SLEEP QUALITY AND CLINICAL ROTATIONS: UNVEILING THE IMPACT ON FINAL‑YEAR NURSING STUDENTS
DOI:
https://doi.org/10.37231/apj.2025.8.2.736Abstract
Abstract: Sleep disturbances are common among students and may be exacerbated by shift work. Nursing students encounter shift patterns during clinical rotations, which can affect sleep quality. This study evaluated sleep quality among fourth‑year nursing students at IIUM Kuantan, described the intensity of their clinical rotations and examined the association between rotation intensity and sleep quality. This descriptive cross‑sectional study was conducted among 136 fourth‑year nursing students at IIUM Kuantan. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and a validated questionnaire measuring clinical rotation intensity. Analyses were performed using SPSS; Fisher's exact test was used to examine the association between sleep quality and clinical rotation intensity. A p‑value < 0.05 was considered statistically significant. Of the 136 participants, 33 (24.3%) reported good sleep quality and 103 (75.7%) reported poor sleep quality. Clinical rotation intensity was reported as low by 1 participant (0.7%), moderate by 93 participants (68.4%) and high by 42 participants (30.9%). Fisher's exact test indicated no significant association between sleep quality and clinical rotation intensity (p = 0.559). In conclusion, poor sleep quality was common among the participating nursing students but was not significantly associated with clinical rotation intensity in this sample. Further studies with larger, multi‑centre samples and objective sleep measures are recommended to explore this relationship more comprehensively.
Keywords: Sleep Quality; Clinical Rotation; Shift Work; Nursing Students
References
Alameri, R. A. et al. (2024). Sleep Quality and Fatigue Among Nurses Working in High‑Acuity Clinical Settings in Saudi Arabia: a cross‑sectional study. BMC Nursing, 23(1), 1–7.
Allen R. Kunselman M.A. (2024). A Brief Overview of Pilot Studies and Their Sample Size Justification. Fertility and Sterility,121(6), 899-901.
Almalki, A., Shehata, M., Siddiqui, K. et al. (2025). Sleep Quality Among a Sample of Medical Students and the Association with Academic Performance: An Updated Data. Journal of Epidemiology and Global Health, 15, 8.
Belingheri, M., Luciani, M., Ausili, D., Paladino, M. E., Di Mauro, S., De Vito, G., & Riva, M. A. (2022). Sleep disorders and night-shift work in nursing students: a cross-sectional study. La Medicina del lavoro, 113(1), e2022003.
Benjamin, L. S., Pasay-An, E., Pangket, P., Alqarni, A. S., Gonzales, F., Sacgaca, L., Mahmoud, D. A., Mohsen, M. M., Ali Hamdi, Y. S., & Shanmugam, S. R. (2024). Impact of Sleep and Psychological Well-Being on the Academic and Clinical Performance of Nursing Students in Saudi Arabia. Psychology Research and Behavior Management, 17, 1355–1364.
Bujang, M. A., Omar, E. D., Foo, D. H. P., & Hon, Y. K. (2024). Sample size determination for conducting a pilot study to assess reliability of a questionnaire. Restorative Dentistry & Endodontics, 49(1), e3.
Buysse,D.J., Reynolds,C.F., Monk,T.H., Berman,S.R., & Kupfer,D.J. (1989). The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research, 28(2), 193-213.
D’ettorre, G., Pellicani, V., Caroli, A., & Greco, M. (2020). Shift work sleep disorder and job stress in shift nurses: Implications for preventive interventions. Medicina Del Lavoro, 111(3), 195–202.
De Menezes Júnior, L. A. A. et al. (2023). Determinants of poor sleep quality in adults during the coronavirus disease pandemic: COVID‑Inconfidentes, a population‑based study. São Paulo Medical Journal, 141(4), 2022139–2022140.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4.
Huang, Q., Tian, C. & Zeng, X. T. (2021). Poor sleep quality in nurses working or having worked night shifts: a cross‑sectional study. Frontiers in Neuroscience, 15, 638973.
Hsu, H. C., Lee, H. F., & Lin, M. H. (2021). Exploring the association between sleep quality and heart rate variability among female nurses. International Journal of Environmental Research and Public Health, 18(11), 5551.
Khan, F., Haroon, H., Murtaza, H., & Anwar, E. (2016). Determinants of Sleep Quality among Undergraduate Students of Universities of Karachi. Annals of Psychophysiology, 3(1), 04–13.
Kim, H. Y. (2017). Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restorative Dentistry & Endodontics, 42(2), 152–155.
Marta, P. et al. (2017). Can physical activity influence the quality of sleep among the elderly? Journal of Education Health and Sport 7(12), 288-305.
Merellano-Navarro, E., Bustamante-Ara, N., Russell-Guzmán, J., Lagos-Hernández, R., Uribe, N., & Godoy Cumillaf, A. (2022). Association between Sleep Quality and Physical Activity in Physical Education Students in Chile in the Pandemic Context: A Cross-Sectional Study. Healthcare (Basel), 10(10), 1930.
Ocansey J., Nertey J., & Awini A.T. (2024). Sleep Quality Among Student Nurses in a Ghanaian Tertiary Institution: A Cross-Sectional Study. Research Square, 1, 1-16.
Saat N. Z. M., Hanawi S. A., Chan K. S., Hanafiah H., Teh S. C., Aznan S. R., Joan C Ahmad S., Zulkefli Z. H. (2020). Sleep Quality among University Students: Associations between Demographic Factors and Physical Activity Level. International Journal of Pharmaceutical Research & Allied Sciences, 9(3), 57–65.
Setia, M. S. (2016). Methodology Series Module 3: Cross-sectional Studies. Indian Journal of Dermatology, 61(3), 261–264.
Wangsan, K., Chaiear, N., Sawanyawisuth, K., Klainin-Yobas, P., Simajareuk, K., & Boonsawat, W. (2022). Which Shiftwork Pattern Is the Strongest Predictor for Poor Sleep Quality in Nurses? International Journal of Environmental Research and Public Health, 19(21).
Xiong, W., Huang, J. & Zhu, A. (2021). The relationship of sleep quality among internship nurses with the clinical learning environment and mental stress: a cross‑sectional survey. Sleep Medicine, 83, 151–158.
Yazdi, Z., Sadeghniiat-Haghighi, K., Javadi, A. R. H. S., & Rikhtegar, G. (2014). Sleep quality and insomnia in nurses with different circadian chronotypes: Morningness and eveningness orientation. Work, 47(4), 561– 567.
Yu, L., Zhou, H., Li, J., & Yu, X. (2025). Shift work sleep disorder in nurses: a concept analysis. BMC nursing, 24(1), 18.
Zhang, L. et al. (2016). Influencing factors for sleep quality among shift‑working nurses: a cross‑sectional study in China using 3‑factor Pittsburgh Sleep Quality Index. Asian Nursing Research, 10(4), 277–282.
Zhao, H., Lu, C. & Yi, C. (2023). Physical activity and sleep quality association in different populations: a meta‑analysis. International Journal of Environmental Research and Public Health, 20(3), 1864.
Downloads
Published
Versions
- 2025-11-01 (2)
- 2025-10-31 (1)
Issue
Section
License
Upon acceptance of an article, authors will be asked to transfer copyright. This transfer will ensure the widest possible dissemination of information. A notification will be sent to the corresponding author confirming receipt of the manuscript. If excerpts from other copyrighted works are included, the author(s) must obtain written permission from the copyright owners and credit the source(s) in the article.
