Introduction
The anesthesia department serves as the primary site for treating severely ill patients, characterized by elevated risks and intense pressure. Prolonged working hours and heavy workloads can result in physical exhaustion and emotional stress for healthcare professionals. [1‐2]. Stress and maladjustment may precipitate, exacerbate, or prolong a broad range of comorbid conditions that include insomnia and depression [3‐4]. With the increase of work pressure, sleep disorders have become a prominent public health problem. The main symptoms of sleep disorders are difficulty falling asleep, difficulty maintaining sleep, or inability to fall back asleep after waking up in the morning [5‐6], and sleep quality [7‐9].
Sleep is one of the most important physiological needs of human beings, and individuals with chronic insomnia are prone to worry and anxiety about sleep [10]. Studies have found that individuals with sleep disorders are prone to sleep-related worry, which can induce depressive symptoms and affective disorders [11‐12]. Sleep-related worry refer to individual worries about the consequences of poor sleep and decreased sleep control, and is conceptualized as a 24-hr phenomenon [13‐14]. It has been found to significantly correlate with sleep parameters and sleep quality, as well as daytime impairment [15‐16]. Sleep-related worry, which play a pivotal role in the development of sleep disruptions, may potentially serve as a mental pathway leading to depressive symptoms [17].
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Currently, research indicates that nurses often suffer from sleep disturbances, inadequate sleep duration, suboptimal sleep quality, and sleep deprivation, attributed to the unique characteristics of their work environment and nature [18‐19]. Significant sleep disturbances can adversely affect nurses’ cognitive functioning, physical and mental well-being, and pose risks to patient safety [20‐21]. Furthermore, numerous studies have identified various factors associated with sleep, encompassing social support, psychological factors, stress perception, and personal lifestyle habits [22‐25]. Under constant work pressure, nursing staff may exhibit limited self-regulatory capabilities, leading to self-regulatory fatigue which can induce negative thoughts and disrupt sleep [13, 26‐27]. Relevant studies have shown that the relationship between self-regulatory of fatigue and worry, especially sleep-related worry [13, 28‐29]. A research involving 257 young elite athletes, with an average age of 16.8, revealed that those experiencing clinically significant burnout symptoms exhibited notably more impaired sleep-related worry [28]. In addition, a study of 368 shift nurses in China have found that the higher the degree of self-regulatory fatigue, the higher the degree of sleep-related worry [13].
At present, studies on presenteeism among medical staff in China mostly focus on medical students [30‐31] and teenagers [32‐34]. There is still a lack of research on the status quo and influencing factors of sleep-related worry among anesthesiology nurses.
Hence, the objective of this study is to ascertain the current state of sleep-related concerns among nurses in the anesthesia department, and to investigate the impact of insomnia, perceived stress, self-regulatory fatigue, and social support on these concerns. This will facilitate the development of targeted interventions aimed at enhancing nursing quality and ensuring the safety of surgical patients.
Method
Study design and participants
This study was a cross-sectional study design. A total of 330 nurses in the department of anesthesiology from 9 3 A Grade hospitals (3 A Grade hospital is the highest level hospital in the “three-level six-category” classification system for hospitals in China) in Sichuan Province, were selected as the study participants by convenient sampling method from August to October 2024.
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Inclusion criteria:
(1) Holding a nurse practitioner qualification;
(2) Having at least one year of experience working in the anesthesia department;
(3) Agreement to participate in this study based on informed consent and voluntary basis.
Exclusion criteria:
(1)
Nurses who have completed specialized studies, clinical practice, and standardized educational training.
(2)
Nurses who were temporarily absent during the study period due to medium or long-term educational programs, illness, maternity, or personal reasons.
(3)
Individuals with a past history of significant organic, mental, or psychological disorders.
Measures
General information questionnaire Drawing upon literature reviews and expert input, the research team crafted a questionnaire on general information. This encompassed demographics such as age, gender, number of children, marital status, and educational background. Additionally, it covered employment details including job type, position, years of service, monthly night shifts, weekly overtime hours, job satisfaction, and experiences of workplace violence within the past year.
