Shift work sleep disorder and job stress in shift nurses: implications for preventive interventions

Gene‒environment interaction effect of hypothalamic‒pituitary‒adrenal axis gene polymorphisms and job stress on the risk of sleep disturbances

Background

Studies have shown that chronic exposure to job stress may increase the risk of sleep disturbances and that hypothalamic‒pituitary‒adrenal (HPA) axis gene polymorphisms may play an important role in the psychopathologic mechanisms of sleep disturbances. However, the interactions among job stress, gene polymorphisms and sleep disturbances have not been examined from the perspective of the HPA axis. This study aimed to know whether job stress is a risk factor for sleep disturbances and to further explore the effect of the HPA axis gene × job stress interaction on sleep disturbances among railway workers.

Methods

In this cross-sectional study, 671 participants (363 males and 308 females) from the China Railway Fuzhou Branch were included. Sleep disturbances were evaluated with the Pittsburgh Sleep Quality Index (PSQI), and job stress was measured with the Effort-Reward Imbalance scale (ERI). Generalized multivariate dimensionality reduction (GMDR) models were used to assess gene‒environment interactions.

Results

We found a significant positive correlation between job stress and sleep disturbances (P < 0.01). The FKBP5 rs1360780-T and rs4713916-A alleles and the CRHR1 rs110402-G allele were associated with increased sleep disturbance risk, with adjusted ORs (95% CIs) of 1.75 [1.38-2.22], 1.68 [1.30-2.18] and 1.43 [1.09-1.87], respectively. However, the FKBP5 rs9470080-T allele was a protective factor against sleep disturbances, with an OR (95% CI) of 0.65 [0.51-0.83]. GMDR analysis indicated that under job stress, individuals with the FKBP5 rs1368780-CT, rs4713916-GG, and rs9470080-CT genotypes and the CRHR1 rs110402-AA genotype had the greatest risk of sleep disturbances.

Conclusions

Individuals carrying risk alleles who experience job stress may be at increased risk of sleep disturbances. These findings may provide new insights into stress-related sleep disturbances in occupational populations.

Levels of actigraphy-derived physical activity among Polish nurses: factors associated with the prevalence of selected metabolic disorders

Numerous studies demonstrate a relationship between physical activity and the development of non-communicable diseases. Nurses play a crucial role in the healthcare system, and their demanding work can have an impact on their health. The objective of this cross-sectional study was to assess physical activity in relation to factors predisposing to the occurrence of specific metabolic disorders among Polish nurses. The measurements included physical activity level using ActiGraph GT3X, body weight composition using Tanita MC-980, body mass index, waist circumference, blood pressure using Welch Allyn 4200B, lipid profile, and fasting blood glucose using CardioChek PA. The results indicate that nearly one-third (31.75%) of the total sample of studied nurses do not meet the criteria for the minimum amount of physical activity of at least moderate intensity. Furthermore, over half of the surveyed nurses (55.5%) were classified as overweight or obese based on BMI, and almost half (42.86%) had abdominal obesity. The regression model, employing linear regression, revealed that factors predisposing to selected metabolic disorders were age, engaging in multiple jobs, and the number of steps per day. There is a pressing need to implement comprehensive and supportive initiatives to improve the overall health condition of nurses in Poland through increased physical activity. Activating and supporting this professional group is an investment that benefits not only the nurses themselves but also the healthcare system and the entire nation.

