Applied Nursing Research 55 (2020) 151250

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Applied Nursing Research

journal homepage: www.elsevier.com/locate/apnr

Relationships between sleep quality, mindfulness and work-family conflict T

in Chinese nurses: A cross-sectional study
⁎
Kexian Liu (BS, RN)a,c, Tingting Yin (MSM, RN)b, Qu Shen (EdD, RN)a,
a
Nursing Department, School of Medicine, Xiamen University, Xiamen City, Fujian Province 361101, China
b
Department of Critical Care Medicine, Zhongshan Hospital Affiliated to Xiamen University, Xiamen City, Fujian Province, 361004, China
c
Nursing Department, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, 310016, China

A R T I C LE I N FO A B S T R A C T

Keywords: Background: To improve nursing quality and safety, it is essential to better understand relationships between
Nurses sleep quality, mindfulness, and work-family conflict among nurses.
Sleep quality Purpose: To examine the relationships among sleep quality, mindfulness and work-family conflict, and the
Mindfulness mediating effect of mindfulness.
Work-family conflict
Methods: A cross-sectional study was conducted using survey data from five comprehensive tertiary first-class
hospitals in Xiamen. Two thousand three hundred seventy-two nurses' data were used as the final sample.
Spearman correlations were calculated, bootstrapping analysis, path analysis was conducted.
Findings: The sleep quality of nurses was not optimal. Work-family conflict was positively correlated with the
Pittsburgh Sleep Quality Index (PSQI) score, while mindfulness level was negatively associated with it.
Mindfulness played a mediating role in the prediction of sleep quality based on work-family conflict.
Conclusions: To improve nursing quality, interventions are needed to enhance nurses' sleep quality through
mindfulness and work-family conflict improvement.

1. Introduction 2. Background

Sleep is a necessary and positive cyclic process involving a variety of
physiological and psychological phenomena (Jiang, 2010). In recent
years, sleep problems have become increasingly severe. According to a
2010 survey, 29.9% of employees in the United States sleep for < 6 h a
day (Luckhaupt, Tak, & Calvert, 2010), while sleep time has declined
each year over the past ten years (Welsh, Ellis, & Mai, 2014). ‘Sleep
deprivation’ was recognized as a ‘public health epidemic’ in 2015, and
the Centers for Disease Control and Prevention has prioritized ‘sleep
hygiene’ education (Faber, Häusser, & Kerr, 2017). Sleep problems
(sleep deficiency, sleep disorders, etc.) have also been tested and ver-
ified in Britain (Groeger, Zijlstra, & Dijk, 2004), Sweden (Westerlund
et al., 2008) and other countries. In China, the sleep condition is also
not optimal. The average sleep duration of residents aged 15–69 in
China is decreasing. More than one-third of these residents suffer from
poor sleep quality. The physical and mental diseases caused by sleep
problems are consistent and seriously affect the physical and mental
health of the residents in China (Yin et al., 2011a, 2011b). With regard
to nurses, sleep problems and their adverse effects are more significant.
Please refer to the Background for details.
Nurses' professional work, the long-term disordered rhythm of life,
and pressure from all aspects of life result in sleeping problems, af-
fecting the efficiency and quality of nursing work (Gander et al., 2019).
In related studies, the sleep quality of nurses was poor (Li, Li, Xie, Shao,
and Dong, 2018). A total of 58.4% of female nurses and 38.4% of male
nurses had sleep disorders (Giorgi, Mattei, Notarnicola, Petrucci, &
Lancia, 2018); the proportion of nurses with poor sleep quality was
79.8% in Korea (Park, Lee, & Park, 2018). In summary, the sleeping
status of nurses is not optimal, and management should pay close at-
tention to this topic.
A study explored the impact of sleep quality, including its effects on
work, safety, psychology, and other aspects (Lin, Ye, Peng, Yin, &
Wang, 2018). The worse the sleep quality of nurses, the more likely
they are to suffer from depression and inattention in their daily work.
The sleep problem will reduce their sense of personal identity and in-
crease their frustration (Chin, Guo, Hung, Yang, & Shiao, 2015). Thus,
the nurses gradually lose their enthusiasm for work. For nurses in the
operating room, they are more likely to be in a sub-health state due to
poor sleep quality, which threatens the quality and safety of their

