{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:03:45Z","timestamp":1784099025651,"version":"3.55.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Guangxi Clinical Key Specialty Construction Project","award":["2025070"],"award-info":[{"award-number":["2025070"]}]},{"name":"Guangxi Science and Technology Program: Key Research and Development Project","award":["2025FNFN96726"],"award-info":[{"award-number":["2025FNFN96726"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Work-related musculoskeletal disorders (WMSDs) are highly prevalent among nurses and threaten workforce stability. Although sleep disturbance is known to be associated with WMSDs, the psychosocial pathways underlying this relationship remain poorly understood. This study aims to examine whether sense of agency and perceived social support mediate the relationship between sleep quality and WMSDs among hospital nurses, using a structural equation modeling approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A convenience sample of staff nurses was recruited from six tertiary hospitals in three Chinese cities. Participants self-reported sociodemographics, the Pittsburgh Sleep Quality Index (PSQI), sense of personal control, perceived social support, and the 12-month prevalence\/number of WMSDs. Structural equation modeling with maximum likelihood estimation was constructed to examine the hypothesized pathways, and bias-corrected bootstrap analysis was conducted to analyze the mediating effect of the sense of agency and perceived social support between sleep quality and the number of WMSDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our study included information from 1,388 nurses working in clinical settings. After controlling the factors of gender, length of service, night shift, frequent trunk flexion, frequent heavy lifting, and perceived work fatigue, the PSQI of nurses showed a direct negative association with the sense of agency and perceived social support. Perceived social support had a direct positive impact on the sense of agency, and perceived social support and agency had a direct negative impact on the number of WMSDs in nurses (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), \u03c72\/df\u202f=\u202f7.466, CFI\u202f=\u202f0.906, RMSEA\u202f=\u202f0.070, and the model demonstrated acceptable fit indices. The direct effect accounted for 81.8% of the total effect, while the indirect effects through three significant mediation paths accounted for 18.2% of the total effect (indirect effect\u202f=\u202f0.035, total effect\u202f=\u202f0.192).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even after accounting for established ergonomic and occupational covariates, poor sleep quality was not only directly associated with a higher number of WMSD sites among nurses but also showed an indirect association with WMSDs through lower sense of agency and perceived social support. Interventions that protect and bolster these psychosocial resources should be embedded within integrated musculoskeletal-health frameworks addressing biological, psychological, and social determinants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1881980","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:04:39Z","timestamp":1784095479000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of sleep quality on work-related musculoskeletal disorders among nurses: a structural equation model integrating psychosocial factors"],"prefix":"10.3389","volume":"14","author":[{"given":"Lai","family":"Lichong","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Pengxin","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Qini","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Jie","sequence":"additional","affiliation":[{"name":"The First People's Hospital of Yulin","place":["Yulin, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu","family":"Haichen","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhixin","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huang","family":"Caiyan","sequence":"additional","affiliation":[{"name":"Nanxishan Hospital of Guangxi Zhuang Autonomous Region","place":["Guilin, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chai","family":"Yidan","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huang","family":"Ping","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu","family":"Haowei","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeng","family":"Jingyun","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhou","family":"Huimin","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huang","family":"Huiqiao","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhou","family":"Dongna","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liao","family":"Yifen","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"100938","DOI":"10.1016\/j.ijans.2025.100938","article-title":"Nursing workforce in collapse: a narrative review of global shortages, burnout, and the future of health system resilience","volume":"24","author":"Amini Rarani","year":"2026","journal-title":"Int J Afr Nurs Sci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e231809","DOI":"10.1001\/jamahealthforum.2023.1809","article-title":"Physician and nurse well-being and preferred interventions to address burnout in hospital practice: factors associated with turnover, outcomes, and patient safety","volume":"4","author":"Aiken","year":"2023","journal-title":"JAMA Health Forum"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"104826","DOI":"10.1016\/j.ijnurstu.2024.104826","article-title":"The prevalence and risk factors of work-related musculoskeletal disorders among nurses in China: a systematic review and meta-analysis","volume":"157","author":"Wang","year":"2024","journal-title":"Int J Nurs Stud"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1651921","DOI":"10.3389\/fpubh.2025.1651921","article-title":"A systematic review and meta-analysis on the prevalence and demographic risk factors of work-related musculoskeletal disorders in construction workers","volume":"13","author":"Santos","year":"2025","journal-title":"Front Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1186\/s12891-023-06457-z","article-title":"Musculoskeletal disorders among doctors