Introduction

In the modern world highly revolving technology, the use of smartphones has become a very necessary gadget. According to studies, there are 5.22 billion smartphone users in the world. This accounts for 66.6 % of the global population data according to 2021. Moreover, the number of smartphone users has increased by 1.8% from January 2020 to January 2021 during the covid-19 pandemic period.¹⁾ On average, a person spends 6 hours and 54 minutes on the internet. A person accesses their phone 160 times a day, or once every 9 minutes, according to 2020 statistics. In class, 49 percent of pupils are using their smartphones as a distraction. As a result, 76.19 percent of professors think that students' use of smartphones during class is distracting.¹⁾ It has been seen that students preoccupied while on a smartphone, get decreased awareness of what is happening around their surroundings, he/she is not aware of what she is speaking, doing, or eating as their eyes and mind is focusing on their smartphone. According to Hassan et al. said that utilised for online learning or other types of learning, smartphones have a detrimental impact on students' academic performance. Students spend the bulk of their time on their smartphones, which severely lowers their ability to communicate and work in groups.² People use their smartphones more frequently during COVID -19 periods because all universities provide online courses. The majority of people have demonstrated smartphone addiction. 69.7% of respondents said they could not focus on their homework at home, 97.6% of them said they had nomophobia, and 45.1% said they were addicted to their smartphones.³

Overuse of smartphones reduces sleep quality, which has an impact on students' learning, focus, memory, and ability to make decisions.⁴ Students at universities require enough, high-quality sleep for optimal academic success. Despite having a strong understanding of the value of sleep and how it affects their academic performance, students often neglect their sleep schedules.⁵

Sleep quality has significant impact on cognitive ability and physical strength, the consequences of poor sleep quality and also have some serious problem such as depression, impaired work performance, and poor overall quality of life.⁶⁾ Students spend more time browsing social media and gaming apps on their smartphones, which results in excessive smartphone use, time spent on the device other than for studying, and low academic achievement.⁷ The nursing profession is the backbone of the health care system and nursing students are one of the upcoming healthcare givers whose own health wellbeing is very important to provide health services. This topic is chosen because very few studies are performed in India on undergraduate nursing students. This study is giving a picture depicting addition of smartphone and its impact on quality of sleep and academic performance in student nurses who are undoubtedly a pillar of a successfully working community healthcare system.

Methods

In this cross-sectional descriptive research design, we evaluated the mobile addiction and its impact on quality of sleep and academic performance among nursing students in from March to May 2022. The study participants were selected by using the total enumerative sampling technique. The sample size calculation is based on a similar study found through the review of literature done by Noruzi Kuhdasht⁸⁾ where d=confidence interval, that is 7% (0.07) t=1.96, it is standard deviation score for 95% set interval p=assumed or estimated proportion so p=0.24 q=(1-p) = 1-0.24 q=0.76, the sample size was calculated as 143, while considering 10% non-response rate, a total sample size of 160 participants were considered for present study.

Nursing students who have smartphone and using for last 6 months were included in the study. Those Students who already suffer from sleep issues and are using sleep medicine and not available at the time of data collection were excluded from the study. Based on the objective of the study self-structured questionnaire and standard tools were used to gather information regarding smartphone addiction, quality of sleep and academic performance. It consists of following part: (i) Demographic data: It includes 10 questions related to socio demographic data such as age, gender, education, living area, duration of smartphone use, daily hours spent on smartphone, when you wake up in the morning at what time you check your smartphone, use of smartphone, frequency of smartphone use, and family history of sleep disorder; (ii) The Smartphone addiction scale short version (SAS-SV): this scale is a self-reported, standardised questionnaire that measures smartphone addiction. Short-version of SAS consists of 10 items on six-point Likert’s scale named with strongly agree to strongly disagree. All 10 items are positive items. The Cronbach’s alpha reliability of SAS-SV is 0.911,⁹⁾ (iii) Pittsburgh Sleep Quality Index (PSQI): standardized and self-rated questionnaire which assesses sleep quality and disturbances over month time interval. Quality of sleep includes quantitative aspects of sleep, such as sleep durations, sleep latency or number of arousals, as well as more purely subjected aspects, such as depth or restfulness of sleep. The PSQI contains 19 self-rated questions which are included in the scoring the 19 self-rated items are combined to form seven component scores. The index has score for 7 items: quality of sleep, delay of falling asleep, effective duration of sleep, sleep efficacy, sleep disorders, needed number of sleep-inducing pills, and day-time performance. Each item has a score of 0 to 3 (0 indicates no difficulty and 3 indicates severe difficulty) and these items form overall score of 0 to 21. The reliability of PQSI is 0.726,¹⁰⁾ (iv) Self-structured academic performance scale: the self-structured academic performance scale was prepared by investigators to assess the academic performance among the nursing students. This tool consisted of 9 items of 3 points Likert’s scale Scoring: For positive items: always (3), sometimes (2), never (1). If the student score between 9-15, will be having good academic performance and if score is between 22-27, considered as poor academic performance. The Cronbach’s alpha reliability of the scale is 0.887.