⁎
Corresponding author.
E-mail address: shenqumail@163.com (Q. Shen).

https://doi.org/10.1016/j.apnr.2020.151250
Received 28 November 2019; Received in revised form 2 March 2020; Accepted 3 March 2020
0897-1897/ © 2020 Elsevier Inc. All rights reserved.
K. Liu, et al.
nursing performance (Gander et al., 2019). Therefore, the adverse ef-
fects of sleep problems cannot be underestimated. How do we start to
improve the quality of sleep among nurses? Mindfulness and family
conflict may be worth considering.
Mindfulness is described as “the awareness that emerges through
paying non-judgmental attention on purpose, in the present moment, to
the unfolding of experience moment by moment” (Kabat-Zinn, 1994).
Reasonable mindfulness training can effectively improve primary
chronic sleep disorders caused by mental factors and physical diseases
(Tao, Chen, & Pei, 2017); Song (2016) reported that mindfulness is a
protective factor for sleep quality among oncology nurses. That is,
mindfulness plays an active role in the maintenance of physical and
mental health. Although studies have shown that mindfulness training
is closely related to sleep quality, the mechanism underlying the re-
lationship between mindfulness and the sleep quality of nurses is still
insufficient and deserves further study.
Work-family conflict is manifested in the failure to perform family
responsibilities due to a busy work schedule or when family affairs
affect the efficiency and quality of work (Zhang, Griffeth, & Fried,
2012). Work-family conflict has many adverse effects. Work-family
conflict is related to sleep quality. The more prominent the work-family
conflict is, the worse the sleep quality is (Chen, Zheng, & Chen, 2017);
this association was confirmed in Marina Nützi's research (2015)(Nützi
et al., 2015). Besides, family-work conflict, long-term work, and having
children in the family were negatively correlated with the sleep dura-
tion of nurses, while family-work conflict had a more significant impact
on sleep duration than work-family conflict (Berkman, Liu, Hammer,
et al., 2015). Although studies have shown that work-family conflict
has many adverse effects, there is still a lack of research on the corre-
lation between work-family conflict and sleep quality in China, espe-
cially among nurses with high occupational risk, high intensity of work,
and intense levels of professionalism.
In summary, despite the relevant research at home and abroad, no
cross-sectional study with a large sample has been performed in
Xiamen, the special economic zone in China; moreover, the related
concepts involved in such studies deserve further discussion.
The present study aimed to identify the mediating effect of mind-
fulness on the relationship between sleep quality and work-family
conflict. The specific research aims were 1) to describe the status of
sleep quality of nurses, 2) to analyze the correlations among sleep
quality, mindfulness and work-family conflict among nurses, and 3) to
examine the mediating effect of mindfulness on the relationship be-
tween sleep quality and work-family conflict.
3. Methods
3.1. Study design
We conducted a cross-sectional descriptive study with a con-
venience sampling method, including 2372 nurses from 5 comprehen-
sive tertiary first-class hospitals (the highest level general hospital in
mainland China) in Xiamen, Fujian Province, a southeast coastal city in
China.
3.2. Participants
Employed nurses with professional qualifications recognized in
comprehensive tertiary first-class hospitals in Xiamen were eligible to
participate in this study. A cross-sectional online survey was used.
Assuming a standard deviation of 1.2, an alpha level of 5%, and a delta
level of 1%, the required sample size was 553 (Ni, Chen, & Liu, 2010).
Considering a rate of 10%–15% for incomplete or invalid cases, the
