背景：护士常面临不规律工作时间、高强度工作负荷及长期值班等挑战，这些因素会影响其工作表现和身心健康。睡眠时型、睡眠质量和血清同型半胱氨酸（Hcy）等生理因素，以及自我效能和自我复原力等心理资源，会对护士的工作警觉度和工作表现造成影响，进而影响患者安全。现有研究多集中在单一因素的影响，本研究旨在从多个维度探讨护士的个人资源与工作警觉度的综合关系，为个性化健康管理和合理工作安排提供依据。

目的：本研究旨在基于工作要求-资源模型（Job Demands-Resources Model，JD-R）的个人资源部分和前期研究基础，从护士个人生理资源（血清Hcy、睡眠时型、睡眠质量）和心理资源（自我复原力、自我效能和抑郁症状）角度入手，探索其与护士工作警觉度之间的关系。

方法：采用横断面研究设计，于2024年3月至2024年12月便利选取北京市某三级甲等专科医院在岗的病房护士。使用一般资料问卷、简版清晨-夜晚型问卷、匹兹堡睡眠质量指数问卷、Epworth 嗜睡量表、自我复原力量表、一般自我效能感量表、抑郁自评量表等主观量表，抽取静脉血标本检测血清 Hcy 水平、使用精神运动警觉测试仪器（PVT-192）测量客观警觉度水平。采用SPSS 26.0进行数据现状描述、单因素和相关性分析，使用Mplus 8.3软件构建各变量与工作警觉度的关系模型，模型拟合度检验采用Yuan-Bentler校正法。

结果：

1. 研究对象的一般资料：本研究共纳入136名病房护士，以女性护士为主（89.0%），平均年龄35.18 ± 7.38岁，其中白班护士 63 人（46.3%），轮班护士 73 人（53.7%）。

2. 个人资源和工作警觉度水平：个人资源方面，护士的平均血清 Hcy 水平为10.86 ± 3.94 μmol/L，水平异常者占 45.6%；睡眠时型中清晨型和夜晚型分别占比 22.8%和16.2%，睡眠时型和班次不匹配者占11.03%；57.4%的护士睡眠质量较差；自我复原力得分为35.56 ± 8.02分，自我效能得分为25.93 ± 6.15分，抑郁症状得分为39.18 ± 9.43分，8.8%的护士存在抑郁症状。工作警觉度方面，日间嗜睡度平均得分为9.90 ± 6.10分；白班和夜班的平均反应时间分别为283.31 ± 39.90ms和284.10 ± 23.81ms。

3. 不同特征护士的个人资源和工作警觉度差异：对于 Hcy 水平，不同性别、学历的护士其 Hcy 水平差异具有统计学意义：男性护士的 Hcy 水平显著高于女性护士（P = 0.010）；专科学历的护士的 Hcy 水平高于本科护士（P = 0.008）。对于睡眠时型，不同年龄组、子女数、工作年限、职称护士的差异具有统计学意义：年龄越大，睡眠时型得分越高，越偏向清晨型（P < 0.001）；没有孩子的护士的睡眠时型得分低于有孩子的护士（P < 0.001）；工作年限超过 15 年的护士其睡眠时型得分高于不超过 15 年的护士（P < 0.05）；主管护师的得分高于护士和护师（P < 0.05）。对于睡眠质量，年龄 ≤ 35岁的护士其睡眠质量好于年龄 > 45 岁的护士（P = 0.020）；职称为护士的睡眠质量好于较高职称的护士（P < 0.05）；而轮班护士的睡眠质量较白班护士更差（P = 0.033），抑郁症状得分也更高（P = 0.038）。此外，护师的自我效能感明显低于主管护师（P < 0.001）。

工作警觉度方面，不同学历护士的夜班警觉度不同，学历越高，夜班警觉度越好（P < 0.05）；而不同班次类型护士的主客观警觉度差异均不显著（P > 0.05）；不同睡眠时型的警觉度差异主要体现在夜班警觉度，夜晚型的警觉度明显高于另外两型（vs.清晨型，P < 0.001；vs.中间型，P = 0.002）。轮班护士的白班警觉度低于夜班警觉度（P = 0.021），清晨型轮班护士白班的警觉度更高（P = 0.016），夜晚型轮班护士夜班的警觉度更高（P < 0.001），而中间型轮班护士的白夜班警觉度无显著差异。

4. 个人资源与工作警觉度之间的关系：相关性分析和关系模型结果显示，各变量间的相关性仅在轮班护士中成立，Hcy 水平与睡眠质量呈正相关（β = 0.831，P < 0.001）、与自我复原力成负相关（β = -0.246，P = 0.041）；睡眠时型（β = -0.272，P = 0.001）、Hcy 水平（β = -0.415，P = 0.004）和自我效能（β = 0.530，P < 0.001）三者均会对轮班护士的夜班警觉度水平产生影响。

结论：本研究发现，护士的个人资源整体较好，但与工作警觉度的关系主要存在于轮班护士群体中，且主要影响其夜班警觉度。清晨型和夜晚型轮班护士在与其匹配的班次的警觉度水平较高，而是否轮班对白班的警觉度影响不大。睡眠时型、血清 Hcy 水平和自我效能会显著影响轮班护士夜班警觉度水平。建议管理者在排班时考虑护士的睡眠时型，提供灵活的休息时间和引进渐进式轮班制；关注血清Hcy水平，结合饮食、休息和健康教育帮助护士提高工作警觉度；提供心理健康支持，帮助其更好应对轮班工作带来的挑战。

Background: Nurses often face challenges such as irregular working hours, high work intensity, and long shifts, which can negatively affect their job performance and overall health. Physiological factors such as chronotype, sleep quality, and serum homocysteine (Hcy) levels, along with psychological resources such as self-efficacy and resilience, influence nurses' alertness and job performance, which in turn impact patient safety. Most existing studies focus on individual factors, whereas this study aims to explore the comprehensive impact of nurses' personal resources on job alertness from multiple dimensions, providing evidence for personalized health management and optimal work scheduling.