and nursing officers: an occupational hazard of overstrained healthcare delivery system in western Rajasthan, India","volume":"24","author":"Mahajan","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1375817","DOI":"10.3389\/fpubh.2024.1375817","article-title":"Physical activity, musculoskeletal disorders, burnout, and work engagement: a cross-sectional study on Italian white-collar employees","volume":"12","author":"Amatori","year":"2024","journal-title":"Front Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"105273","DOI":"10.1016\/j.ijnurstu.2025.105273","article-title":"The prevalence and risk factors of shift work disorder among nurses: a systematic review and meta-analysis","volume":"174","author":"Zhao","year":"2025","journal-title":"Int J Nurs Stud"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.3233\/WOR-211113","article-title":"Do sleep and psychological factors influence musculoskeletal pain among nurses?","volume":"75","author":"Niu","year":"2023","journal-title":"Work"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e14329","DOI":"10.1111\/jsr.14329","article-title":"Psychophysical changes after total sleep deprivation and experimental muscle pain","volume":"34","author":"Hertel","year":"2025","journal-title":"J Sleep Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"104613","DOI":"10.1016\/j.ijnurstu.2023.104613","article-title":"Construction and evaluation of a predictive model for compassion fatigue among emergency department nurses: a cross-sectional study","volume":"148","author":"Xie","year":"2023","journal-title":"Int J Nurs Stud"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1177\/21650799231193578","article-title":"Workplace psychosocial factors and their association with musculoskeletal disorders: a systematic review of longitudinal studies","volume":"71","author":"Bezzina","year":"2023","journal-title":"Workplace Health Saf"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"584145","DOI":"10.3389\/fpsyg.2020.584145","article-title":"Measuring the sense of agency: a French adaptation and validation of the sense of agency scale (F-SoAS)","volume":"11","author":"Hurault","year":"2020","journal-title":"Front Psychol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.sleh.2023.11.011","article-title":"The effects of insufficient sleep and adequate sleep on cognitive function in healthy adults","volume":"10","author":"Zimmerman","year":"2024","journal-title":"Sleep Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"101556","DOI":"10.1016\/j.smrv.2021.101556","article-title":"Improving sleep quality leads to better mental health: a meta-analysis of randomised controlled trials","volume":"60","author":"Scott","year":"2021","journal-title":"Sleep Med Rev"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"102163","DOI":"10.1016\/j.smrv.2025.102163","article-title":"The impairments of sleep loss on core executive functions: general and task-specific effects","volume":"84","author":"Cao","year":"2025","journal-title":"Sleep Med Rev"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.3934\/publichealth.2024055","article-title":"Vicarious trauma, coping strategies and nurses' health outcomes: An exploratory study","volume":"11","author":"Piras","year":"2024","journal-title":"AIMS Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s12912-025-02762-1","article-title":"Nurses retention: the impact of transformational leadership, career growth, work well-being, and work-life balance","volume":"24","author":"AbdELhay","year":"2025","journal-title":"BMC Nurs"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1186\/s12912-024-02452-4","article-title":"Influencing factors of work engagement among ophthalmic specialized nurses in China: a cross-sectional study","volume":"23","author":"Ren","year":"2024","journal-title":"BMC Nurs"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1111\/jan.16356","article-title":"How is social support defined, categorized and measured in studies of work-related musculoskeletal disorders among hospital nurses: a scoping review","volume":"81","author":"Asuquo","year":"2025","journal-title":"J Adv Nurs"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e093124","DOI":"10.1136\/bmjopen-2024-093124","article-title":"Prevalence of work-related musculoskeletal disorder and its associated factors among weavers in low- and middle-income countries: a systematic review and meta-analysis","volume":"15","author":"Geto","year":"2025","journal-title":"BMJ Open"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1552","DOI":"10.3389\/fpsyg.2017.01552","article-title":"The sense of agency scale: a measure of consciously perceived control over one's mind, body, and the immediate environment","volume":"8","author":"Tapal","year":"2017","journal-title":"Front Psychol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1448486","DOI":"10.3389\/fneur.2024.1448486","article-title":"Editorial: sleep disorders in neuromuscular diseases: treatable conditions: the evolving scenario of sleep in neuromuscular disorders","volume":"15","author":"Angelini","year":"2024","journal-title":"Front Neurol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1499297","DOI":"10.3389\/fnetp.2025.1499297","article-title":"Insomnia increases the risk for specific autoimmune diseases: a large-scale retrospective cohort study","volume":"5","author":"Stenger","year":"2025","journal-title":"Front Netw Physiol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1428951","DOI":"10.3389\/fnins.2024.1428951","article-title":"The causal relationship between sleep characteristics and multi-site pain perception: a two-sample mendelian randomization study","volume":"18","author":"Yin","year":"2024","journal-title":"Front Neurosci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1007\/s11325-025-03413-0","article-title":"Implications of sleep loss or sleep deprivation on muscle strength: a systematic review","volume":"29","author":"Easow","year":"2025","journal-title":"Sleep Breath"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1080\/07420528.2025.2600581","article-title":"Sleep loss costs performance: physical, cognitive, and psychological impairments after 26 h of sleep deprivation in student