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write a maximum of 3 double spaced typed pages, notincluding title page and references. APA style Your paper is not a summary of the article. You must include your own ideas and thefollowing information in your paper.1. Introduction: Must include a description and background of the topic and purpose of your paper.2. Explain why this is an important topic in nursing. How has it impacted the profession?3. What are some suggestions made in the article to address this issue?4. Explain what you believe is a good solution to address this issue and why?5. Conclusions: An overall analysis of the significance of your findings. Not just a summayonly from the article I attched
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Res Dev Med Educ, 2021, 10, 16
doi: 10.34172/rdme.2021.016
TUOMS
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https://rdme.tbzmed.ac.ir
Original Research
Academic burnout among undergraduate nursing students: Predicting
the role of sleep quality and healthy lifestyle
ID
ID
ID
Habibolah Naderi1 , Hamidreza Dehghan2* , Shahrbanoo Dehrouyeh3 , Elaheh Tajik4
ID
Department of Psychology, Faculty of Humanities and Social Sciences, The University of Mazandaran,Babolsar, Iran
Department of Educational Psychology, Faculty of Humanities and Social Sciences, The University of Mazandaran,
Babolsar, Iran
3
Department of Educational Psychology, Adib Institute of Higher Education, Mazandaran, Iran
4
Department of Clinical Psychology majoring in Family Therapy, The University of Science and Culture, Tehran, Iran
1
2
Article info
Article History:
Received: 1 January 2021
Accepted: 10 July 2021
epublished: 28 July 2021
Keywords:
Burnout
Nursing Students
Sleep Quality
Lifestyle
Abstract
Background: Academic burnout is a serious threat that can affect any student’s academic life,
especially nursing students. Sleep quality and a healthy lifestyle are variables are related to
academic burnout. This study aimed to predict undergraduate nursing students’ academic
burnout based on sleep quality and lifestyle.
Methods: The study was descriptive and correlational in design. The statistical population
included all undergraduate nursing students of the Razi School of Nursing and Midwifery at
the Kerman University of Medical Sciences (Kerman, Iran; 2016-2017 academic year). Of 270
students,143 students were selected using a random cluster sampling method. The Academic
Burnout Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the LifeStyle Inventory
were used to collect data. A linear regression analysis using the enter method was employed
for data analysis.
Results: There was a significantly positive correlation between students’ academic burnout and
total PSQI score (P = 0.000, r = 0.547) and some of its sub-scales, including subjective sleep
quality (P = 0.000, r = 0.607), sleep latency (P = 0.019, r = 0.196), sleep duration (P = 0.014,
r = 0.206), sleep disturbance (P = 0.000, r = 0.346), and daytime dysfunction due to sleepiness
(P = 0.000, r = 0.654). Conversely, the relationship between students’ academic burnout
and healthy lifestyle was negatively significant (P = 0.000, r = -0.507). Thus, the potential for
undergraduate nursing students’ academic burnout can be predicted by sleep quality and
lifestyle (P = 0.000, F = 23.480).
Conclusions: By improving sleep quality and living a healthier lifestyle, students may be less
likely to experience academic burnout.
Introduction
Historically, most studies around the concept of “burnout”
have been conducted in work-related backgrounds.1
However, this concept has recently been extended to
academic contexts as “academic burnout”.1-2 Academic
burnout is characterized as a type of negative attitude
or behavior towards education.3 Academic burnout is
caused by anxiety and decreases the amount of energy
and concentration available for cognitive tasks related to
training4. It manifests itself through feelings of exhaustion
due to academic demands (emotional exhaustion),
having a cynical and detached attitude towards academic
demands (cynicism) and feeling incompetent as a student
(inefficiency).5-6 Generally, students working in healthrelated fields, particularly nursing students, are the most
vulnerable to academic burnout.3-7 One study showed that
approximately 40% of nursing students had experienced
academic burnout.8 Another study found a high rate of
academic burnout among students, where 23.5%, 16.7%,
and 17.9% had high levels of emotional exhaustion,
cynicism, and reduced academic efficacy, respectively.9
Depressed mood, behavioral problems, and academic
failures are the most common consequences of academic
burnout.10 Most victims of academic burnout feel little
desire for academic achievement and experience a high
inclination towards classroom absence and dropping out
as well.11
With respect to the literature, sleep quality is closely
associated to many students’ problems, in both health
or academic contexts.12 Increased health concerns,
*Corresponding author: Hamidreza Dehghan, Email: hamiddehghan313@umz.ac.ir
© 2021 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, as long as the original
authors and source are cited. No permission is required from the authors or the publishers.