Association Between Occupational Stress and Sleep Quality: A Systematic Review

Occupational stress and sleep quality are prevalent issues that can impact the physical and mental well-being of adults. An association between occupational stress and sleep quality has been found. However, this association is not entirely the same across different occupational groups. Additionally, variations are present in the research design and instruments employed.This systematic review aims to investigate the association between these two factors and identify gaps and limitations in current research. Articles published between January 1, 2011, and December 31, 2022, were retrieved from the WOS, Scopus, and PubMed databases. Out of 1225 articles, 38 studies met the predetermined inclusion and exclusion criteria and were included in the review. In the study, research designs, samples, instruments, and associations between occupational stress and sleep quality were statistically analyzed.These studies encompassed a diverse range of occupations, including both blue-collar and white-collar workers. Cross-sectional study is the most common research method. The Pittsburgh Sleep Quality Index (PSQI) was the most frequently utilized tool for assessing sleep quality, while there was a wide variety of measurement tools employed to assess occupational stress. The association between occupational stress and sleep quality consistently demonstrated a negative association, although the specific dimensions varied among studies. Moreover, several other factors were identified to have direct or indirect effects on occupational stress and sleep quality. For future research in this field, we propose four recommendations: (1) Consider utilizing objective measures to assess occupational stress and sleep quality. (2) Employ controlled experiments to further validate the causal relationship between occupational stress and sleep quality. (3) Investigate occupational groups that have received less attention. (4) Take into account the potential influence of other factors on occupational stress and sleep quality.

Social Support and Daytime Sleepiness Among Chinese Medical Students: Mediating Roles of Loneliness and Problematic Smartphone Use

Background

Sleep problems have become a serious threat to public health worldwide. Daytime sleepiness is an important indicator of many sleep problems, which have a significant impact on academic performance, physical and mental health, and wellbeing among medical students. We aimed to explore the factors associated with daytime sleepiness among medical students.

Methods

We conducted a cross-sectional survey of 466 medical students recruited via convenience sampling. Self-rated psychometric scales, including the Social Support Rate Scale, the Epworth Sleepiness Scale, the Chinese version of the UCLA loneliness scale, and the Mobile Phone Addiction Index (MPAI), were utilized to evaluate social support, daytime sleepiness, loneliness, and problematic smartphone use. A sequential mediation model was constructed with daytime sleepiness as the dependent variable, social support as the independent variable, and loneliness and problematic smartphone use as mediating variables. Age, gender, and grade were taken as covariates.

Results

Social support among medical students was negatively associated with loneliness, problematic smartphone use, and daytime sleepiness (p < 0.01). A sequential mediation analysis showed that loneliness (the first mediator) and problematic smartphone use (the second mediator) sequentially mediated the path from social support to daytime sleepiness among medical students (β = -0.008; 95% CI = -0.016, -0.002). Moreover, there were also significant mediating roles observed in the relationship between social support and daytime sleepiness via loneliness only (β = -0.037; 95% CI = -0.062, -0.015) and problematic smartphone use only (β = -0.022; 95% CI = -0.041, -0.008).

Conclusion

Social support, loneliness, and problematic smartphone use among medical students influenced their daytime sleepiness. Interventions targeting medical student loneliness and problematic smartphone use behaviors might attenuate the effects from low levels of social support and further improve daytime sleepiness.

Risk prediction of sleep disturbance in clinical nurses: a nomogram and artificial neural network model

BACKGROUND

Sleep disturbance occur among nurses at a high incidence.

AIM

To develop a Nomogram and a Artificial Neural Network (ANN) model to predict sleep disturbance in clinical nurses.

METHODS

A total of 434 clinical nurses participated in the questionnaire, a cross-sectional study conducted from August 2021 to June 2022.They were randomly distributed in a 7:3 ratio between training and validation cohorts.Nomogram and ANN model were developed using predictors of sleep disturbance identified by univariate and multivariate analyses in the training cohort; The 1000 bootstrap resampling and receiver operating characteristic curve (ROC) were used to evaluate the predictive accuracy in the training and validation cohorts.

RESULTS

Sleep disturbance was found in 180 of 304 nurses(59.2%) in the training cohort and 80 of 130 nurses (61.5%) in the validation cohort.Age, chronic diseases, anxiety, depression, burnout, and fatigue were identified as risk factors for sleep disturbance. The calibration curves of the two models are well-fitted. The sensitivity and specificity (95% CI) of the models were calculated, resulting in sensitivity of 83.9%(77.5-88.8%)and 88.8% (79.2-94.4%) and specificity of83.1% (75.0-89.0%) and 74.0% (59.4-84.9%) for the training and validation cohorts, respectively.

