title: The Relationships Among Sleep Quality and Chronotype, Emotional Disturbance, and Insomnia Vulnerability in Shift Nurses.
abstract: BACKGROUND
  Shift work is a prominent feature of most nursing jobs. Although chronotype, emotional disturbance, and insomnia vulnerability are important factors for patients with insomnia in general, their effects on shift nurses are unknown.
  
  
  OBJECTIVE
  This study explores the relationships between the sleep quality of shift nurses and the variables of chronotype, emotional disturbance, and insomnia vulnerability.
  
  
  METHODS
  A survey was conducted with 398 shift nurses in a medical center. Chronotype, emotional disturbance, insomnia vulnerability, and sleep quality were evaluated using the Smith Morningness-Eveningness Questionnaire, the Brief Symptom Rating Scale, the Ford Insomnia Response to Stress Test, and the Pittsburgh Sleep Quality Index, respectively.
  
  
  RESULTS
  On the Pittsburgh Sleep Quality Index, 70.1% of the participants scored higher than 5. Multiple regression analysis revealed that, together with night shift work (b [SE] = 1.05 [0.35], p = .003), higher levels of emotional disturbance (b [SE] = 0.30 [0.05], p < .001) and higher insomnia vulnerability (b [SE] = 0.18 [0.03], p < .001) were predictors of poor sleep quality and that chronotype was not a predictor of poor sleep quality. The multiple mediator model indicated that emotional disturbance significantly mediated an indirect effect of evening chronotype preference on poor subjective sleep quality (one subscale of the Pittsburgh Sleep Quality Index).
  
  
  CONCLUSIONS
  In addition to shift patterns, emotional disturbance and high insomnia vulnerability are factors that may be used to identify shift nurses who face a higher risk of sleep disturbance. Because evening chronotype may indirectly influence subjective sleep quality through the pathway of emotional disturbance, further research into the mechanism that underlies this pathway is warranted.
authors.affiliation: 1MSc, RN, Department of Nursing, National Taiwan University Hospital, and Department of Nursing, College of Medicine, National Taiwan University 2PhD, MD, Visiting Staff, Department of Psychiatry, and Center of Sleep Disorders, National Taiwan University Hospital 3PhD, MD, Director, Division of Psychosomatic Medicine, Department of Psychiatry, National Taiwan University Hospital 4MPH, MD, Director, Department of Psychiatry, Shuang-Ho Hospital, and Department of Psychiatry, Taipei Medical University 5EMBA, PhD, RN, Professor, Department of Nursing, College of Medicine, National Taiwan University, and Director, Department of Nursing, National Taiwan University Hospital.
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Lee
authors.forename: Hsi-Chung
authors.initials: HC
authors.lastname: Chen
authors.forename: Mei-Chih
authors.initials: MC
authors.lastname: Meg Tseng
authors.forename: Hsin-Chien
authors.initials: HC
authors.lastname: Lee
authors.forename: Lian-Hua
authors.initials: LH
authors.lastname: Huang
mesh_terms: D000328:Adult; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D009740:Nursing Staff; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology*; D013624:Taiwan