Naderi et al
irritability, chronic fatigue, attention problems, depressed
mood, unsatisfactory academic progress, and academic
failures are prevalent among students with sleep
disorders.12 Moreover, many studies have indicated a
direct relationship between academic burnout and sleep
quality.13-14 In one study, it was found that exhaustion as a
component of academic burnout is significantly correlated
to poor sleep quality, disengagement (composed of
cynicism and inefficacy), and daytime dysfunction due
to sleepless.15 Another study also indicated a positive
correlation between academic burnout and sleep quality.1
Gruber et al. found that participation in a sleep education
program yielded improvements in academic performance
and sleep quality.16
In addition to the undeniable relationship between sleep
quality and academic burnout, a healthy lifestyle appears
to be necessary to attain good sleep. A healthy lifestyle,
in general, requires a well-balanced diet, regular physical
activity, and the smoking cessation.17 Based on the
research, those who maximize healthy lifestyle behaviors
reduce the risk of dangerous and chronic diseases such
as cardiovascular disease, stroke, diabetes, and various
kinds of fatal cancers.18 While there is supposed to be
an increase in students’ knowledge of healthy lifestyle
behaviors during academic life, there is a general lack of
health-promoting or disease-prevention behaviors among
nursing students.13 This means that nursing students do
not always adhere to health-promoting lifestyles19 at a
rate one might expect based on their education. This
negligence in adopting health-promoting lifestyles can
be associated with several consequent problems: anxiety,
gastrointestinal upset, headache, insomnia,20 daytime
sleepiness, and morning tiredness.21
Although some studies have investigated the relationship
between sleep quality and lifestyle with burnout, those
studies have mainly focused on employed/graduated
nurses rather than undergraduate students; and instead
of academic burnout, they have been conducted around
employment burnout. In contrast, fewer studies have
been conducted with undergraduate nursing students.
Therefore, this study helps address a paucity of research
among undergraduate nursing students, since academic
burnout in undergraduate nursing students can harm the
students’ mental health in various ways and pave the way
for future job burnout. Hence, this study aimed to predict
undergraduate nursing students’ academic burnout based
on sleep quality and lifestyle.
Material and Methods
This study used a descriptive and correlational design.
The statistical population included all undergraduate
nursing students of the Razi School of Nursing and
Midwifery at the Kerman University of Medical Sciences
(Kerman, Iran; 2016-2017 academic year). Of a total of
250 students, 165 students (10% more than the suggested
sample size) were identified as participants. The sample
2
Res Dev Med Educ, 2021, 10, 16
size was calculated using Krejcie and Morgan’s samplesize table (confidence = 95%, margine of error = 0.05%);
sampling was performed using a random cluster sampling
method. For sampling, each of 10 available classrooms
was considered a cluster. In each cluster, students
were invited to participate in the research. The study
instruments were then randomly delivered to over 50%
of interested students. After collecting the completed
instruments, 12 incomplete questionnaires were excluded
from the analysis. Data analysis was performed with 143
participants in all. A linear regression analysis using the
enter method also employed for data analysis. Criteria for
entering the research were: being a nursing student; no
history of known psychiatric disorders; and filling out an
informed consent form. To observe ethical considerations,
participation in the study was completely optional, and
participants were free to leave at any time. As mentioned,
informed consent was obtained from participants, and no
names were collected and the instruments were coded to
ensure that the participants were not identified and could
answer freely. The study was registered with and approved
by the Research Ethics Committees of the University of
Mazandaran (Approval ID: IR.UMZ.REC.1400.007).