Sleep-related Worry scale The sleep-related worry of anesthesiology nurses was assessed through the Chinese version of presenteeism scale, which was compiled by Jansson FM [15], and introduced and sinicized by Chinese scholar Shi Xuliang [12]. The Cronbach’s α coefficient is 0.954. The scale contains 2 dimensions: worrying about the consequences of sleep (6 items) and being unable to control sleep (4 items). The Likert 5-point scale was used, and the answer options were assigned 1–5 points from “strongly disagree” to “strongly agree”. The total score ranged from 10 to 50, with higher scores indicating more serious worries about sleep.
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Self-regulatory Fatigue Scale The self-regulatory fatigue of anesthesiology nurses was assessed through the work-family conflict scale, which was developed by Nes LS [35], and translated into Chinese by Chinese scholar Wang Li-gang [36]. Its Cronbach’s α coefficient is 0.756. The scale included 3 dimensions of cognition, emotion and behavior, with a total of 16 items. Likert 5-point scale was used, and the answer options were assigned 1–5 points from “strongly disagree” to “strongly agree”. Total scores range from 16 to 80, with higher scores indicating greater self-regulatory fatigue.
The Perceived Stress Scale The perceived stress of anesthesiology nurses was measured through the perceived stress scale, which was Compiled by Nielsen MG [37], had a Cronbach’s α coefficient of 0.78. The perceived stress scale was used to evaluate the perceived stress level of nurses in the last month. The 10-item scale was scored on a 5-point scale from 0 to 4, and the answer options were assigned from 0 to 4 points from “never” to “always”. The total score ranges from 0 to 40, with higher total scores indicating stronger perceived stress levels.
Athens Insomnia Scale The athens insomnia of anesthesiology nurses was measured through the athens insomnia scale, which was compiled by Dan Sedmark [38], had a Cronbach’s α coefficient of 0. 928. Eight items including sleep onset time, night wake up, early wake up, sleep duration, sleep quality, daytime mood, daytime physical function, and daytime sleepiness were assessed. The answer options were assigned from 0 to 3 points from “no problem” to “severe delay or no sleep”. The total score ranges from 0 to 24, with < 4 indicating no sleep disturbance, 4–6 as suspected insomnia, and ≥ 7 as insomnia. Coefficient is 0. 928. Eight items including sleep onset time, night wake up, early wake up, sleep duration, sleep quality, daytime mood, daytime physical function, and daytime sleepiness were assessed. The answer options were assigned from 0 to 3 points from “no problem” to “severe delay or no sleep”. The total score ranges from 0 to 24, with < 4 indicating no sleep disturbance, 4–6 as suspected insomnia, and ≥ 7 as insomnia.
Perceived Social Support Scale The social support of anesthesiology nurses was measured through the Chinese version of perceived social.
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support scale, which was compiled by Dahlem [39]and the Chinese version was translated and revised by Jiang Qianjin [40]. It has a Cronbach’s α coefficient of 0.954 and contains 12 items and mainly evaluates three aspects of individual family support, friend support and other support. Likert 7-point scoring method was used, and the answer options were assigned 1–7 points from “strongly agree” to “strongly agree”. The total score ranged from 12 to 84, with higher scores indicating higher levels of social support. The total score of 61 to 84 was defined as high support level, 37 to 60 as medium support level, and 12 to 36 as low support level.
Ethical considerations and data collection
The research project received approval from the Clinical Trial Ethics Committee at the Affiliated Hospital of Southwest Medical University (approval number: KY2024303). Prior to commencement, all participants were clearly informed about the voluntary nature of the study and the confidentiality of their data, following the acquisition of permissions from the participating hospitals. Collecting Data from the online platform at http://www.wjx.cn, a widely accessed free survey resource in China, our research developed survey links and QR codes. From August to October 2024, these tools facilitated widespread dissemination and efficient online data gathering. Prior to the main survey, a pilot study involving 15 anesthesia nurses was conducted, leading to refinements in the questionnaire based on their feedback. To uphold the integrity of the survey and data reliability, we integrated reverse validation questions and made all responses compulsory. Additionally, we implemented a unique IP address strategy to prevent duplicate and incomplete submissions. To maintain survey quality, we established a minimum response time of 5 min, which was rigorously monitored by the research team to guarantee the authenticity and relevance of the collected data. Ultimately, 353 questionnaires were gathered, with 23 deemed ineligible, resulting in 330 valid questionnaires and an effective response rate of 93%.