sample size was set at 615–650. The survey link was sent to potential
participants through both the Association of Xiamen Nursing Staff and
personal referrals. The recruitment period was from December 2018 to
February 2019.
2
Applied Nursing Research 55 (2020) 151250
3.3. Data collection
First, the researchers presented the aim of the study and its design to
the heads of the hospitals to obtain their approval. Questionnaires were
then distributed to nurses by heads of department. Participants received
a survey packet that contained the questionnaire, a cover letter ex-
plaining the study's purposes and an informed consent form.
3.4. Measurements
3.4.1. Demographics
The general information questionnaire was designed by the re-
searcher based on relevant literature and research experience. The
survey mainly collected the social demographic data of the nurses, in-
cluding 20 items, such as sex, age, education level, personal monthly
income, and physical exercise.
3.4.2. Sleep quality
Sleep quality was assessed using the PSQI (Buysse, Reynolds, &
Monk, 1989; Liu, Tang, & Hu, 1996). The PSQI reflects the sleep quality
of an individual in the past month. The scale assesses seven aspects of
sleep: subjective sleep quality, sleep duration, sleep time, sleep effi-
ciency, sleep disorders, the use of hypnotic drugs, and the effects on
daytime function. According to the individual scores of 0–3, the PSQI is
calculated as the sum of all factors. A total PSQI score > 16 indicates
inferior sleep quality, 11–15 indicates poor sleep quality, 6–10 indicates
moderate sleep quality, and < 5 indicates good sleep quality. Lu
Taoying and her colleagues tested its reliability and validity. Cronbach's
α coefficient was 0.84, the retest reliability was 0.81, and the internal
consistency coefficient was 0.702 (Lu, Li, & Xia, 2014).
3.4.3. Mindfulness
Mindfulness was assessed using the Mindfulness Attention
Awareness Scale (Brown & Ryan, 2003). The scale has a single-di-
mensional structure, including 15 items. A Likert 6-level scoring
method was used. Each item had a corresponding score of 1–6 from
“always” to “never”. The higher the score, the higher the level of
mindfulness. Mindfulness was divided into three levels: 66–90 in-
dicated high mindfulness, 41–65 showed moderate mindfulness, and
below 40 indicated low mindfulness. The Cronbach's α coefficient was
0.890, and the internal consistency coefficient was 0.872 (Brown &
Ryan, 2003).
3.4.4. Work-family conflict
Work-family conflict was assessed using the Work-Family Conflict
Scale (Carlson, Kacmar, & Williams, 2000). The scale includes two
subscales: work-to-family conflict (the first five questions) and family-
to-work conflict (the last five questions). There are ten items on the
scale, including two dimensions of work-family conflict and family-
work conflict. The five-point scoring method is used to measure the
level of conflict from “totally inconsistent” (1 point) to “totally con-
sistent” (5 points). The higher the score, the higher the level of conflict.
The internal consistency coefficients of the work-to-family conflict scale
and the family-to-work conflict scale were 0.88 and 0.89, and the
Cronbach's α coefficients of the total scale and each dimension were
0.85, 0.93 and 0.86, respectively (Carlson et al., 2000).
3.5. Data analysis
Statistical analyses were conducted using SPSS (v.21.0).and AMOS
(v.24.0). Descriptive statistics such as the mean, percent, and standard
deviation of the sample and study variables were obtained. The
Spearman correlation coefficient was calculated to define the correla-
tions among study variables. As structural equation modeling produces
a more accurate estimate over mediational analysis, we used AMOS to
examine the direct and indirect effects of the model. Based on the
K. Liu, et al. Applied Nursing Research 55 (2020) 151250

