Late chronotype and high social jetlag are associated with burnout in evening-shift workers: Assessment using the Chinese-version MCTQshift

Association between chronotype, social jetlag, sleep quality, and academic burnout among nursing students: A cross-sectional study

Academic burnout in nursing students is a serious problem worldwide that results in emotional exhaustion, cynicism and low professional efficacy. The aim of the current study was to examine the association between sleep quality and circadian rhythm indicators and academic burnout among Iranian nursing students. This cross-sectional study was conducted on 325 undergraduate nursing students studying at Qazvin University of Medical Sciences between November and February 2023. Data collection was carried out using self-report questionnaires including demographic characteristics, The Pittsburgh Sleep Quality Index (PSQI), reduced-Morningness-Eveningness Questionnaire (r-MEQ), and the Maslach Burnout Inventory-Student Survey (MBI-SS). Social jetlag (SJL) was defined as the absolute value of the difference between the midpoint of sleep on free days (MSF) and the midpoint of sleep on workdays (MSW). Data were analyzed using univariate and multivariate linear regression models. About 31.4% of participants had evening chronotype and almost half of them suffered from poor sleep quality. About 47.7% of the participants had SJL ≥ 2 h. In the multivariate linear regression model, students with evening chronotype compared to morning chronotype experienced more academic burnout in emotional exhaustion, cynicism and professional efficacy. PSQI score was only correlated with emotional exhaustion and cynicism subscales. Increased SJL was a predictor on all three subscales of academic burnout. The findings suggested that evening chronotype, poor sleep quality, and high SJL were associated with increased likelihood of academic burnout in nursing students. Assessment of circadian preference and sleep quality is beneficial for timely identification and prevention of academic burnout in nursing students.

Relationship between social jetlag and body mass index in nurses working shift schedules: a cross-sectional study

This study aimed to explore the relationship between shift-working nurses' social jetlag and body mass index (BMI) and provide a theoretical basis for nursing managers to develop appropriate health interventions. Shift work is unavoidable in nursing and is associated with circadian rhythm disorders. Social jetlag is prevalent in shift-working nurses and is associated with adverse health outcomes (particularly metabolism-related indicators). BMI is a significant metabolic indicator, and research has demonstrated its effectiveness in predicting the formation of metabolic syndrome. The relationship between social jetlag and BMI can be explained by considering physiological, psychological, and behavioral factors. However, most studies on social jetlag and health status are focused on non-shift nurse populations, with fewer studies on shift workers. Five tertiary hospitals located at similar latitudes in Southwest China were selected for the study. We surveyed 429 shift-working nurses using sociodemographic data, the Munich Chronotype Questionnaire for Shift Workers, and BMI. The restricted cubic spline model was used to analyze the relationship between social jetlag and BMI among shift-working nurses, and segmented linear regression was performed around the inflection point using multiple linear regression analysis. The results revealed that social jetlag (82.0 [85.0] min) was experienced by 64.6% of the shift-working nurses. After controlling for confounding variables, the model with seven knots had the lowest accepted Akaike information criterion value, and there was a U-shaped relationship between shift-working nurses' BMI and social jetlag in this model; its inflection (lowest) point of 20.7 was considered the cut-off point. Segmented regression showed that for BMI < 20.7, BMI was significantly negative with standardized social jetlag; whereas with BMI > 20.7, BMI was significantly positive with standardized social jetlag. BMI has a U-shaped relationship with social jetlag, and attention should be paid to overweight or underweight shift-working nurses to detect early circadian rhythm disorder. Shift-working nurses with high social jetlag tended to have higher/lower BMI, which should be further investigated in the future, to minimize metabolic diseases among them.

Associations Among Social Jet Lag, Sleep-Related Characteristics, and Burnout of Nurses in Tertiary Hospitals

To investigate the status of social jet lag (SJL) through sociodemographic factors among clinical nurses and examine the correlation with burnout. There has been relatively little research on the possible factors resulting in SJL among nurses in China and its role in burnout. A multicenter cross-sectional study recruited 596 nurses from 7 Chinese hospitals. Online questionnaires were delivered to assess sociodemographics, shift work, SJL, chronotypes, and the burnout of nurses. Nurses had severe levels of SJL. The number of children, forms of employment, specialty area, length of professional service, and chronotypes were the main predictors of SJL. Moreover, SJL affected burnout (emotional exhaustion and deindividuation), and reducing the nurses' SJL could relieve their burnout. Additional evidence-based interventions indicate that reducing the SJL is essential as the nurses are suffering severe job burnout.

