J Korean Acad Nurs.  2018 Oct;48(5):622-635. 10.4040/jkan.2018.48.5.622.

Structural Equation Model for Sleep Quality of Female Shift Work Nurses

  • 1Department of Nursing, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Korea.
  • 2College of Nursing · Gerontological Health Research Center in Institute of Health Sciences, Gyeongsang National University, Jinju, Korea. mogu@gnu.ac.kr


This study aimed to develop and test a structural model for sleep quality in female shift work nurses. The hypothetical model was constructed on the basis of Spielman's 3P model of insomnia and previous research related to the sleep quality of shift nurses.
This cross-sectional study used structural equation modeling and recruited 285 female shift work nurses from four general and university hospitals with over 300 beds located in C and J cities in Gyeongsangnamdo. Data were collected from September 27 to October 20, 2016, and then analyzed using descriptive statistics, Pearson's correlation, and structural equation modeling. The study used SPSS/Win 18.0 and AMOS 18.0 in processing the data.
The final model showed good fit to the empirical data: χ2/df=2.19, SRMR=.07, RMSEA=.07, AGFI=.85, TLI=.91, GFI=.93, GFI=.89, NFI=.87. The factors that influenced sleep quality were sleep hygiene (β=.32), perceived shift work status (β=−.16), stress response (β=.16), shift work experience (β=.15), perceived health status (β=−.14), and circadian rhythm (β=−.13) explaining 36.0% of the variance.
The model of sleep quality of the shift work nurses constructed in this study is recommended as a model to understand and predict the sleep quality of shift work nurses. The results suggest that strategies for improving the sleep quality of shift work nurses should focus on sleep hygiene, perceived health status, stress response, circadian rhythm, perceived shift work status, and shift work experience.


Nurses; Shift Work Schedule; Sleep; Psychological stress; Sleep Hygiene

MeSH Terms

Circadian Rhythm
Cross-Sectional Studies
Hospitals, University
Models, Structural
Sleep Initiation and Maintenance Disorders
Stress, Psychological


  • Figure 1 Theoretical framework and hypothetical model.

  • Figure 2 Path diagram for the modified model.


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