Measures
Academic Burnout Questionnaire
This questionnaire was developed by Breso et al. (1997)
to measure academic burnout using a 5-point Likert
scale. The questionnaire has three subscales: academic
exhaustion (5 items; score range: 5 to 25), cynicism (4
items; score range: 4 to 20), and academic inefficiency
(6 items; score range: 6 to 30). It has 15 total items, and
the total possible score ranges from 15 and 75.6 The
reliability of the original version of the questionnaire has
been estimated at 70%, 82%, and 75% for the academic
exhaustion, cynicism, and academic inefficiency subscales,
respectively.1 The reliability of the Persian version of
the questionnaire (calculated using Cronbach’s alpha) is
also reported to be 0.70, 0.82, and 0.75 for exhaustion,
cynicism, and inefficiency subscales, respectively.22 Azizi
Abargooi reported the total reliability of the questionnaire
as 0.87.23 In one study, Naami assessed the validity of this
instrument by calculating the correlation coefficients of
the instrument with the Student Stress Questionnaire.24
The obtained values were 0.79, 0.82, and 0.75 for academic
exhaustion, cynicism, and academic inefficiency,
respectively. The internal consistency method was used
to calculate the instrument’s reliability in this study.
Cronbach’s alpha for the total score was 0.81, and its
subscales, i.e., exhaustion, cynicism, and inefficiency,
were 0.75, 0.85, and 0.85, respectively.
Pittsburgh Sleep Quality Index (PSQI):
This instrument contains 19 self-reported items combined
to form seven component scores. The focus of each item
is on the person’s sleep quality over the last month. Each
Academic burnout among undergraduate nursing students
item is scored on a 4-point Likert scale (from 0 to 3, with
0 representing no difficulty and 3 representing severe
difficulty), and the total possible score ranges from 0 to
21. The higher scores indicate inferior sleep quality, and
a total score of over five is associated with poor sleep
quality.23 Subjective sleep quality, sleep latency, sleep
duration, sleep efficiency, sleep disturbance, use of sleep
medication, and daytime dysfunction due to sleepiness are
the seven components of the instrument.25 The reliability
and validity of the instrument were verified via a registered
study conducted at Tehran Institute of Psychiatry.26 In that
study, the calculated reliability was equal to 0.83, and the
calculated validity was between 0.86 and 0.89. In addition,
Mohammad Gholi Mezerji et al employed a panel of nine
experts in psychology and health education to assess
the validity of the instrument.27 They observed excellent
values for the Item Content Validity Index (≥0.78) and
the Scale Content Validity Index (≥0.90) in their study.
In the current study, the reliability of the instrument
was calculated by the internal consistency method. The
obtained values of Cronbach’s alpha coefficient for all the
subscales were in an acceptable range (from 0.71 to 0.94).
Lifestyle Inventory
This instrument was constructed by Miller and Smith and
consists of 20 items.28 On a 5-point Likert scale, respondents
are required to rate the frequency with which they adopt
20 positively stated lifestyle habits.29 A higher score is
indicative of a healthier lifestyle.30 The manufacturers
have used Cronbach’s alpha and test-retest for assessing
reliability and have reported the corresponding values as
0.77 and 0.75, respectively.31 This instrument has good
psychometric properties in Iranian studies. For instance,
the test-retest reliability of the instrument has been
reported as 0.86. 31-32 A group of faculty members from the
School of Nursing and Midwifery of Khorasgan University
approved the face and content validity of the instrument.31
The reliability of the instrument was calculated in the
current study (using the internal consistency method),
and Cronbach’s alpha was equal to 0.81.