Data analysis
SPSS 22.0 software was used for statistical analysis of the data. The count data were expressed as frequency, and the measurement data were expressed as (x ± s). Chi-square test, two independent sample t test and analysis of variance were used for bivariate analysis. Pearson correlation analysis and multiple hierarchical regression analysis were used to explore the influencing factors of sleep-related worry of nurses in the Department of Anesthesiology. P < 0.05 was considered as statistically significant. The sleep-related worry score among nurses in the Anesthesiology department served as the dependent variable in our analysis. Using single factor analysis, we identified variables with notable impacts. Subsequently, we conducted a multiple linear regression analysis, incorporating self-regulatory fatigue, perceived stress, Athens insomnia score, and perceived social support as independent variables. By examining the standardized β coefficients through linear regression, we estimated and compared the unique and separate influences of these predictors. This method was also employed to explore relationships between exposures and the outcome variable, and to determine the proportion of variance (r-squared) explained by the outcome variables. Statistical significance was determined at a P-value of less than 0.05.
Results
General information and sleep-related worry of anesthesiology nurses
The score of sleep-related worry of nurses in anesthesiology department was (32.53 ± 12.00), and the median score was 36.00. Among the surveyed anesthesia nurses, 6.1% (20/330) of nurses had the highest score of 50, and 7.9% (26/330) had the lowest score of 10. The comparison of sleep worry scores of anesthesiology nurses with different characteristics is shown in Table 1.
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Table 1
Comparison of sleep-related worry scores of anesthesiology nurses with different characteristics
items | n(%) | Sleep-related worry score(x ± s) | t/F | p | |
|---|---|---|---|---|---|
Gender | -0.213 | 0.831 | |||
Male | 34(10.3) | 32.12 ± 8.86 | |||
Female | 296(89.7) | 32.58 ± 12.32 | |||
Age (years) | 0.716 | 0.489 | |||
<30 | 62(18.8) | 32.55 ± 9.90 | |||
30–40 | 212(64.2) | 32.98 ± 12.36 | |||
>40 | 56(17.0) | 30.82 ± 12.77 | |||
Marital status | 0.338 | 0.714 | |||
Unmarried | 60(18.2) | 32.70 ± 10.89 | |||
Married | 254(77.0) | 32.65 ± 12.41 | |||
Divorced/widowed | 16(4.8) | 30.13 ± 9.12 | |||
Number of children | 0.028 | 0.973 | |||
0 | 72(21.8) | 32.25 ± 11.78 | |||
1 | 160(48.5) | 32.65 ± 11.61 | |||
≥ 2 | 160(48.5) | 32.55 ± 12.87 | |||
Education | 0.792 | 0.454 | |||
Secondary and tertiary education | 32(9.7) | 34.38 ± 11.04 | |||
Undergraduate | 294(89.1) | 32.27 ± 12.15 | |||
Graduate and above | 4(1.2) | 37.50 ± 5.20 | |||
Mode of employment | -1.166 | 0.247 | |||
Contract | 268(81.2) | 32.13 ± 11.70 | |||
Establishment | 62(18.8) | 34.26 ± 13.19 | |||
Years of work (years) | 1.234 | 0.293 | |||
<5 | 38(11.5) | 30.05 ± 10.04 | |||
5–10 | 108(32.7) | 32.13 ± 11.82 | |||
>10 | 184(55.8) | 33.28 ± 12.44 | |||
Professional Title | 3.422 | 0.034 | |||
Primary level | 202(61.2) | 31.20 ± 11.75 | |||
Intermediate level | 108(32.7) | 34.89 ± 12.16 | |||
Advanced level | 20(6.1) | 33.30 ± 12.25 | |||
Job Position | -1.938 | 0.080 | |||
Clinical Nurse | 320(97.0) | 32.38 ± 12.08 | |||
Nursing administrator | 10(3.0) | 37.40 ± 7.90 | |||
Night shifts per month (n) | 5.801 | 0.003 | |||
0–5 | 283(85.8) | 31.76 ± 12.28 | |||