procedure of mediational effect analysis put forward by Zhao, Lynch, Table 1

and Chen (2010), the bootstrap method with 5000 bootstrap samples Demographic characteristics of respondents (n = 2372).
was selected to confirm the significance of the mediating effect of Variable n %
mindfulness on the link between sleep quality and work-family conflict;
this method is included as an option in SPSS (Hayes, 2013; Preacher, Department
Internal Medicine 733 30.9
2004).
Surgery 461 19.4
Paediatrics 174 7.3
3.6. Ethical considerations Obstetrics and Gynaecology Department 298 12.6
Emergency Department 224 9.4
The study protocol was approved by the Research Ethics Committee Intensive Care Unit 93 3.9
Operating Room 156 6.6
of Xiamen University (XDYX2019003). Informed consent was required
Administrative Management 13 0.5
to be provided on the first page of the survey. Participants provided Other 220 9.3
their consent by clicking a button on this page. The online survey Sex
platform was deactivated when the target sample size was reached. Male 62 2.6
Female 2310 97.4
Age
4. Findings ≤29 1144 48.2
30-39 931 39.2
4.1. Demographics 40-49 234 9.9
≥50 63 2.7
Work seniority
The respondents' ages ranged from 18 to 58 years (M = 31.18,
≤4 years 824 34.7
SD = 7.20). A high proportion of respondents (97.4%) were female. 5-14 years 1071 45.2
Despite all participants being registered nurses, respondents came from 15-24 years 302 12.7
a wide variety of educational backgrounds. The vast majority (98.2%) ≥25 years 175 7.4
earned a college degree (41.9%) or a bachelor's degree (56.3%), but Education level
Secondary specialized school 34 1.4
others had a secondary school education (1.4%) or earned a master's Junior College 993 41.9
degree (0.4%). The sample reflected the educational diversity of the Undergraduate 1335 56.3
nursing workforce of the healthcare providers in Xiamen, Fujian Master 10 0.4
Province. In terms of marriage, most (62.6%) were married, and half of Title
Primary 1568 66.1
the respondents (56.7%) had children (Table 1).
Intermediate 638 26.9
Senior 166 7.0
4.2. Status of sleep quality, mindfulness, and work-family conflict Post
Yes 457 80.7
The respondents' PSQI scores ranged from 0 to 21 (M = 7.56, No 1915 19.3
Number of long night shifts per month
SD = 3.62). A low proportion of respondents (30.7%) had good sleep 0 416 17.5
quality. The mindfulness levels of the respondents appeared to be 1-2 226 9.5
moderate, with scores ranging from 15 to 90 (M = 64.17, SD =13.06). 3-4 1294 54.6
In terms of work-family conflict, the scores ranged from 1 to 5 ≥5 436 18.4
Marital status
(M = 2.68, SD = 0.82) (Table 2).
Unmarried 888 37.4
Married 1484 62.6
4.3. Correlations among mindfulness, work-family conflict, and sleep Children
quality Childless 1026 43.3
Have children 1346 56.7
Monthly income (after tax)
There were significant correlations among mindfulness, work-family ≤3500 yuan 77 3.2
conflict, and sleep quality. The higher the mindfulness level of the 3501-5000 yuan 392 16.5
nurses, the lower the PSQI scores (r = −0.332, p < 0.01), and the 5001-8000 yuan 1298 54.7
better they perceived their work-family conflict (r = −0.304, 8001-12500 yuan 584 24.6
≥12501 yuan 19 0.8
p < 0.01). PSQI scores and work-family conflict revealed a positive
Long-term disease distress
correlation (r = 0.248, p < 0.01) (Table 3). Yes 334 14.1
No 2038 85.9
4.4. Mediating effect of mindfulness Regular physical exercise
Yes 293 12.4
No 2079 87.6
The result of the analysis of the mediating effect of mindfulness on Habit of drinking tea or coffee
the relationship between sleep quality and work-family conflict did not Yes 399 16.8
include 0 (LLC I = 0.1817, ULC I = 0.3446), which revealed the sig- No 1973 83.2
nificant mediating effect of mindfulness (the size of the mediating effect Use of cell phone before bedtime
Yes 2120 89.4
was 0.2627). Controlling for the median value of mindfulness, the im-
No 252 10.6
pact of work-family conflict on sleep quality was also significant, and Seek a doctor if not sleeping well
the result (LLCI = 0.6368, ULCI = 0.9775) did not include 0. Yes 470 19.8
Therefore, mindfulness plays a mediating role in the impact of work- No 1902 80.2
family conflict on sleep quality, but it is not the only mediating vari-
able. If nurses can't balance between work and family, their sleep
quality will be affected. However, a high level of mindfulness will re- of the mechanism of the relationships among the work-family conflict,
duce the impact of work-family conflict on sleep quality, and nurses get mindfulness, and sleep quality of nurses was proposed, and the model
better sleep quality. There are additional missing mediating variables, was in good agreement with the sample data and could be accepted.
which require further study. Besides, the pattern of results from the revised model was different from
Based on the above findings, a hypothetical model (revised) (Fig. 1) that of the initial model. The total effects and direct effects of work-

3
K. Liu, et al. Applied Nursing Research 55 (2020) 151250

Table 2 substantial than that in the initial model (Table 4).