Relationship between burnout levels of nurses and their circadian preference, sleep quality, and personality traits

Occupational stress and burnout are widely encountered among many healthcare professionals, including nurses and doctors, as well as among members of other professions. For example, nurses, who have disrupted circadian rhythms, are seen to have sleep problems. In addition, their personality traits are also considered to be related with burnout. This study aimed to identify nurses' circadian preference and personality traits along with their effects on sleep quality and their relationship with burnout. In this study, 211 nurses (40 male, 171 female) using the correlational model from quantitative research methods was used since the variables of morningness/eveningness, personality trait, sleep quality, and burnout were aimed to be investigated at once, without intervention, within the predictivity context of the relationship among them. When the scores obtained from the burnout scale were examined, it was observed that the emotional exhaustion and personal accomplishment subdimensions were so close to the median value and mean, while depersonalization was quite low compared to these sub-dimensions. The participants' sleep quality was seen to be at the lowest step of the poor sleep quality class. When the scores obtained from the MESSI scale are examined, it is seen that the scores obtained from the morning affect dimension are above the median value, and the highest average according to the Five-Factor Personality Traits Scale is obtained in the subdimensions of agreeableness and conscientiousness. Female gender, constantly work at night, having a high number of weekly working hours increased burnout level. Additionally Evening chronotype, poor sleep quality, neuroticism, agreeableness, extroversion and conscientiousness personality traits were found to be associated with burnout in this study. In the study, being of different chronotypes, having other personality traits, and varying sleep quality scores were seen to affect the sub-dimensions of burnout.

Social jetlag and quality of life among nursing students during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Amid drastic changes in the educational environment and continued substitution of in-person learning with online learning owing to the COVID-19 pandemic, it is important to analyze the predictors of quality of life among nursing students to devise strategies to enhance their quality of life. This study aimed to identify the predictors of nursing students' quality of life during the COVID-19 pandemic, focusing on social jetlag.

METHODS

In this cross-sectional study, data were collected from 198 Korean nursing students in 2021, using an online survey. Chronotype, social jetlag, depression symptoms, and quality of life were assessed using the Korean version of the Morningness-Eveningness Questionnaire, Munich Chronotype Questionnaire, Center for Epidemiological Studies Depression Scale, and World Health Organization Quality of Life Scale abbreviated version, respectively. Multiple regression analyses were performed to identify the predictors of quality of life.

RESULTS

Factors affecting participants' quality of life were age (β = - 0.19, p = .003), subjective health status (β = 0.21, p = .001), social jetlag (β = - 0.17, p = .013), and depression symptoms (β = - 0.33, p < .001). These variables accounted for 27.8% of the variance in quality of life.

CONCLUSION

As the COVID-19 pandemic continues, the social jetlag of nursing students has decreased compared to before the pandemic. Nevertheless, the results showed that mental health issues such as depression affect their quality of life. Therefore, it is necessary to devise strategies to support students' ability to adapt to the rapidly changing educational environment and promote their mental and physical health.

The association of sleep quality and burnout among Chinese medical residents under standardized residency training in a tertiary hospital

PURPOSE

To investigate the impact of sleep quality and chronotype on job burnout among medical residents under standardized residency training (SRT) in a tertiary hospital in Beijing, China.

METHODS

Medical residents in the Department of Internal Medicine of Peking Union Medical College Hospital were assessed by Morning and Evening Questionaire-5 (MEQ-5), Pittsburgh sleep quality index (PSQI), and Maslach Burnout Inventory-General Survey (MBI-GS). Factors associated with burnout were analyzed.

RESULTS

A total of 142 respondents returned completed questionnaires. Burnout was present in 85 (60%) residents. Prevalence of high emotional exhaustion, high depersonalization, and low personal accomplishment were 51%, 28%, and 18%, respectively. The global PSQI score of residents was 5.9 ± 2.4, and the self-reported sleep duration was 6.2 ± 0.8 h/day. The MEQ-5 distribution skewed towards morningness, with a median score of 14.5 [13.0, 16.3]. Poor daytime function significantly predicted emotional exhaustion and depersonalization. Chronotypes were not associated with any of the burnout components.

CONCLUSION

Sleep-related daytime dysfunction was strongly related to burnout. Strategies protecting the sleep of residents should be incorporated into the SRT programs for both efficiency and sustainability considerations.

Associations among social jetlag, sleep-related characteristics, premenstrual symptoms, depression, and body mass index of female nursing students

PURPOSE

This study aimed to identify the predictors of female nursing students' body mass index (BMI), including social jetlag.

DESIGN AND METHODS

This secondary data analysis of a cross-sectional survey conducted in 2015 included data of 304 female undergraduate nursing students. A hierarchical regression analysis was performed to identify the predictors of BMI.