CONCLUSIONS

The sleep disturbance risk prediction models constructed in this study have good consistency and prediction efficiency, and can effectively predict the occurrence of sleep disturbance in clinical nurses.

Attitudes of Employees in Unaccompanied Children's Shelters and Work-Related Stress During the COVID-19 Pandemic

Data related to the stress of employees in shelters for unaccompanied minors are scarce, especially when considering the escalation of the refugee issue. This study analyzed aspects of this issue as it was carried out in child protection organizations in Greece, which is a country where a huge number of immigrants and refugees pass through and thousands of professionals are employed in this field.More specifically, the aim of this study was to examine the stress (general, perceived, work-related) and burnout symptoms of a specific group of employees exposed to the COVID-19 quarantine restrictions, employees at the 'front line' of care in shelters that host unaccompanied minors and teenagers.The study was carried out from March 2020 to December 2021, when social restrictions and other preventive measures were imposed. The study sample was recruited from non-governmental organizations and shelters for unaccompanied minors, in the urban area of the center of Athens, i.e. the International Organization for Migration, The Home Project, Arsis, Iliachtida, and Zeuxis. The sample consisted of employees at the 'front line' of care in shelters that hosted unaccompanied minors and teenagers. Participants were professionals whose duty was to deal with and respond to the needs of children and adolescents within the shelters they lived in. Participants completed the following questionaires before and after the pandemic restrictions: the Job Stress Measure (JSM), the Maslach Burnout Inventory (MBI), the Perceived Stress Scale (PSS), the Stress in General Scale (SiGS) and a questionnaire of 11-items regarding COVID-19, focusing on the professionals' perceived stress, working conditions, working demands and the impact of COVID-19 on all the aforementioned.The study sample consisted of 50 employees (40 females, 10 males; mean age ± SD 31.46 ± 7.91 years) in hostels for unaccompanied minors. A statistically significant difference was found only in SiGS, with increased stress after COVID-19 (p = 0.001). In terms of sex, significant differences were found at baseline in PSS and Emotional Exhaustion (p = 0.036 and p = 0.028, respectively) (females revealed higher levels than males). Age and educational level were factors that interacted with the increased levels in SiGS after COVID-19 (p = 0.015 and p = 0.006, respectively). Moreover, significant differences were found at baseline in PSS (p = 0.004), with higher levels observed in employees with higher education. Workers who did not work remotely had lower levels in Personal Accomplishment after COVID-19 compared to employees who worked remotely (p = 0.050). Interestingly, the JSM showed a tendency for decreased stress levels after the implementation of the quarantine, suggesting that the employees' work-related stress remained approximately at the same levels. On the other hand, perceived stress increased as the job demands remained the same, while social and personal outlet was in appeasement.The necessity for more research to be held among health professionals is evident and is also imperative to carry out interventional studies to manage stress and thus, provide better mental health services to unaccompanied minors. There is also need for further research in similar populations of professionals outside the urban context of Athens, i.e. in the Greek islands near the sea borders, where the refugees' entries are higher in number and more frequent.

Anxiety and sleep quality among front-line nurses treating first wave COVID-19 in China: The mediating role of mindfulness

AIM

To explore anxiety, sleep quality, and mindfulness of frontline nurses at the initial epicenter of the pandemic, to examine the mediating effects of mindfulness.

BACKGROUND

COVID-19 was first identified in Wuhan, China in January 2020. Nurses were at the forefront of care and treatment across hospitals in response to the pandemic.

METHODS

Single site cross-sectional survey conducted in Wuhan province (China) between March and April in 2020. Quantitative analysis of survey data from N118 nurses working in the frontline COVID response. Questionnaires included: The general information questionnaire, the Self-Anxiety Scale, the Short Inventory of Mindfulness, and the Pittsburgh Sleep Quality Index.