Results
A total of 143 undergraduate nursing students participated
in this study. Of these, 91 (63.6%) were female and 52
(36.4%) were male. Twenty (14%) were freshmen, 28
(20%) were sophomores, 39 (27%) were juniors, and 56
(39%) were seniors. Sixty (42%) lived in dormitories and
83 (58%) lived at home with their parents. A majority of
students (86; 60%) had poor sleep quality, defined as a
total PSQI score over 5. The mean age of the students was
22.85±2.4 years. Table 1 shows the descriptive statistics of
the variables of the study.
Pearson’s correlation was used to explore the relationship
between the variables. Before that, the assumptions of the
test were met. The output of the Kolmogorov-Smirnov test
permitted the application of parametric tests (significant
at p>0.05).
As Table 2 shows, while there was a significant positive
correlation between students’ academic burnout and
total PSQI score (P = 0.000, r = 0.547) and some of the
sub-scales, including subjective sleep quality (p = 0.000,
r = 0.607), sleep latency (P = 0.019, r = 0.196), sleep
duration (P = 0.014, r = 0.206), sleep disturbance (P = 0.000,
r = 0.346) and daytime dysfunction due to sleepiness
(P = 0.000, r = 0.654), the relationship between students’
academic burnout and healthy lifestyle was negatively
significant (P = 0.000, r = -0.507). Meanwhile, the obtained
correlation between students’ academic burnout and
variables such as sleep efficiency (P = 0.657, r = 0.037)
and use of sleep medication (P = 0.094, r = 0.141) was not
significant. To predict students’ academic burnout based
on sleep quality and lifestyle, a linear regression analysis
(via the eEnter method) was employed.
As Table 3 shows, the regression model is statistically
Table 1. Descriptive statistics (N = 143)
Variables
Sub-Scales
Mean
Sleep quality
Subjective sleep quality
Sleep latency
Healthy lifestyle
Academic burnout
SD
Min
Max
1.02
0.9
0
3
0.85
0.87
0
3
Sleep duration
1.54
0.93
0
3
Sleep efficiency
0.16
0.36
0
1
Sleep disturbance
1.27
0.88
0
3
Use of sleep medication
0.36
0.56
0
2
Day dysfunction due to Sleepiness
0.77
0.97
0
3
Total PSQI score
5.97
3.55
1
16
Healthy lifestyle
58.92
10.97
35
88
Exhaution
11.02
2.98
5
17
Cynicism
6.38
2.13
4
14
Inefficiecy
10.59
3.25
6
18
Total academic burnout
27.87
5.56
17
40
Res Dev Med Educ, 2021, 10, 16
3
Naderi et al
significant (P = 0.000, F = 23.480), meaning that some
predictor variables can predict academic burnout among
participants.
As can be seen from Table 4, subjective sleep
quality(P = 0.001, β = 0.289), sleep disturbance (P = 0.001,
β = 0.260), daytime dysfunction due to sleepiness
(P = 0.001, β = 0.423) and healthy lifestyle (P = 0.041,
β = -0.145) significantly predicted nursing students’
academic burnout. These variables accounted for 58% of
academic burnout variance (see Table 3).
burnout. This raises a question: how does academic
burnout in undergraduate nursing students relate to poor
sleep quality? It is likely that a major part of the answer
lies in the nature of the nursing field itself. Nursing
students, unlike students in many other fields, experience
specific stressful situations such as a busy academic life,
standing for extended periods of times during training,
working night shifts, observing patients’ pain and trauma,
and so forth, which can impose a great deal of stress on
these students.33 High levels of stress can interrupt the
process of normal sleep and lead to sleep deprivation34,35.