FINDINGS

Social jetlag was the most potent predictor of BMI, followed by premenstrual symptoms and sleep quality.

PRACTICE IMPLICATIONS

This study presents foundational data for developing interventions for social jetlag management as a strategy to prevent obesity in female nursing students by identifying factors predicting BMI.

Social jetlag and depression in female rotating-shift nurses: A secondary analysis

PURPOSE

This study aimed to identify the predictors of depression among female rotating-shift nurses.

DESIGN AND METHODS

This secondary data analysis used data of 190 Korean female rotating-shift nurses from the parent study conducted in 2018. A multiple logistic regression analysis was performed to identify the predictors of depression.

FINDINGS

Young age, poor sleep quality, and greater morning-shift social jetlag predicted depression among female nurses working a three-shift schedule.

PRACTICE IMPLICATIONS

Nursing management should consider scheduling shifts to minimize nurses' social jetlag and develop interventions for improving sleep quality to prevent depression among female rotating-shift nurses.

Direction and magnitude of social jetlag are associated with obesity: Results from a sample of hospital employees

Social jetlag, the discrepancy between social and biological timing, has been suggested to disturb metabolic functions. However, the relationship between social jetlag and obesity has been inconsistent in other studies. In this study we examined the association between social jetlag and obesity among day and shift workers. We invited 2508 day workers and 1383 shift workers from a hospital worker health cohort to participate in a 2018-2019 survey on their sleep behaviors. Shift-specific social jetlag was quantified using the Munich ChronoType Questionnaire, and body mass index was measured during annual physical examinations. The distributions of shift-specific social jetlag were illustrated, and logistic regression analysis was used to examine the association between social jetlag and obesity. We found that high level of social jetlag (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.08-1.47) and positive social jetlag (OR = 2.25, 95% CI = 1.30-3.90) during evening shifts were associated with obesity after adjustment for age, sex, health behaviors, and sleep quality. During night shift periods, sleep time varied greatly on free days, but the participants slept at similar times, namely 16:00, on workdays. In conclusion, phase advance on workdays and high levels of social jetlag were associated with obesity. Sleep timing should therefore be recommended according to the relative phase of individuals' preferred sleep time and work time.

Impact of sleep timing on attention, sleepiness, and sleep quality among real-life night shift workers with shift work disorder: a cross-over clinical trial

STUDY OBJECTIVES

To examine the effect of sleep timing intervention on sleep quality, attention, and sleepiness at work among night shift workers with shift work disorder.

METHODS

We recruited 60 real-life night shift workers through advertisements to participate this cross-over clinical trial. Shift work disorder was confirmed with interview and sleep log. Participants were designated to follow evening sleep (15:00-23:00) and morning sleep (09:00-17:00) schedules in a randomized order. Chronotype was confirmed by the Munich Chronotype Questionnaire. Sleep behaviors and light exposure were recorded using actigraphy. Outcome measures were sleepiness evaluated by the Karolinska Sleepiness Scale, sleep quality evaluated by the Pittsburgh Sleep Quality Index, and attention performance assessed with psychomotor vigilance test. Differences in outcome between the morning and evening sleep schedules were compared using repeated measures ANOVA.

RESULTS

The participants slept for longer durations during evening sleep schedules compared with morning sleep schedules. Lower sleepiness scores, higher sleep quality, and shorter reaction times and less lapse numbers in the psychomotor vigilance test were observed for participants during evening sleep schedules than morning sleep schedules after adjustment for light exposure and sleep duration. Significant interaction effects were observed for reaction time and lapse number between chronotype and sleep schedule, where the differences between sleep schedules were most prominent among those with late chronotypes.

CONCLUSIONS

It is recommended that night shift workers with shift work disorder arrange to sleep in the evening instead of the morning for better sleep and attention performance, especially those with late chronotypes.

TRIAL REGISTRATION

Sleep Schedule Intervention Study Among Night Shift Workers, https://clinicaltrials.gov/ct2/show/NCT04160572, ClinicalTrials.gov Identifier: NTC04160572.

