. These limitations can be addressed in future research by incorporating large sample size and robust research design. Three arm randomized control trials can be conducted including groups performing yoga and physical exercise and a group without intervention. Studies also can be conducted using biomarkers of stress such as serum or salivary cortisol as well as electroencephalography. In addition, future studies to evaluate the effect of yoga on nursing professionals' overall health as well as patients' care could quantify the actual benefit of yoga.


   Conclusion Top


The finding of the present study suggested integrative yoga intervention significantly reduced the perceived stress and improved the sleep quality of the nursing professional. Therefore, yoga can be cost-effective tools to manage the stress and improve the quality of sleep of the nursing professional, which can lead to the improvement in overall health of nurses and reduction in patient care errors. Based on the finding of the present pilot study, further studies can be conducted with larger sample size and robust research design.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bhatia N, Kishore J, Jiloha R. Occupational stress amongst nurses from two tertiary care hospitals in Delhi. Australas Med J 2010;3:731-8.  Back to cited text no. 1
    
2.
Chatzigianni D, Tsounis A, Markopoulos N, Sarafis P. Occupational stress experienced by nurses working in a Greek regional hospital: A cross-sectional study. Iran J Nurs Midwifery Res 2018;23:450-7.  Back to cited text no. 2
    
3.
Maharaj S, Lees T, Lal S. Prevalence and risk factors of depression, anxiety, and stress in a cohort of Australian nurses. Int J Environ Res Public Health 2018;16:61.  Back to cited text no. 3
    
4.
Bagheri H, Shahabi Z, Ebrahimi H, Alaeenejad F. The association between quality of sleep and health-related quality of life in nurses. J Hayat 2007;12:13-20.  Back to cited text no. 4
    
5.
Hasson D, Gustavsson P. Declining sleep quality among nurses: A population-based four-year longitudinal study on the transition from nursing education to working life. PLoS One 2010;5:e14265.  Back to cited text no. 5
    
6.
Lin SL, Huang CY, Shiu SP, Yeh SH. Effects of yoga on stress, stress adaption, and heart rate variability among mental health professionals – A randomized controlled trial. Worldviews Evid Based Nurs 2015;12:236-45.  Back to cited text no. 6
    
7.
Chien PL, Su HF, Hsieh PC, Siao RY, Ling PY, Jou HJ. Sleep quality among female hospital staff nurses. Sleep Disord 2013;2013:283490.  Back to cited text no. 7
    
8.
Allan JL, Farquharson B, Johnston DW, Jones MC, Choudhary CJ, Johnston M. Stress in telephone helpline nurses is associated with failures of concentration, attention and memory, and with more conservative referral decisions. Br J Psychol 2014;105:200-13.  Back to cited text no. 8
    
9.
Mark G, Smith AP. Occupational stress, job characteristics, coping, and the mental health of nurses. Br J Health Psychol 2012;17:505-21.  Back to cited text no. 9
    
10.
Kunert K, King ML, Kolkhorst FW. Fatigue and sleep quality in nurses. J Psychosoc Nurs Ment Health Serv 2007;45:30-7.  Back to cited text no. 10
    
11.
Pilcher JJ, Ginter DR, Sadowsky B. Sleep quality versus sleep quantity: Relationships between sleep and measures of health, well-being and sleepiness in college students. J Psychosom Res 1997;42:583-96.  Back to cited text no. 11
    
12.
Kane PP. Stress causing psychosomatic illness among nurses. Indian J Occup Environ Med 2009;13:28-32.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Shao MF, Chou YC, Yeh MY, Tzeng WC. Sleep quality and quality of life in female shift-working nurses. J Adv Nurs 2010;66:1565-72.  Back to cited text no. 13
    
14.
Khamisa N, Oldenburg B, Peltzer K, Ilic D. Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health 2015;12:652-66.  Back to cited text no. 14
    
15.
Johnson AL, Jung L, Song Y, Brown KC, Weaver MT, Richards KC. Sleep deprivation and error in nurses who work the night shift. J Nurs Adm 2014;44:17-22.  Back to cited text no. 15
    
16.
Adib-Hajbaghery M, Khamechian M, Alavi NM. Nurses' perception of occupational stress and its influencing factors: A qualitative study. Iran J Nurs Midwifery Res 2012;17:352-9.  Back to cited text no. 16
    
17.
Sharma P, Davey A, Davey S, Shukla A, Shrivastava K, Bansal R. Occupational stress among staff nurses: Controlling the risk to health. Indian J Occup Environ Med 2014;18:52-6.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
McVicar A. Workplace stress in nursing: A literature review. J Adv Nurs 2003;44:633-42.  Back to cited text no. 18
    
19.
Oommen H, Wright M, Maijala H. Stress-promoting and stress-relieving factors among nurses in rural India: A case study. Divers Equal Health Care 2010;7:189-200.  Back to cited text no. 19
    