Undoubtedly, students with inadequate sleep or poor
sleep quality cannot concentrate as well on their lessons
or learn them properly.35 Moreover, if sleep problem
becomes persistent, accumulation of chronic stress
overwhelms students, leading them to academic stress35
and eventually to academic burnout.35-36 Additionally,
since nursing students undergo unwanted changes in their
sleep habits, accumulation of sleeplessness combined with
insupportable stress does not let them easily get rid of
academic burnout.15
In line with some previous studies, the current study
also showed a negative relationship between students’
academic burnout and a healthy lifestyle,13-19,37 meaning
that having a healthy lifestyle is associated with a lower
rate of academic burnout.13-19,38 As mentioned earlier,
contrary to common belief, increasing nursing students’
awareness of healthy lifestyle habits during formal
education does not necessarily lead to their adherence
to a healthy lifestyle.19 Many nursing students reported
insufficient sleep, poor eating habits, and no regular
exercise.13 However, those students who are able adhere to
public health recommendations or who spend their spare
time doing activities that are part of a healthy lifestyle
tend to have lower academic burnout scores.36 Due to
the inverse relationship between a healthier lifestyle and
academic burnout, it can be maintained that a healthy
Discussion
This study was conducted to ascertain the ability to predict
undergraduate nursing students’ academic burnout based
on sleep quality and healthiness of lifestyle. The study
showed a significant positive correlation between students’
academic burnout and sleep quality. Because a higher
score in the PSQI indicates more significant problems
with sleep quality, it can be assumed that students who
had poor sleep quality also had higher levels of academic
Table 2. Pearson’s correlation for academic burnout, sleep quality,
and healthy lifestyle
Academic burnout
Variables
Correlation
coefficient
Significance
Subjective sleep quality
0.607
0.000
Sleep latency
0.196
0.019
Sleep duration
0.206
0.014
Sleep efficiency
0.037
0.657
Sleep disturbance
0.346
0.001
Use of sleep medication
0.141
0.094
Day dysfunction due to sleepiness
0.654
0.000
Total PSQI score
0.547
0.000
Healthy lifestyle
-0.507
0.000
Table 3. Regression model summarhy for predicting academic burnout based on sleep quality and lifestyle
Model
Regression
R
R-Square
Adjusted R-Square
Standard Error
F
Significance
0.764
0.584
0.559
3.696
23.480
0.000
Table 4. Regression coefficients of academic burnout based on sleep quality and lifestyle
B
Standard Error
27.620
2.502
Subjective sleep quality
1.786
0.501
Sleep latency
-0.226
0.533
Sleep duration
-0.428
0.424
Sleep efficiency
-0.947
1.087
Sleep disturbance
1.642
0.360
Use of sleep medication
-0.539
0.664
Day dysfunction due to sleepiness
2.410
0.458
Healthy lifestyle
-0.073
0.036
Constant
4
Res Dev Med Educ, 2021, 10, 16
Beta
T
Significance
11.040
0.001
0.289
3.564
0.001
-0.036
-0.425
0.672
-0.072
-1.010
0.314
-0.063
-0.871
0.385
0.260
4.565
0.001
-0.054
-0.812
0.418
0.423
5.261
0.001
-0.145
-2.062
0.041
Academic burnout among undergraduate nursing students
lifestyle is no more than some simple habits such as
regular physical activity, strength training, fruit and
vegetable consumption, and good sleep quality.36 These
simple habits can affect students’ academic burnout in
different ways: physical activities can enhance students’
executive function,37 shield them from conditions such as
depression, anxiety, and burnout, reduce their academic
stress, and consequently protect them from academic
burnout.39 Enhancement of sleep quality can improve
students’ academic performance via increasing vigilance,
concentrating their attention, and improving their mental
readiness.16 Taking a good nutritional regimen into
consideration as a critical factor of any healthy lifestyle
can substantially influence both the development and
health of the brain and its function. As a part of every
healthy lifestyle, a good nutritional regimen is critical for
improved cognition and academic performance because it
provides good building blocks for the brain to create and
maintain connections.40
Strengths and limitation
One of the most significant strengths of this study was
that it demonstrated that academic burnout, which is one
of the most important factors affecting nursing students’
current and future performance, can be reduced. This goal
can be accomplished by providing students with training
on prioritizing quality sleep and adopting healthier
lifestyles. The most critical limitation of this study was the
lack of segregation between male and female students and
between freshmen, sophomores, juniors, and seniors in
the analysis. Future studies may be indicated to see if there
are gender differences or if class level makes a difference.