RESULTS

Front-line nurses' anxiety was positively associated with sleep quality and mindfulness was negatively associated with anxiety and sleep quality. Mindfulness had a mediating role on anxiety and sleep quality, with intermediary adjustment effects (ES = 0.136, 95 % CI 0.02 to 0.26), accounting for 21.9 % of the total effect ratio.

CONCLUSIONS

Anxiety causes a reduction in sleep quality and mindfulness can help with anxiety. Mindfulness strategies may help during periods of higher anxiety in the workplace; however, other factors must be considered. Further research is required on strategies for assisting nurses during periods of extreme anxiety.

The Mediating Role of Cumulative Fatigue on the Association between Occupational Stress and Depressive Symptoms: A Cross-Sectional Study among 1327 Chinese Primary Healthcare Professionals

Occupational stress and depressive symptoms are common among professionals in the primary healthcare system, and the former can lead to a more severe level of the latter. However, there are few studies on the mediating effect of occupational stress on depressive symptoms using cumulative fatigue as a mediating variable. The Core Occupational Stress Scale, the Self Diagnosis Scale of Workers' Cumulative Fatigue, and the Patient Health Questionnaire were used in the proposed study. To analyze and test the mediating effect, the hierarchical regression analysis method and the Bootstrap method were applied. Our results showed that occupational stress was positively correlated with the level of cumulative fatigue (p < 0.01) and depressive symptoms (p < 0.01). Cumulative fatigue played a partial, mediating role between the four dimensions of occupational stress and depressive symptoms, and the effect size of occupational stress and each dimension was 0.116 (95% CI: 0.096-0.135, p < 0.001), -0.204 (95% CI: -0.245--0.166, p < 0.001), 0.179 (95% CI: 0.143-0.218, p < 0.001), 0.333 (95% CI: 0.283-0.385, p < 0.001), and -0.210 (95% CI: -0.292--0.132, p < 0.001), respectively, while the percentages of the mediating effects were 43.56%, 44.46%, 48.58%, 71.26%, and 45.80%, respectively. Occupational stress can directly or indirectly affect depressive symptoms through the mediating effect of cumulative fatigue. Therefore, primary healthcare professionals can reduce occupational stress, which in turn relieves depressive symptoms, and thus reduce cumulative fatigue levels.

A study on the correlation between work stressors and the coping styles of outpatients and emergency nurses in 29 pediatric specialty hospitals across China

OBJECTIVE

This study aimed to better understand the current situation involving work stressors and the coping styles of outpatient and emergency nurses in 29 pediatric specialty hospitals across China. The study analyzed this correlation to provide a reference for the occupational stress management of pediatric nurses.

METHODS

From June to September 2020, 1,457 outpatient and emergency nurses in 29 pediatric specialty hospitals across China were selected as study participants, and a questionnaire survey was conducted using the Basic Information Questionnaire, the Chinese version of the Work Stressor Scale for Nurses, and the Simple Coping Style Scale.

RESULTS

The assessed stress level of outpatient and emergency nurses in 29 tertiary pediatric specialty hospitals nationwide is lower than the results of the survey of the 2007 domestic norm, p < 0.05. The stressors related to nurses' expectations, family conflicts, the nature of nursing work, patient factors, and workload were lower compared with the national norm (p < 0.05). The positive coping style score on the Simple Coping Style Scale for pediatric outpatient nurses was (36.66 ± 6.16), and work stressors were positively associated with negative coping styles (p < 0.01). Multiple regression analysis showed that the influencing factors of work stressors among pediatric outpatient and emergency nurses correlated with the authorized size, age, working years of nurses, work department, and negative coping styles.

CONCLUSION

Negative coping styles were present among pediatric outpatient and emergency nurses and were associated with work stressors. The influencing factors of stressors mainly correlated with the clinical establishment, age, years of employment as a nurse, work department, and negative coping styles.

Association between circadian rhythm and sleep quality among nursing interns: A latent profile and moderation analysis

BACKGROUND

Disturbances in circadian rhythms are common among night-shift workers and result in poor sleep quality. Nevertheless, the heterogeneity of circadian rhythms and their relationship with sleep quality is less explored in nursing interns. Therefore, we aimed to identify the latent subtypes of circadian rhythm, explore their relationship with sleep quality, and evaluate their moderating role between perceived stress and sleep quality in nursing interns.