6–10 | 42(12.7) | 36.14 ± 8.72 | |||
>10 | 5(1.5) | 46.00 ± 5.58 | |||
Overtime hours per week (h) | 2.738 | 0.029 | |||
<5 | 67(20.3) | 28.51 ± 12.29 | |||
5–10 | 131(39.7) | 33.33 ± 11.41 | |||
10–15 | 78(23.6) | 33.74 ± 11.36 | |||
15–20 | 22(6.7) | 31.72 ± 10.25 | |||
>20 | 32(9.7) | 35.31 ± 14.80 | |||
Self-rated health status | -6.330 | <0.001 | |||
health | 172(52.1) | 28.74 ± 12.67 | |||
sub-health | 158(47.9) | 36.66 ± 9.69 | |||
Current working status | 18.458 | <0.001 | |||
Satisfied | 164(49.7) | 28.70 ± 12.86 | |||
In general | 158(48.9) | 36.35 ± 9.46 | |||
Dissatisfied | 8(2.4) | 35.75 ± 15.01 | |||
Experienced workplace violence in the past year | 3.222 | 0.001 | |||
Yes | 32(9.7) | 38.94 ± 9.06 | |||
No | 298(90.3) | 31.85 ± 12.09 | |||
To explore the correlation between sleep-related worry and self-regulatory fatigue, perceived stress, Athens insomnia and perceived social support in nurses of anesthesiology department
In Table 2, it showed that the total score of self-regulatory fatigue of anesthesia nurses was (47.01 ± 9.25). The total score of stress perception was (28.84 ± 7.96). Athens insomnia total score was (17.18 ± 6.24); The total score of perceived social support was (61.56 ± 14.93), of which 175 (53.0%) had high level of support, 123 (37.3%) had medium level of support, and 32 (9.7%) had low level of support. Sleep-related worry was positively correlated with the total score of self-regulatory fatigue (r = 0.459, P < 0.001), the total score of perceived stress (r = 0.489, P < 0.001), and the total score of Athens insomnia (r = 0.671, P < 0.001). And negatively correlated with the total score of perceived social support (r=-0.362, P = 0.002).
Table 2
Correlation of variables
Variable | score | sleep-related worry (r) | P |
|---|---|---|---|
Professional Title ( Primary level, Intermediate level, Advanced level) | 0.119 | 0.031 | |
Night shifts per month (n) (0–5;6–10;>10) | 0.179 | 0.001 | |
Overtime hours per week (h) (<5;5–10;10–15;15–20;>20) | 0.129 | 0.019 | |
Self-rated health status (health; sub-health) | 0.33 | < 0.001 | |
Current working status (Satisfied; In general; Dissatisfied) | 0.304 | < 0.001 | |
Experienced workplace violence in the past year (Yes; No) | -0.175 | 0.001 | |
Total score of self-regulatory fatigue(16–80) | 47.01 ± 9.25 | 0.459 | < 0.001 |
Total score of perceived Stress scale(0–40) | 28.84 ± 7.96 | 0.489 | < 0.001 |
Total score of Athens insomnia scale(0–24) | 17.18 ± 6.24 | 0.671 | < 0.001 |
Total score of perceived social support scale(12–84) | 61.56 ± 14.93 | -0.362 | < 0.001 |
Multivariate analysis of sleep-related worry of nurses in department of anesthesiology
The Sleep-related Worry Scale score for nurses working in the Anesthesiology Department served as the outcome variable. For the multiple linear regression analysis, we utilized statistically significant variables identified through single factor analysis, alongside the composite scores for self-regulatory fatigue, perceived stress, Athens insomnia, and perceived social support as predictor variables. The measured data values were replaced, with the coding schemes for other predictor variables outlined in Table 3. Table 4 revealed that health status, self-regulatory fatigue, perceived stress, insomnia, and social support were significant predictors of sleep-related worry among anesthesiology nurses (P < 0.05). The adjusted R-squared value was 0.511, indicating that these variables collectively accounted for 51.1% of the total variability in the dependent variable.