Descriptive statistics of the main variables (n = 2372).
Sleep Status n (%) M ± SD 5. Discussion

Subjective sleep quality In this study, we examine the relationships among sleep quality,
0 176 (7.4)
mindfulness, and work-family conflict and the mediating effect of
1 1077 (45.4)
2 913 (38.5)
mindfulness on the relationship between sleep quality and work-family
3 206 (8.7) conflict among Chinese nurses. Sleep quality is a comprehensive index
Sleep latency to evaluate the effectiveness of sleep. It is a combination of objective
0 321 (13.5) evaluation (sleeping time, waking times, etc.) and subjective evaluation
1 805 (33.9)
(sleeping difficulty, rest degree, etc.) (Lin et al., 2018). Nurses' sleep
2 707 (29.8)
3 539 (22.7) quality was not optimal, with only 30.7% of the nurses had good sleep
Sleep persistence quality. According to studies, the sleep status of nurses was worse than
0 942 (39.7) that of the general population (Giorgi et al., 2018; Li, Li, Xie, Shao, &
1 981 (41.4)
Dong, 2018; Park et al., 2018). We posit that the possible reasons are as
2 33.8 (14.2)
3 111 (4.7)
follows (Hughes and Rogers, 2004; Bao, 2018; Song, 2018): unin-
Habitual sleep efficiency terrupted shifts; overtime; high intensity of work paired with a rela-
0 1455 (61.3) tively low salary level; the standby system prevents the days off from
1 569 (24.0) being fully utilized; the assessment system requires a large amount of
2 184 (7.8)
the nurses' time and energy; the nursing profession is highly profes-
3 164 (6.9)
Sleep disorder sional and related to people's health and life, resulting in high occu-
0 190 (8.0) pational stress; the Xiamen comprehensive tertiary first-class hospitals
1 755 (31.8) are involved, with heavy tasks, high labor intensity, high shift fre-
2 971 (40.9) quency and likelihood of disturbing sleep rhythm. Nurses' poor sleep
3 456 (19.2)
Sodium amytal
quality is likely to cause safety problems (e.g., nursing errors) and
0 2204 (92.9) medical disputes, so the associated harm cannot be underestimated (Liu
1 86 (3.6) & Chen, 2015). Nurses play an essential role in the physiological, psy-
2 44 (1.9) chological, and social needs of patients (Yang et al., 2019). Nursing
3 38 (1.6)
work also affects the physiological, psychological, and social status of
Autonomous dysfunction
0 566 (23.9) nurses (Anon (2017). This finding suggests that it is necessary to study
1 988 (41.7) the situation of sleep quality among nurses and explore the related
2 628 (26.5) mechanisms to provide a basis for the establishment of relevant policies
3 190 (8.0) to protect the health of nurses, to ensure the role and status of nurses in
Sleep quality
Very bad 57 (2.4)
the healthcare field and to guarantee safety and quality further.
Poor 402 (16.9) In our study, there was a negative correlation between mindfulness
Moderate 1184 (49.9) and sleep quality among nurses, which is consistent with the findings of
Good 729 (30.7) previous studies (Allen & Kiburz, 2012; Li, 2017; Song, 2016). In recent