MATERIALS AND METHODS

In all, 452 nursing interns were recruited between October 2020 and January 2021 from Be Resilient to Nursing Career (BRNC), which is a multicenter, prospective cohort of a career growth program for nursing students. They were assessed using the 10-item Chinese Perceived Stress Scale, Circadian Type Inventory, and Pittsburgh Sleep Quality Index. Latent profile analysis and moderation analysis were performed.

RESULTS

Overall, 72.3% of the nursing interns reported poor sleep quality. We identified three latent subtypes of circadian rhythms, namely, Vigorousness (40.1%), Inadaptability (18.6%), and Flexibility (41.1%). Females (OR = 1.97, 95% Cl: 1.01-3.83, P = 0.047) with normal body mass index (OR = 1.62, 95% CI: 0.95-2.76, P = 0.078) were prone to Flexibility. Circadian rhythm types significantly moderated the association between perceived stress and sleep quality (P < 0.05).

CONCLUSION

Nursing interns suffer from poor sleep. There exists heterogeneity of circadian rhythm subtypes in nursing interns, and attention should be paid to those with Inadaptability type. The association between perceived stress and sleep quality is significantly moderated by circadian rhythm subtypes.

Work stress in nurses returning to tertiary a general hospitals in China after the delivery of their second child: a cross-sectional study

OBJECTIVE

To investigate the current situation of work stress in nurses returning to work in Chinese tertiary A general hospitals after giving birth to their second child and to analyze influencing factors.

METHODS

From January to April 2021, 448 nurses returning to work after the birth of their second child, working in 23 general hospitals in China, were investigated and completed the postpartum work stress scale and self-rating depression scale.

RESULTS

The total work stress score of returning nurses after giving birth to their second child was 90.40 ± 18.29, and the dimension with the highest score was the role commitment of the mother. Multiple linear regression analysis showed that family monthly income, turnover intention, time since returning to work, age of the first child, and depressive symptoms were the influencing factors on work stress.

CONCLUSION

It is important to reduce the work stress of the nurses returning to work after the birth of their second child. Nursing managers should pay attention to this group of postpartum nurses and formulate targeted measures to alleviate their work stress.

Predictors of Shift Work Sleep Disorder Among Nurses During the COVID-19 Pandemic: A Multicenter Cross-Sectional Study

Background: Nurses have a high incidence of shift work sleep disorder, which places their health and patient safety in danger. Thus, exploring the factors associated with shift work sleep disorder in nurses is of great significance in improving their sleep health, nursing personnel staffing, and scheduling during the COVID-19 pandemic.

Objectives: The purpose of this study was to investigate the incidence of shift work sleep disorder during the COVID-19 pandemic and explore the factors associated with shift work sleep disorder in Chinese nurses.

Methods: This was a multicenter cross-sectional study using an online survey. Stratified cluster sampling was used to include 4,275 nurses from 14 hospitals in Shandong, China from December 2020 to June 2021. Stepwise multivariate logistic regression analysis and random forest were used to identify the factors associated with shift work sleep disorder.

Results: The prevalence of shift work sleep disorder in the sampled shift nurses was 48.5% during the COVID-19 pandemic. Physical fatigue, psychological stress, shift work more than 6 months per year, busyness during night shift, working more than 40 h per week, working more than four night shifts per month, sleeping more than 8 h before night shift, using sleep medication, irregular meals, and high-intensity physical activity were associated with increased odds of shift work sleep disorder. Good social support, good work-family balance, napping two or three times per week, resting more than one day after shifts, intervals of 8 days or more between shifts, and taking turns to rest during the night shift were associated with decreased odds of shift work sleep disorder.

Conclusions: Shift work sleep disorder may be associated with scheduling strategies and personal behavior during the COVID-19 pandemic. To reduce the incidence of shift work sleep disorders in nurses, nursing managers should increase night shift staffing, extend rest days after shift, increase night shift spacing, and reduce overtime, and nurses need to seek more family and social support and control their sleep schedules and diet.

