Hospital-acquired insomnia in patients with heart failure: a mixed methods study

This study aimed to explore patients' experiences with hospital-acquired insomnia and its influencing factors. A convergent parallel mixed-methods design was employed, giving equal priority to quantitative and qualitative strands and integrating them through joint displays and meta-inferences. The study population comprised heart failure patients hospitalised in the Cardiology Clinic of Ağrı Training and Research Hospital between July and December 2024. One hundred fifty-six patients were included in the quantitative phase using the "Hospital-acquired Insomnia Scale" and "Descriptive Information Form." Qualitative data were obtained through semi-structured interviews with 21 participants, reaching data saturation. Quantitative data were analysed with SPSS 23, while qualitative data were evaluated using MAXQDA 2020 software and content analysis. The mean total score on the "Hospital-acquired Insomnia Scale" was 3.79±0.50. Sub-dimension mean scores were 3.98±0.56 for physical environment, 3.78±0.67 for psychological, 3.53±0.81 for safety, 3.94±0.64 for socioeconomic, and 3.58±0.76 for nutritional factors. Qualitative findings highlighted noise, light, disease-related anxiety and other patients in the room as commonly reported barriers to sleep. Patients reported symptoms such as fatigue, weakness, delayed recovery, irritability and restlessness, and reported coping strategies including raising the head, ventilating the room and praying. Integrating quantitative scores with qualitative themes showed that higher subscale scores were consistent with patient narratives describing environmental and psychological disturbances to sleep. Patients with heart failure experience hospital-acquired insomnia that is associated with physical, psychological, socioeconomic, safety and nutritional factors. These findings emphasise the need for individualised nursing interventions to improve sleep hygiene and enhance recovery in hospital settings.