Conclusion
The findings of the study indicated that sleep quality and
a healthier lifestyle can predict undergraduate nursing
students’ academic burnout. By improving sleep quality
and living a healthier lifestyle, students are less likely to
experience academic burnout.
Competing interests
There is no conflict of interest between the authors and the
current study.
Ethical approval
To observe ethical considerations, participation in the study
was completely voluntary, and the participants could withdraw
from the study at any time. As mentioned, informed consent was
obtained from participants, and the instruments contained no
personally identifiable information and were coded to ensure
that the participants answered voluntarily and freely. The study
was registered and approved by the Research Ethics Committees
of the University of Mazandaran (Approval ID: IR.UMZ.
REC.1400.007).
Author Contributions
All authors have participated in the current study: Habibollah
Naderi and Hamidreza Dehghan participated in choosing
the research topic. Hamidreza Dehghan participated in data
collection, Ms. Shahrbanoo Dehrouyeh participated in data
analysis, and Ms. Elaheh Tajik and other authors contributed
to the article, and Hamidreza Dehghan was responsible for
answering the judgments.
Acknowledgments
We would like to express our appreciation to all the nursing
students who participated in this study.
References
1. Arbabisarjou A, Hashemi SM, Sharif MR, Haji Alizadeh
K, Yarmohammadzadeh P, Feyzollahi Z. The relationship
between sleep quality and social intimacy, and academic
burn-out in students of medical sciences. Glob J Health Sci.
2015;8(5):231-8. doi: 10.5539/gjhs.v8n5p231.
2. Kong LN, Yang L, Pan YN, Chen SZ. Proactive personality,
professional self-efficacy and academic burnout in
undergraduate nursing students in China. J Prof Nurs.
2021;37(4):690-5. doi: 10.1016/j.profnurs.2021.04.003.
3. Wang J, Bu L, Li Y, Song J, Li N. The mediating effect of
academic engagement between psychological capital and
academic burnout among nursing students during the
COVID-19 pandemic: a cross-sectional study. Nurse Educ
Today. 2021;102:104938. doi: 10.1016/j.nedt.2021.104938.
4. Kamalpour S, Azizzadeh Forouzi M, Targary B. Relationship
between academic burnout and achievement in nursing
students. J Prevent Med. 2019;6(2):67-74. doi: 10.29252/
jpm.6.2.8. [Persian].
5. Adler-Milstein J, Zhao W, Willard-Grace R, Knox M,
Grumbach K. Electronic health records and burnout:
time spent on the electronic health record after hours and
message volume associated with exhaustion but not with
cynicism among primary care clinicians. J Am Med Inform
Assoc. 2020;27(4):531-8. doi: 10.1093/jamia/ocz220.
6. Bresó E, Salanova M, Schaufeli WB. In search of the “third
dimension” of burnout: efficacy or inefficacy? Appl Psychol.
2007;56(3):460-78. doi: 10.1111/j.1464-0597.2007.00290.x.
7. Li ZS, Hasson F. Resilience, stress, and psychological wellbeing in nursing students: a systematic review. Nurse Educ
Today. 2020;90:104440. doi: 10.1016/j.nedt.2020.104440.
8. Li CQ, Ma Q, Liu YY, Jing KJ. Are parental rearing
patterns and learning burnout correlated with empathy
amongst undergraduate nursing students? Int J Nurs Sci.
2018;5(4):409-13. doi: 10.1016/j.ijnss.2018.07.005.