Impact of stress and coping strategies on insomnia among Polish novice nurses who are employed in their field while continuing their education: a cross-sectional study

OBJECTIVES

To determine to what degree particular coping strategies mediate the association between stress and insomnia in novice nurses who are employed while continuing their education and how type of education moderate the relationships between workplace stress, coping strategies and insomnia.

METHODS

A descriptive cross-sectional study was performed using an online questionnaire, which was completed by 159 novice registered nurses. The questionnaire comprised four components: Athens Insomnia Scale, Perceived Stress at Work (based on Perceived Stress Scale), Brief-Coping Orientation to Problem Experienced (COPE)and metrics with sociodemographic data questions.

RESULTS

Stress was found to be a significant predictor of insomnia among novice nurses. After adjusting the coping strategy, work stress ceased to be a significant predictor of insomnia. Among the strategies, the significant predictors that increased severity insomnia were acceptance, denial and self-blame. Predictors that decreased severity insomnia were use of emotional support and venting. Furthermore, the relationship between both active coping and self-distraction strategies and insomnia was significant for part-time students.

CONCLUSIONS

Insomnia is significant phenomena among novice nurses and are exacerbated by increased stress in the workplace. Choosing appropriate coping strategies for stress that are dependent on the individuals' activities significantly reduce the severity of insomnia caused by work stress.

Personality Traits and Insomnia Symptoms in Shift Workers

The discrepancy between natural sleep-wake rhythm and actual sleep times in shift workers can cause sleep loss and negative daytime consequences. Irregular shift schedules do not follow a fixed structure and change frequently, which makes them particularly harmful and makes affected individuals more susceptible to insomnia. The present study compares insomnia symptoms of non-shift workers, regular shift workers, and irregular shift workers and takes into account the moderating role of the Big Five personality traits and levels of perfectionism. Employees of an Austrian railway company completed an online survey assessing shift schedules, sleep quality and duration, daytime sleepiness, and personality traits. A total of 305 participants, of whom 111 were non-shift workers, 60 regular shift workers, and 134 irregular shift workers, made up the final sample. Irregular shift workers achieved significantly worse scores than one or both of the other groups in time in bed, total sleep time, sleep efficiency, sleep duration, sleep quality, sleep latency, and the number of awakenings. However, the values of the irregular shifts workers are still in the average range and do not indicate clinical insomnia. Participants working regular shifts reported the best sleep quality and longest sleep duration and showed the least nocturnal awakenings, possibly due to higher conscientiousness- and lower neuroticism scores in this group. Agreeableness increased the effect of work schedule on total sleep time while decreasing its effect on the amount of sleep medication taken. Perfectionism increased the effect of work schedule on time in bed and total sleep time. Generalization of results is limited due to the high percentage of males in the sample and using self-report measures only.

Sleep quality and common mental disorder in the hospital Nursing team

Objective:

to determine the prevalence of sleep quality and common mental disorder in Nursing professionals and factors associated with sleep change.

Method:

a cross-sectional, analytical and quantitative study developed with 196 Nursing professionals of a public hospital and a mixed one. Data was collected by means of an instrument of sociodemographic characterization, by the Self-Report Questionnaire 20 and Pittsburgh Sleep Quality Index and were analyzed by descriptive and inferential statistics to identify possible factors associated with sleep changes.

Results:

sleep changes were identified among the Nursing professionals with a frequency of 76.5% (70.4-82.1). Sleep quality was classified as poor in 41.8% (41.8-55.6) and sleep disorder in 27.6%. (21.4-34.2). The prevalence of common mental disorder was identified in 36.7% (30.1-43.9). The main factor for poor sleep quality was the presence of common mental disorder (Odds Ratio: 5.15; p<0.001).

Conclusion:

sleep changes were prevalent and the characteristics of the work environment and the presence of mental disorder showed relevance in the changes.