Sleep quality 7.56 ± 3.62
years, the close relationship between sleep quality and mindfulness has
Mindfulness level
High 1195 (50.4) attracted increasing attention from researchers. Mindfulness can not
Moderate 1065 (44.9) only reduce rumination caused by pre-sleep anxiety and insomnia but
Low 112 (4.7) can also affect sleep quality and duration. The psychological separation
Mindfulness level 64.17 ± 13.06 between individuals mediates the relationship between mindfulness
Work-family conflict 2.68 ± 0.82
Work-to-family 3.08 ± 0.94
and sleep quality. Tao et al. (2017) noted that the mechanism of
Family-to-work 2.29 ± 0.94 mindfulness training to improve sleep quality mainly includes brain
mechanisms and psychological mechanisms. The psychological me-
chanisms include reducing negative emotions (anxiety, depression, fa-
Table 3 tigue, etc.) through mindfulness training, and alleviating sleep pro-
Correlation matrix of the PSQI, mindfulness level and work-family conflict blems. The workload of nurses in comprehensive tertiary first-class
(n = 2372). hospitals in China is large, and the working environment is complex
Variable PSQI ML WTFC FTWC WFC and changing. Nurses are prone to negative emotions. In conclusion,
mindfulness is a protective factor for nurses' sleep quality.
PSQI 1 In this study, work-family conflict was more significant than family-
ML -0.332⁎ 1
work conflict, which was consistent with the findings of relevant studies
WTFC 0.271⁎ -0.234⁎ 1
FTWC 0.157⁎ -0.276⁎ 0.460⁎ 1 (Guo, Xu, Wang, Zou, & Bao, 2018). Our study also found that work-
WFC 0.248⁎ -0.304⁎ 0.838⁎ 0.850⁎ 1 family conflict was positively correlated with PSQI. Berkman et al.
(2015) showed that work-family conflict had a more significant impact
PSQI = Pittsburgh Sleep Quality Index; ML = mindfulness level; WTFC = on nurses' sleep quality than family-work conflict, which was consistent
work-to-family conflict; FTWC = family-to-work conflict; WFC = work-family with our findings. Reduced sleep quality will result in negative emo-
conflict.
⁎ tions and health effects among nurses, thus interfering with their reg-
p < 0.01.
ular work and family life and forming a vicious cycle (Buxton, Hopcia,
Sembajwe, et al., 2012). There are several opinions regarding the
family conflict on mindfulness level and work-family conflict on sleep
psychological mechanism of how work-family conflict affects sleep
quality and the indirect effect of work-family conflict on sleep quality
quality (Yang & Lin, 2018): occupational stress mediates the relation-
based on mindfulness level in the revised model were weaker than those
ship between sleep quality and work-family conflict, and ruminant
in the initial model. On the other hand, the total direct effect of
thinking regulates the influence of work-family conflict on sleep quality
mindfulness level on sleep quality in the revised model was more
and occupational stress. This study will further analyze the mediating