9. Obekpa IO, Amedu MA, Udofia O. Prevalence and pattern
of burnout syndrome and associated quality of life amongst
undergraduates of a tertiary institution in Northern Nigeria.
J Epidemiol Soc Niger. 2020;3(1):39-51. doi: 10.46912/
jeson.6.
10. Madigan DJ, Curran T. Does burnout affect academic
achievement? a meta-analysis of over 100,000 students.
Educ Psychol Rev. 2021;33(2):387-405. doi: 10.1007/
s10648-020-09533-1.
11. Jung YM. Nursing students’ career identity, satisfaction
with major, and career stress by career decision type. Jpn J
Nurs Sci. 2020;17(1):e12281. doi: 10.1111/jjns.12281.
12. Williams AB, Dzierzewski JM, Griffin SC, Lind MJ, Dick D,
Rybarczyk BD. Insomnia disorder and behaviorally induced
insufficient sleep syndrome: prevalence and relationship
to depression in college students. Behav Sleep Med.
Res Dev Med Educ, 2021, 10, 16
5
Naderi et al
2020;18(2):275-86. doi: 10.1080/15402002.2019.1578772.
13. May RW, Bauer KN, Seibert GS, Jaurequi ME, Fincham
FD. School burnout is related to sleep quality and
perseverative cognition regulation at bedtime in young
adults. Learn Individ Differ. 2020;78:101821. doi: 10.1016/j.
lindif.2020.101821.
14. Allen HK, Barrall AL, Vincent KB, Arria AM. Stress and
burnout among graduate students: moderation by sleep
duration and quality. Int J Behav Med. 2021;28(1):21-8. doi:
10.1007/s12529-020-09867-8.
15. Shad R, Thawani R, Goel A. Burnout and sleep quality: a
cross-sectional questionnaire-based study of medical and
non-medical students in India. Cureus. 2015;7(10):e361.
doi: 10.7759/cureus.361.
16. Gruber R, Somerville G, Bergmame L, Fontil L, Paquin S.
School-based sleep education program improves sleep and
academic performance of school-age children. Sleep Med.
2016;21:93-100. doi: 10.1016/j.sleep.2016.01.012.
17. Abulmeaty MMA. Multimodal-lifestyle intervention
produces reduction of the fat mass rather than body
weight loss in men with obesity: a prospective cohort
study. Nutr Clin Metab. 2016;30(2):163-71. doi: 10.1016/j.
nupar.2016.04.001.
18. Ford ES, Bergmann MM, Boeing H, Li C, Capewell S.
Healthy lifestyle behaviors and all-cause mortality among
adults in the United States. Prev Med. 2012;55(1):23-7. doi:
10.1016/j.ypmed.2012.04.016.
19. Tsai YC, Liu CH. An eHealth education intervention to
promote healthy lifestyles among nurses. Nurs Outlook.
2015;63(3):245-54. doi: 10.1016/j.outlook.2014.11.005.
20. Bastani P, Nobakht S, Yusefi AR, Radin Manesh M, Sadeghi
A. Students’ health promoting behaviors: a case study at
Shiraz University of Medical Sciences. Shiraz E-Med J.
2018;19(5):e63695. doi: 10.5812/semj.63695.
21. Ross A, Bevans M, Brooks AT, Gibbons S, Wallen GR.
Nurses and health-promoting behaviors: knowledge may
not translate into self-care. AORN J. 2017;105(3):267-75.
doi: 10.1016/j.aorn.2016.12.018.
22. Naami A. Relationship between quality of learning
experiences and academic burnout in graduate students of
Shahid Chamran University. Psychol Stud. 2009;5(3):11734. [Persian].
23. Azizi Abargouei M. The Relationship Between Self-Efficacy
and Quality of Learning Experiences and Academic
Burnout in Tehran Allameh Tabataba’i Graduate Students
[thesis]. Tehran: Faculty of Education and Psychology,
Allameh Tabataba’i University; 2010. [Persian].