Ethical approval was taken from the institutional ethical committee to conduct the study. The certificate Reference Number is AIIMS/IEC/2022/3890 dated: 25 February 2022. The written permission and informed consent were taken from the principal and students respectively. Confidentiality and anonymity of the students and data collected were maintained throughout the study. To respect the ethical codes, the institution remained anonymous in this study. Data were coded and entered an excel sheet and analysed using SPSS software version 16 (IBM Inc, Armonk, New York, USA). Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used for central and deviation indexes. Inferential statistics were used to find the level of association between the selected personal variables and smartphone addiction, quality of sleep and academics performance.

Result

In the present study, we approached 160 nursing students where 44.4% of students were in the age group of 20-21 years. Most of the students 98.1% were females in this study. The professional course of 87.5% of students was B.Sc. (Hons.) nursing and 12.5% of students were M.Sc. 30 nursing. The Majority of students 86.2% were living in a hostel and 13.8% of students were living at home with parents. Half of the students 51.2% were using smartphones for 1 to 3 years of duration. The majority 37.5% of students spent 1 to 3 hours daily on smartphones. Majority of 31.9% students were check smartphone within 5 minutes after wake up in morning. Majority of 43.8% student’s pickups smartphone 11-20 times per day followed by 19.1% were more than 30 times. The majority of 92.5% students were use the smartphone for academic uses followed by 91.8% were social media. Most of the students 92.5% had no family history of sleep disorder. (Table 1)

Table 2 shows 38.1 % students were having moderate smartphone addiction. This addiction among student’s ranges from 10-45 with a mean of 26.44±8.67. Also 42.5% of students had poor quality of sleep. Quality of sleep among students range from 0 to 13 with a mean 4.73±3.10. Table 2 also shows that 5% of students were having poor academic performance; this scale in students’ ranges from 9 to 24 with a mean of 14.78±3.60.

A significant positive correlation was seen between smartphone addiction and quality of sleep (r=0.45; p<0.001) which states that those students who had greater smartphone addiction had poor quality of sleep and also showed a significant positive correlation between smartphone addiction and academic performance (r=0.5; p<0.001), which states that those students who had smartphone addiction they had poor academic performance. A significant positive correlation was seen between quality of sleep and academic performance (r=0.32; p<0.001) states that those students who had poor quality of sleep were having poor academic performance.

It was found that smartphone addiction and academic performance significant association between hours daily spend on smartphone, time check smartphone after wake up in morning and frequency of smartphone pickups in a day. Furthermore, quality of sleep is significantly associated with duration of smartphone use, hours daily spend on smartphone, time check smartphone after wake up in morning and family history of sleep disorder. (Table 3)

Discussion

Nowadays, a very large number of populations especially the young people is excessively spending their time and enjoying smartphone. However, in recent literature has been revealed that the excessive use of smartphone can influence daily life activities and may cause addiction.¹¹ This study was conducted among 160 nursing students to explore smartphone addiction and its impact on quality of sleep and academic performance among nursing students.

Conclusion

Dependency on gadgets among students has been increasing nowadays, as they spend crucial hours of their day-to-day life on such appliances, which in the long run causes problems in academics and sleep pattern and social life. The present study concluded that increased frequency of smartphone usage among college students leaves a serious impact on their academics and quality of sleep. Therefore, institutions need to develop guidelines and protocols regarding smartphone usage and should also conduct educational activities on the healthy use of smartphones.