4
K. Liu, et al. Applied Nursing Research 55 (2020) 151250

Fig. 1. Revised Standardized Model of Hypothesis of the Mechanism of Nurses'Work-Family Conflict, Mindfulness Level and Sleep Quality.
χ2 = 164.634; p = 0.000; RMSEA = 0.049; TLI (NNFI) = 0.953; CFI = 0.974; χ2/d.f. = 6.585.
SQ = sleep quality; SSQ = subjective sleep quality; SL = sleep latency; SP = sleep persistence; HSE = habitual sleep efficiency; SD = sleep disorder; SA = sodium
amytal; AD = autonomous dysfunction; ML = mindfulness level; WFC = work-family conflict; WTFC = work-to-family conflict; FTWC = family-to-work conflict.

Table 4 & Gong, 2019; Zhao, 2014), including the perspective of professional
Pattern of results in initial and revised models. skills, career development, occupational protection, psychological
Path Initial model Revised model
support, etc. This training would guide nurses to continually improve
themselves, actively seek proper career development, improve their
TE DE IE TE DE IE career adaptability, and lay a good foundation for alleviating possible
work-family conflicts and sleep problems. Second, staff psychological
WFC→ML -0.218 -0.218 0.000 -0.202 -0.202 0.000
WFC→SQ 0.359 0.292 0.071 0.319 0.253 0.066
counseling activities can be carried out, and professional psychological
ML→SQ -0.310 -0.310 0.000 -0.324 -0.324 0.000 counseling for nurses should be provided, incorporating mindfulness
training into activities, such as mindful breathing, body scanning,
WFC = work-family conflict; ML = mindfulness level; SQ = sleep quality. mindfulness stretching, and meditation (Yu, Xu, Liu, & Xiao, 2019).
TE = total effect; DE = direct effect; IE = indirect effect. Last but not least, the work-family conflict of nurses, including the
work-family situation of nurses based on scheduling, assessment,
role of mindfulness in the relationship between work-family conflict learning, bonus distribution, and other aspects, can be investigated and
and sleep quality. analyzed. Through the in-depth study of mindfulness and work-family
Mindfulness mediated the relationship between the work-family conflict, the close relationships among mindfulness, work-family con-
conflict and sleep quality of nurses. In other words, nurses with high flict, and nurses' sleep quality were analyzed, and practical measures
work-family conflict perform poorly in regard to persistent attention, should be applied to actual work. It is valuable to improve sleep quality
awareness, paying attention to the present, and acceptance without and even the quality of life among Chinese nurses.
judgment. Their mindfulness level was low, and their sleep quality was
poor. Individual mindfulness has a positive effect on improving work
engagement and work-family enrichment. Mindfulness training pro- 5.1. Limitations of the study
grams should be considered to train and enhance the mindfulness of
employees in organizational training and development processes First, one of the limitations of the study was that sleep quality,
(Zheng, Ni, & Liu, 2019). The results of this study suggest that nurses mindfulness, and work-family conflict were measured by self-report. As
can be trained by mindfulness decompression and mindfulness-based with all self-reports, common methodological variance, social desir-
cognitive therapy so that nurses can pay more attention to their current ability biases, and response distortion due to ego-related defensive
work and family experiences, thereby reducing negative emotions and tendencies cannot be ignored (Sy, Tram, & O'hara, 2006).
occupational stress and improving the quality of nurses' sleep (Duarte Second, the generalizability of the findings is potentially limited by
and Pinto-Gouveia, 2016; Xing, 2015). the fact that all the respondents' work in a comprehensive tertiary first-
Overall, we found a good option for improving nurses' sleep quality. class hospital in Xiamen, Fujian Province, so the results cannot be
Based on mindfulness and work-family conflict and its two dimensions, generalized to all hospitals in China.
we can make the following suggestions to hospital management. First, Overall, the above limitations of the study constrain its general-
we suggest that scenario simulation, group counseling, flipped class- izability to other organizations. For these reasons, future studies should
rooms and other forms of training can be used to train new nurses (Luo be conducted in the form of multi-center surveys of different medical
institutions in various areas in China.

5
K. Liu, et al.
6. Conclusions
This study examined the mediating effect of mindfulness on the
relationship between sleep quality and work-family conflict among
nurses. A total of 2372 participants were examined in Xiamen, a special
economic zone in China.
Nurses' work-family conflict was negatively correlated with sleep
quality, and their level of mindfulness was positively correlated with
sleep quality. Nurses' mindfulness mediated the relationship between
work-family conflict and sleep quality. Therefore, improving nurses'
mindfulness level and alleviating work-family conflict are effective
ways to enhance nurses' sleep quality. By improving nurses' mindfulness
level, the influence of work-family conflict on nurses' sleep quality can
be modified. Thus mindfulness interventions should be made a priority
when designing interventions to improve nurses' sleep quality.
Funding
This work was supported by the National Natural Science
Foundation of China (Grant No. 71403232) , Council of Xiamen Nurses
(Item No. XM201706) in Xiamen, Fujian Province, China,and XMU
Training Program of Innovation and Enterpreneurship for
Undergraduates（2019Y1739）
Ethical considerations
Informed consent was required to be provided on the first page of
the survey. Participants provided their consent by clicking a button on
this page. The online survey platform was deactivated when the target
sample size was reached. The study protocol was approved by the
Research Ethics Committee of Xiamen University (XDYX2019003).
CRediT authorship contribution statement
Liu Kexian:Conceptualization, Data curation, Writing - original
draft.Yin Tingting:Conceptualization, Data curation, Writing - ori-
ginal draft, Writing - review & editing.Shen Qu:Conceptualization,
Data curation, Writing - original draft, Writing - review & editing.
Declaration of competing interest
None.
Acknowledgements
The authors would like to thank Ms. CHEN Jiangping, Ms. LIN
Wanying, Ms.YANG Jie and Ms. GAO Yixuan for their support and as-
sistance during the recruitment and data collection period. The authors
would also like to thank all participants for their participation in this
study.
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