Table 3
Assignment methods of independent variables
Variable | Assignment of value |
|---|---|
Professional Title | Primary level = 1; Intermediate level = 2; Advanced level = 3 |
Night shifts per month (n) | 0–5 = 1; 6–10 = 2; >10 = 3 |
Overtime hours per week (h) | <5 = 1; 5–10 = 2; 10–15 = 3; 15–20 = 4; >20 = 5 |
Self-rated health status | health = 1; sub-health = 2 |
Current working status | Satisfied = 1; In general = 2; Dissatisfied = 3 |
Experienced workplace violence in the past year | Yes = 1; No = 2 |
Table 4
Multivariate analysis of sleep-related worry of nurses in Department of Anesthesiology (n = 330)
Variable | B | SE | β | t | P | 95%CI |
|---|---|---|---|---|---|---|
self-rated health status | 1.494 | 0.643 | 0.093 | 2.326 | 0.021 | 0.230–2.759 |
self-regulatory fatigue | 0.183 | 0.063 | 0.141 | 2.906 | 0.004 | 0.059–0.307 |
perceived stress | 0.161 | 0.078 | 0.107 | 2.067 | 0.040 | 0.008–0.315 |
insomnia | 0.877 | 0.101 | 0.456 | 8.687 | < 0.001 | 0.679–1.076 |
perceived social support | -0.124 | 0.030 | -0.170 | -4.078 | < 0.001 | -0.184- -0.064 |
Discussion
The results of this study showed that the score of sleep-related worry of anesthesiology nurses was (32.53 ± 12.00), and the median score was 36.00, which was in the middle level. This indicated that most nurses were concerned about the consequences of poor sleep and decreased control ability. Consistent with the results of related studies, sleep problems are common among medical workers, especially those in high-pressure positions [1, 13]. Nurses in the department of anesthesiology are more likely to have sleep and anxiety problems due to heavy work stress. Therefore, nursing managers should pay attention to provide personalized psychological counseling and humanistic care for severe patients, reduce their psychological pressure and sleep disturbance, and create a healthy working environment.
Multivariate analysis showed that compared with nurses with good self-rated health status, nurses with general self-rated health status were more likely to cause sleep-related worry (P < 0.05). Existing studies have identified that health states, such as anxiety, depression and a variety of physical diseases, can lead to impaired sleep quality and insomnia [41‐42]. According to the survey, there is no unified work scope and job responsibility of anesthesia nursing at present, which leads to a large workload of anesthesia nurses [43‐44]. Therefore, they need to be highly focused, so that their minds are constantly in a state of tension and anxiety. In this study, nearly half of the anesthesia nurses (47.9%) had general self-rated health and may have sub-health. The study found that in view of the particularity of the occupation, the general work intensity is high, and the medical staff are in a state of continuous tension, lack of exercise, irregular work and rest and low quality of sleep, which is not conducive to health [45‐46]. Therefore, sub-health status is common. For nurses with serious sleep-related worry, they should be encouraged to participate in physical exercise, keep regular diet and adequate sleep. In addition, managers need to schedule work flexibilities, consider personal needs and health status, and set up psychological counseling channels to provide psychological support for nurses, enhance their self-care ability and improve their sub-health status, so as to reduce their worries about sleep.
The study found that self-regulatory fatigue was positively correlated with sleep concern (r = 0.459, P < 0.001). Self-regulatory fatigue refers to the decrease of the ability or willingness of the individual’s volitional activity during self-control, which can lead to the lack of individual management behavior and the decline of self-management belief [27, 47]. According to the energy model [48], long-term high-load self-regulation can lead to the gradual consumption of psychological resources and regulatory fatigue, which not only affects the quality of nursing services, but also brings challenges to their physical and mental health, and then destroys their self-control ability [27, 49]. Self-control is the ability of individuals to change or stop specific reactions based on specific goals and standards, such as emotions, emotions, cognitive activities, etc [50]. This helps individuals to adopt new behaviors or stop inappropriate behaviors. Nurses in the department of Anesthesiology may have high psychological energy consumption for nurses with sleep disorders due to intense and tedious nursing work [51]. Due to the weakening of self-regulatory ability, nurses become difficult in emotion management, which promotes the formation and solidification of negative thinking patterns, thus further aggravating the degree of sleep-related worry. Therefore, nursing managers can adopt diversified strategies to help nurses reduce stress: introducing mindfulness training to adjust their mentality, promoting peer communication and sharing experience, optimizing scheduling and working environment, and comprehensively reducing self-regulatory fatigue.