Objective: This study, based on the personal resources part of Job demands-resources (JD-R) model and prior research, aims to explore the relationship of nurses' personal physiological resources (serum Hcy, chronotype, sleep quality), psychological resources (self-resilience, self-efficacy and depressive symptoms) and their job alertness.

Methods: A cross-sectional study design was adopted. From March 2024 to December 2024, on-duty ward nurses from a certain tertiary specialized hospital in Beijing were conveniently selected. Data were collected using subjective questionnaires including a demographic survey, the short version of the Morningness-Eveningness Questionnaire, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Self-Resilience Scale, the General Self-Efficacy Scale, and the Depression Self-Rating Scale. Venous blood samples were drawn to measure serum Hcy levels, and the Psychomotor Vigilance Test (PVT-192) was used to assess objective alertness. Data analysis was performed using SPSS 24.0 for descriptive statistics, one-way ANOVA and correlation analysis, and Mplus 8.3 was used to build a relationship model of variables and job alertness, with the Yuan-Bentler test for model fit.

Results:

1. Demographic Information of Study Participants: This study included 136 ward nurses, predominantly female (89.0%), with a mean age of 35.18 ± 7.38 years. Among them, 63 nurses (46.3%) worked day shifts, while 73 nurses (53.7%) worked rotating shifts.

2. Personal Resources and Alertness Levels: Regarding personal resources, the average serum Hcy level of the nurses was 10.86 ± 3.94 μmol/L, with 45.6% exhibiting abnormal levels. In terms of sleep chronotypes, 22.8% of nurses identified as morning types and 16.2% as evening types, while 11.03% had a sleep chronotype misaligned with their shift schedule. A total of 57.4% of nurses reported poor sleep quality. The mean self-resilience score was 35.56 ± 8.02, self-efficacy score was 25.93 ± 6.15, and depression symptoms score was 39.18 ± 9.43, with 8.8% of nurses exhibiting depressive symptoms. Regarding alertness, the mean daytime sleepiness score was 9.90 ± 6.10, and the mean response time for day shift and night shift nurses was 283.31 ± 39.90 ms and 284.10 ± 23.81 ms, respectively.

3. Differences in Personal Resources and Alertness Based on Nurse Characteristics: Regarding the Hcy level, the differences in Hcy levels among nurses of different genders and educational backgrounds were statistically significant: the Hcy level of male nurses was significantly higher than that of female nurses (P = 0.010); the Hcy level of nurses with an associate degree was higher than that of nurses with a bachelor's degree (P = 0.008). For the chronotype score, the differences among nurses of different age groups, the number of children, years of working experience, and professional titles were statistically significant: the older the age, the higher the score of the sleep pattern, and the more inclined it was to the morning pattern (P< 0.001); the sleep pattern score of nurses without children was lower than that of nurses with children (P<0.001); nurses with more than 15 years of working experience had higher sleep pattern scores than those with no more than 15 years of working experience (P<0.05); the score of the head nurse was higher than that of the nurse and the head nurse (P<0.05). Regarding sleep quality, nurses aged ≤ 35 years old have better sleep quality than their age. A 45-year-old nurse (P = 0.020); the sleep quality of nurses with a professional title is better than that of nurses with a higher professional title (P<0.05); rotating shift nurses had significantly poorer sleep quality (P = 0.033) and higher depression scores (P = 0.038) than day shift nurses. Furthermore, the self-efficacy of the nurses was significantly lower than that of the supervisor nurses. (P = 0.001).

In terms of alertness, night shift alertness differed by educational level, with higher education being associated with better night shift alertness (P < 0.05). However, there were no significant differences in alertness between nurses with different shift types (P > 0.05). Differences in alertness across sleep chronotypes were most notable during night shifts, with evening-type nurses exhibiting significantly higher alertness than morning-type (P < 0.001) and intermediate-type nurses (P = 0.002). Rotating shift nurses exhibited lower alertness on day shifts compared to night shifts (P = 0.021). Morning-type rotating shift nurses had higher day shift alertness (P = 0.016), while evening-type rotating shift nurses had higher night shift alertness (P < 0.001), with no significant differences in alertness between day and night shifts for intermediate-type nurses.

4. Relationship Between Personal Resources and Alertness: Correlation analysis and structural equation modeling results revealed that significant correlations existed only among rotating shift nurses. Hcy levels were positively correlated with sleep quality (β = 0.831, P < 0.001) and negatively correlated with self-resilience (β = -0.246, P = 0.041). Sleep chronotype (β = -0.272, P = 0.001), Hcy levels (β = -0.415, P = 0.004), and self-efficacy (β = 0.530, P < 0.001) all influenced the night shift alertness level of rotating shift nurses.

Conclusion: This study found that nurses' personal resources were generally adequate, but their impact on alertness was primarily observed among rotating shift nurses, particularly influencing night shift alertness. Morning-type and evening-type rotating shift nurses exhibited higher alertness levels during their corresponding shifts, while shift type had little effect on day shift alertness. Sleep chronotype, serum Hcy levels, and self-efficacy all influenced the night shift alertness level of rotating shift nurses. It is recommended that managers consider nurses' sleep chronotypes when creating schedules, offer flexible rest periods, and implement progressive shift systems. Additionally, attention should be given to serum Hcy levels, and strategies involving diet, rest, and health education can help improve nurses' work alertness. Psychological health support should also be provided to help nurses better cope with the challenges posed by shift work.