20.
Lombardo B, Eyre C. Compassion fatigue: A nurse's primer. Online J Issues Nurs 2011;16:3.  Back to cited text no. 20
    
21.
Richard AA, Shea K. Delineation of self-care and associated concepts. J Nurs Scholarsh 2011;43:255-64.  Back to cited text no. 21
    
22.
Nahm ES, Warren J, Zhu S, An M, Brown J. Nurses' self-care behaviors related to weight and stress. Nurs Outlook 2012;60:e23-31.  Back to cited text no. 22
    
23.
Crane PJ, Ward SF. Self-healing and self-care for nurses. AORN J 2016;104:386-400.  Back to cited text no. 23
    
24.
Fang R, Li X. A regular yoga intervention for staff nurse sleep quality and work stress: A randomised controlled trial. J Clin Nurs 2015;24:3374-9.  Back to cited text no. 24
    
25.
Mehrabi T, Azadi F, Pahlavanzadeh S, Meghdadi N. The effect of yoga on coping strategies among intensive care unit nurses. Iran J Nurs Midwifery Res 2012;17:421-4.  Back to cited text no. 25
    
26.
Alexander GK, Rollins K, Walker D, Wong L, Pennings J. Yoga for self-care and burnout prevention among nurses. Workplace Health Saf 2015;63:462-70.  Back to cited text no. 26
    
27.
Patil NJ, Nagaratna R, Tekur P, Manohar PV, Bhargav H, Patil D. A randomized trial comparing effect of yoga and exercises on quality of life in among nursing population with chronic low back pain. Int J Yoga 2018;11:208-14.  Back to cited text no. 27
[PUBMED]  [Full text]  
28.
Cocchiara RA, Peruzzo M, Mannocci A, Ottolenghi L, Villari P, Polimeni A, et al. The use of yoga to manage stress and burnout in healthcare workers: A systematic review. J Clin Med 2019;8:284.  Back to cited text no. 28
    
29.
Raingruber B, Robinson C. The effectiveness of Tai Chi, yoga, meditation, and Reiki healing sessions in promoting health and enhancing problem solving abilities of registered nurses. Issues Ment Health Nurs 2007;28:1141-55.  Back to cited text no. 29
    
30.
Ando M, Natsume T, Kukihara H, Shibata H, Ito S. Efficacy of mindfulness-based editation therapy on the sense of coherence and mental health of nurses. Health (Irvine) 2011;3:118-22.  Back to cited text no. 30
    
31.
van der Riet P, Levett-Jones T, Aquino-Russell C. The effectiveness of mindfulness meditation for nurses and nursing students: An integrated literature review. Nurse Educ Today 2018;65:201-11.  Back to cited text no. 31
    
32.
Smith SA. Mindfulness-based stress reduction: An intervention to enhance the effectiveness of nurses' coping with work-related stress. Int J Nurs Knowl 2014;25:119-30.  Back to cited text no. 32
    
33.
Ghawadra SF, Abdullah KL, Choo WY, Phang CK. Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. J Clin Nurs 2019;28:3747-58.  Back to cited text no. 33
    
34.
Cohen S, Kamararck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.  Back to cited text no. 34
    
35.
Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci) 2012;6:121-7.  Back to cited text no. 35
    
36.
Cohen S, Janicki-Deverts D. Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 20091. J Appl Soc Psychol 2012;42:1320-34.  Back to cited text no. 36
    
37.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.  Back to cited text no. 37
    
38.
Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 2002;53:737-40.  Back to cited text no. 38
    
39.
Buysse DJ, Hall ML, Strollo PJ, Kamarck TW, Owens J, Lee L, et al. Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med 2008;4:563-71.  Back to cited text no. 39
    
40.
Anderson R, Mammen K, Paul P, Pletch A, Pulia K. Using yoga Nidra to improve stress in psychiatric nurses in a pilot study. J Altern Complement Med 2017;23:494-5.  Back to cited text no. 40
    
41.
Beddoe AE, Murphy SO. Does mindfulness decrease stress and foster empathy among nursing students? J Nurs Educ 2004;43:305-12.  Back to cited text no. 41
    
42.
Vempati RP, Telles S. Yoga-based guided relaxation reduces sympathetic activity judged from baseline levels. Psychol Rep 2002;90:487-94.  Back to cited text no. 42
    
43.
Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, et al. Yoga asana sessions increase brain GABA levels: A pilot study. J Altern Complement Med 2007;13:419-26.  Back to cited text no. 43
    
44.
Riley KE, Park CL. How does yoga reduce stress? A systematic review of mechanisms of change and guide to future inquiry. Health Psychol Rev 2015;9:379-96.  Back to cited text no. 44
    



 
 
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