Chronotype patterns associated with job satisfaction of shift working healthcare providers

Job satisfaction of healthcare providers is important for their own health and also the quality of care provided to their patients. The aim of our study was to measure the chronotype patterns among healthcare providers and its association with their job satisfaction. Using stratified cluster random sampling, we recruited 210 healthcare providers working permanent morning or evening shifts for a cross-sectional study in Sari, Iran. By in-person interview, we collected data on demographic characteristics and assessed both chronotype, using the Horne-Östberg M-E Questionnaire, and job satisfaction, using the Danet's Job Satisfaction Questionnaire. We grouped job satisfaction scores into four ordinal categories and assessed correlations with study variables by ordinal multivariate logistic regression. The average age of the participants was 39.0 (SD 8.02) years. Most were younger than 45 years of age (74.27%), female (66.67%), married (62.24%), of high income (45.71%), and employed in permanent full-time healthcare work (56.67%). Overall, 63.4% of the participants had moderately high to high job satisfaction. Those who worked the morning shift who were moderate morning and high morning chronotypes, compared to those who were intermediate chronotype, had a statistically significant adjusted odd ratio (AOR), respectively, of 11.36 and 6.53 of higher job satisfaction. Likewise, those who worked the evening shift and were moderate evening and high evening chronotype, compared to intermediate chronotype, had a statistically higher AOR of job satisfaction, respectively, 3.44 and 32.63. We found the match between chronotype and work shift schedule to be linked with increased job satisfaction. If the findings are verified in other investigations, the relatively easy measure of chronotype should be considered to assign people to a work shift to improve job satisfaction of healthcare and perhaps other workers.

Nurse Burnout Predicts Self-Reported Medication Administration Errors in Acute Care Hospitals

BACKGROUND

Every one out of 10 nurses reported suffering from high levels of burnout worldwide. It is unclear if burnout affects job performance, and in turn, impairs patient safety, including medication safety. The purpose of this study is to determine whether nurse burnout predicts self-reported medication administration errors (MAEs).

METHODS

A cross-sectional study using electronic surveys was conducted from July 2018 through January 2019, using the Copenhagen Burnout Inventory. Staff registered nurses (N = 928) in acute care Alabama hospitals (N = 42) were included in this study. Descriptive statistics, correlational, and multilevel mixed-modeling analyses were examined.

RESULTS

All burnout dimensions (Personal, Work-related, and Client-related Burnout) were significantly correlated with age (r = -0.17 to -0.21), years in nursing (r = -0.10 to -0.17), years of hospital work (r = -0.07 to -0.10), and work environment (r = -0.24 to -0.57). The average number of self-reported MAEs in the last 3 months was 2.13. Each burnout dimension was a statistically significant predictor of self-reported MAEs (p < .05).

CONCLUSIONS

Nurse burnout is a significant factor in predicting MAEs. This study provides important baseline data for actionable interventions to improve nursing care delivery, and ultimately health care, for Alabamians.

Modifiable risk factors related to burnout levels in the medical workplace in Taiwan: cross-sectional study

OBJECTIVES

To detect the combined effects of lifestyle factors on work-related burnout (WB) and to analyse the impact of the number of weekend catch-up sleep hours on burnout risk in a medical workplace.

DESIGN

Cross-sectional study.

SETTING

Hospital-based survey in Taiwan.

PARTICIPANTS

In total, 2746 participants completed the hospital's Overload Health Control System questionnaire for the period from the first day of January 2016 to the end of December 2016, with a response rate of 70.5%. The voluntary participants included 358 physicians, 1406 nurses, 367 medical technicians and 615 administrative staff.

PRIMARY AND SECONDARY OUTCOME MEASURES

All factors that correlated significantly with WB were entered into a multinomial logistic regression after adjustment for other factors. The dose-response relationship of combined lifestyle factors and catch-up sleep hours associated with WB was explored by logistic regression.

RESULTS

Abnormal meal time (adjusted OR 2.41, 95% CI 1.85 to 3.15), frequently eating out (adjusted OR 1.49, 95% CI 1.12 to 1.97), lack of sleep (adjusted OR 5.13, 95% CI 3.94 to 6.69), no exercise (adjusted OR 1.41, 95% CI 1.10 to 1.81) and >40 work hours (adjusted OR 2.72, 95% CI 2.08-3.57) were independently associated with WB (for high level compared with low level). As the number of risk factors increased (1-5), so did the proportion of high severity of WB (adjusted OR 1.39, 95% CI 0.45 to 4.27, to adjusted OR 32.98, 95% CI 10.78 to 100.87). For those with more than 7 hours' sleep on workdays, weekend catch-up sleep (≤0/>0 and ≤2/>2 hours) was found to be related to an increase of burnout risk (adjusted OR 4.91, 95% CI 2.24 to 10.75/adjusted OR 4.94, 95% CI 2.54 to 9.63/adjusted OR 6.74, 95% CI 2.94 to 15.46).

CONCLUSION

WB in the medical workplace was affected by five unhealthy lifestyle factors, and combinations of these factors were associated with greater severity of WB. Weekend catch-up sleep was correlated with lower burnout risk in those with a short workday sleep duration (less than 7 hours). Clinicians should pay particular attention to medical staff with short sleep duration without weekend catch-up sleep.