Song Yang, Yang Fengzhi, Sznajder Kristin, Yang Xiaoshi
School of Fundamental Sciences, China Medical University, Shenyang, China.
School of Public Health, China Medical University, Shenyang, China.
Front Psychiatry. 2020 Nov 13;11:566196. doi: 10.3389/fpsyt.2020.566196. eCollection 2020.
Job burnout has become an increasing prevailing phenomenon among nurses in both developed and developing countries. There is a paucity of research exploring the relationship between perceived stress (i.e., the level of one's perception or appraisal of stress rather than objective stressful events) and job burnout and no existing literature examining the mediating role of sleep quality in the relationship between these two constructs. The objective of the study was to examine if sleep quality mediates the relationship between perceived stress and job burnout. Cross-sectional data were collected from a total of 1,013 nurses working in six public tertiary hospitals in China. The self-administered questionnaire included demographic information, the Maslach Burnout Inventory-General Scale, the Pittsburgh Sleep Quality Index and the Perceived Stress Scale. Hierarchical multiple regression (HMR) analyses were performed to examine the contribution of each covariate to the prediction of job burnout. Structural equation modeling (SEM) was employed to test whether the proposed relationships between variables involved existed. Both perceived stress and poor sleep quality exhibited strong positive associations with job burnout among Chinese nurses. The SEM analysis confirmed the direct pathway from perceived stress to burnout and the indirect pathway mediated by sleep quality. The direct effect of perceived stress on job burnout was found to be statistically significant and positive (β = 0.69, < 0.05). There existed statistically significant effects of sleep quality on both perceived stress (β = 0.48) and job burnout (β = 0.29). The path coefficients of perceived stress on job burnout were significantly reduced (β = 0.56) when sleep quality was modeled as a mediator. The bias-corrected and accelerated bootstrap test revealed that sleep quality had a significant mediating effect on the relationship between perceived stress and job burnout (a b = 0.139, BCa 95%, CI: 0.110~0.174). Perceived stress might exert significant effects on burnout both directly and indirectly through the mediating role of sleep quality. Efforts to reduce burnout among nurses in clinical settings may benefit from interventions for coping with perceived stress and practices for promoting healthy sleep.
职业倦怠在发达国家和发展中国家的护士中已成为一种日益普遍的现象。探索感知压力（即个人对压力的感知或评估水平，而非客观的压力事件）与职业倦怠之间关系的研究很少，且尚无现有文献考察睡眠质量在这两个构念之间关系中的中介作用。本研究的目的是检验睡眠质量是否中介了感知压力与职业倦怠之间的关系。横断面数据收集自中国六家公立三级医院的1013名护士。自填式问卷包括人口统计学信息、马氏职业倦怠量表通用版、匹兹堡睡眠质量指数和感知压力量表。进行分层多元回归（HMR）分析以检验每个协变量对职业倦怠预测的贡献。采用结构方程模型（SEM）来检验所涉及变量之间的假定关系是否存在。在中国护士中，感知压力和睡眠质量差均与职业倦怠呈强烈正相关。SEM分析证实了从感知压力到倦怠的直接路径以及由睡眠质量介导的间接路径。发现感知压力对职业倦怠的直接效应具有统计学意义且为正向（β = 0.69，<0.05）。睡眠质量对感知压力（β = 0.48）和职业倦怠（β = 0.29）均有统计学意义的影响。当将睡眠质量作为中介变量建模时，感知压力对职业倦怠的路径系数显著降低（β = 0.56）。偏差校正和加速自助法检验表明，睡眠质量对感知压力与职业倦怠之间的关系具有显著的中介作用（a×b = 0.139，BCa 95%，CI：0.110~0.174）。感知压力可能通过睡眠质量的中介作用直接和间接地对倦怠产生显著影响。在临床环境中减少护士职业倦怠的努力可能受益于应对感知压力的干预措施和促进健康睡眠的做法。