athletes","volume":"43","author":"Khcharem","year":"2026","journal-title":"Chronobiol Int"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"103256","DOI":"10.1016\/j.autneu.2025.103256","article-title":"Exercise-mediated modulation of autonomic nervous system and inflammatory response in sleep-deprived individuals: a narrative reviews of implications for cardiovascular health","volume":"259","author":"Saputro","year":"2025","journal-title":"Auton Neurosci"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1037\/bul0000497","article-title":"Cognitive mechanisms underlying sense of agency: Meta-analytic reviews of behavioral and neuroimaging studies","volume":"151","author":"Zhao","year":"2025","journal-title":"Psychol Bull"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.2147\/PRBM.S414625","article-title":"Effect of social media addiction on executive functioning among young adults: the mediating roles of emotional disturbance and sleep quality","volume":"16","author":"Zhang","year":"2023","journal-title":"Psychol Res Behav Manag"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"17470218251365225","DOI":"10.1177\/17470218251365225","article-title":"Sense of agency and ideomotor learning: high dispositional sense of agency is linked to better action-effect learning","volume":"2025","author":"Puech","year":"2006","journal-title":"Q J Exp Psychol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"429","DOI":"10.3390\/ijerph22030429","article-title":"The differentiated roles of resilient behavior and job crafting in interaction with work intensity and their impact on employee health and performance","volume":"22","author":"Voss","year":"2025","journal-title":"Int J Environ Res Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1149367","DOI":"10.3389\/fpubh.2023.1149367","article-title":"The influence of sleep on job satisfaction: examining a serial mediation model of psychological capital and burnout","volume":"11","author":"Opoku","year":"2023","journal-title":"Front Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1089\/jmf.2022.0042","article-title":"The perceived impact of ashwagandha on stress, sleep quality, energy, and mental clarity for college students: qualitative analysis of a double-blind randomized control trial","volume":"25","author":"Baker","year":"2022","journal-title":"J Med Food"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"101122","DOI":"10.1016\/j.bbih.2025.101122","article-title":"Interleukin-6 moderates the relationship between social support, strain, and future depressive symptoms","volume":"49","author":"Aw","year":"2025","journal-title":"Brain Behav Immun Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.jsr.2022.05.004","article-title":"Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature","volume":"82","author":"Albanesi","year":"2022","journal-title":"J Saf Res"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"706","DOI":"10.3390\/healthcare11050706","article-title":"Compassion fatigue and perceived social support among polish nurses","volume":"11","author":"Pergol-Metko","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1097\/HNP.0000000000000637","article-title":"Associations among social jet lag, sleep-related characteristics, and burnout of nurses in tertiary hospitals","volume":"38","author":"Shen","year":"2024","journal-title":"Holist Nurs Pract"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1080\/13607863.2025.2484354","article-title":"Reciprocal relationship between sense of control and social support: a random-intercept cross-lagged panel model","volume":"29","author":"Kim","year":"2025","journal-title":"Aging Ment Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12968\/hmed.2024.1045","article-title":"Prediction model and assessment of work-related musculoskeletal disorders among nurses in tertiary hospitals in China: a cross-sectional study","volume":"86","author":"Yin","year":"2005","journal-title":"Br J Hosp Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"19333","DOI":"10.1038\/s41598-019-55114-w","article-title":"Shift rotation, circadian misalignment and excessive body weight influence psychomotor performance: a prospective and observational study under real life conditions","volume":"9","author":"Rosa","year":"2019","journal-title":"Sci Rep"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"3345","DOI":"10.4103\/jfmpc.jfmpc_158_24","article-title":"Influence of shift work on sleep quality and circadian patterns of heart rate variability among nurses","volume":"13","author":"Panwar","year":"2024","journal-title":"J Family Med Prim Care"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"uiae042","DOI":"10.1093\/joccuh\/uiae042","article-title":"A longitudinal study of rotating shift type and attention performance of acute and critical care nurses with chronotype as moderator variable","volume":"66","author":"Lee","year":"2024","journal-title":"J Occup Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"14705","DOI":"10.1038\/s41598-025-99477-9","article-title":"Mixed adverse ergonomic factors exposure in relation to work-related musculoskeletal disorders: a multicenter cross-sectional study of Chinese medical personnel","volume":"15","author":"Liu","year":"2025","journal-title":"Sci Rep"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"108076","DOI":"10.1016\/j.biopsycho.2021.108076","article-title":"Development and recovery time of mental fatigue and its impact on motor function","volume":"161","author":"Magnuson","year":"2021","journal-title":"Biol Psychol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"893","DOI":"10.2147\/RMHP.S259339","article-title":"Effort-reward imbalance, resilience and perceived organizational support: a moderated mediation model of fatigue in Chinese nurses","volume":"13","author":"Liu","year":"2020","journal-title":"Risk Manag Healthc Policy"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1881980\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:04:40Z","timestamp":1784095480000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1881980\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2026.1881980"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1881980","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"article-number":"1881980"}}