The results showed that nurses with more serious insomnia had more serious sleep-related worry (r = 0.671, P < 0.001). Insomnia itself is a sleep disorder characterized by the inability to fall asleep or to remain asleep, resulting in insufficient sleep. When individuals experience insomnia, they often feel tired, distractibility, and memory loss [52]. These physiological discomforts can easily trigger worries about sleep [10, 53], and worry about sleep is itself a psychological stressor. This stress also hinders relaxation, aggravates insomnia [54], and can cause “sleep anxiety” in the long run [55]. In conclusion, there is a complex interrelation between insomnia and sleep-related worry. Comprehensive intervention and treatment are needed. Nurses should adjust their living habits and psychological adjustment. Reduce light interference and caffeine, alcohol and other stimulants before going to bed. Relax and reduce tension and anxiety through meditation and deep breathing. At the same time, nursing managers should promote the knowledge of healthy sleep, optimize the arrangement of work and rest, and create a good environment to further alleviate nurses’ sleep-related worry and improve sleep quality.
Previous studies have found that perceived social support can play a role in mental health through a buffering model [56]. Social support can buffer the negative impact of stressful events on an individual’s physical and mental health. The present study found that nurses with lower levels of perceived social support had more serious sleep-related worry. Perceived social support was negatively correlated with sleep concern (r=-0.362, P = 0.002). Therefore, it is necessary to provide social support for anesthesiology nurses at multiple levels including family, hospital and national system. The hospital management should launch publicity and advocacy activities to enhance the awareness of the medical team on the value of nurses in the department of anesthesiology, and build an efficient and collaborative scientific doctor-nurse cooperation model. At the national level, the relevant policies promulgated by the Chinese health authorities have played an important role in promoting the development of anesthesia nursing [57], significantly improving nurses’ professional identity and effectively reducing sleep-related worry caused by insufficient social support.
Limitations
This study has several limitations. Firstly, as the vast majority of the participants in this study were female (89.7%), the conclusions may not be fully applicable to male anesthesia nurses. Second, due to the use of non-random/non-probability sampling and limited sample size, caution should be exercised when generalizing the findings to the whole country. Future studies with larger scale and random sampling are recommended. Finally, the cross-sectional design limits inference of causality. Therefore, a causal link could not be established, which limited the depth of the study to some extent. In addition, since the study data mainly rely on the recall of the participants, this is bound to be affected by the individual memory ability, which in turn produces recall bias, which undoubtedly increases the limitation of the study. In the future, longitudinal research can be conducted to further explore and propose effective strategies to reduce sleep-related worry of anesthesia nurses.
Conclusions
Anesthesiology nurses have serious sleep-related worry, which need to be further improved. Clinical nursing managers should pay attention to the special needs of nurses in the department of anesthesiology, and reduce the sleep-related worry of anesthesiology nurses by improving their insomnia symptoms, reducing their stress and self-regulatory fatigue, and improving the level of social support.
Acknowledgements
We thank our team, managers, and nurses from the Hospital.
Declarations
Ethics approval and consent to participate
Ethical approval for this study has been obtained from Clinical Trial Ethics Committee, Affiliated Hospital of Southwest Medical University[KY2024303]. All participants voluntarily signed an informed consent after fully understanding the purpose, methods, potential risks and possible benefits of the study. During the study, we strictly complied with the provisions of the Declaration of Helsinki and the Chinese Ethical guidelines to ensure the rights and safety of the subjects and their data.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
Clinical trial number
Not applicable.
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