Sleep Quality as a Mediator in the Relationship Between Perceived Stress and Job Burnout Among Chinese Nurses: A Structural Equation Modeling Analysis
Yang Song, Fengzhi Yang, Kristin K. Sznajder, Xiaoshi Yang
Abstract
Background: Job burnout has become an increasing prevailing phenomenon among nurses in both developed and developing countries. There is a paucity of research exploring the effect of perceived stress (i.e., the level of one’s perception or appraisal of stress rather than objective stressful events) on burnout and no existing literature examining the mediating role of sleep quality in the relationship between perceived stress and job burnout. The objective of the study was to examine the mediating effect of sleep quality in the relationship between perceived stress and job burnout. Methods: Cross-sectional data were collected from a total of 1013 nurses working in 6 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. Results: 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, p < 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: 0.233~0.386). Conclusion: Perceived stress exerted effects on burnout both directly and indirectly through the mediating role of sleep quality. Efforts to reduce burnout among nurses may benefit from interventions for coping with perceived stress and practices for promoting healthy sleep.