24. Naami A. The Relationship Between Quality of Learning
Experience with Academic Burnout Among MA students
of Shahid Chamran University of Ahvaz. Ahvaz, Iran:
Shahid Chamran University of Ahvaz; 2009. [Persian].
25. Seyedi Chegeni P, Gholami M, Azargoon A, Hossein Pour
AH, Birjandi M, Norollahi H. The effect of progressive
muscle relaxation on the management of fatigue and
quality of sleep in patients with chronic obstructive
pulmonary disease: a randomized controlled clinical trial.
Complement Ther Clin Pract. 2018;31:64-70. doi: 10.1016/j.
ctcp.2018.01.010.
26. Farhadi Nasab A, Azimi H. Study of patterns and subjective
quality of sleep and their correlation with personality traits
among medical students of Hamadan University of Medical
Sciences. Avicenna J Clin Med. 2008;15(1):11-5. [Persian].
6
Res Dev Med Educ, 2021, 10, 16
27. Mohammad Gholi Mezerji N, Naseri P, Omraninezhad
Z, Shayan Z. The reliability and validity of the Persian
version of Pittsburgh sleep quality index in Iranian people.
Avicenna J Neuro Psycho Physiology. 2017;4(3):95-102.
doi: 10.32598/ajnpp.4.3.95.
28. Abedini Baltork M, Mir Shamsi FS. Correlation between
resilience and mental health with lifestyle and parenting
styles of veterans’ spouses a case study of Ardakan city.
Iran J War Public Health. 2019;11(3):161-7. doi: 10.29252/
ijwph.11.3.161. [Persian].
29. Kalkbrenner MT, Gormley B. Development and initial
validation of scores on the Lifestyle Practices and Health
Consciousness Inventory (LPHCI). Meas Eval Couns Dev.
2020;53(4):219-37. doi: 10.1080/07481756.2020.1722703.
30. Gomaa WS, Mohamed HA, Morad AH. Assessment lifestyle
for patients with chronic obstructive pulmonary disease.
Egypt J Health Care. 2020;11(2):273-85. doi: 10.21608/
ejhc.2020.106957.
31. Kosravizad M. Survey the relation between life-style related
to nutritional behaviour and severity of chronic renal
railure in Shiraz MRI hospital at 2013. Nursing Journal of
the Vulnerable. 2015;2(2):49-59. [Persian].
32. Miller LH, Smith AD. The Miller-Smith Lifestyle
Assessment Inventory. Brookline: Biobehavioral Associates;
1988.
33. Ahmadidastjerdi H, Kejbaf MB, Kazemi H.
The
effectiveness of group training of Islamic meditation model
on lifestyle and generalized anxiety in married women with
generalized anxiety disorder. Biquarterly Journal of Studies
in Islam & Psychology. 2016;10(19):75-82. [Persian].
34. Dobrowolska B, Zec A, Tosoratti J, Machul M, Pokorná A,
Nascimento C, et al. Night shifts as a learning experience
among nursing students across Europe: findings from a
cross-sectional survey. Nurse Educ Today. 2020;90:104441.
doi: 10.1016/j.nedt.2020.104441.
35. Zhang Y, Chernaik M, Hallet K. Relationship issues
among college nursing students: associations with stress,
coping, sleep, and mental disorders. Teach Learn Nurs.
2017;12(4):246-52. doi: 10.1016/j.teln.2017.06.005.
36. Lee KP, Yeung N, Wong C, Yip B, Luk LHF, Wong S.
Prevalence of medical students’ burnout and its associated
demographics and lifestyle factors in Hong Kong. PLoS One.
2020;15(7):e0235154. doi: 10.1371/journal.pone.0235154.
37. Wald A, Muennig PA, O’Connell KA, Garber CE.
Associations between healthy lifestyle behaviors and
academic performance in U.S. undergraduates: a secondary
analysis of the American College Health Association’s
National College Health Assessment II. Am J Health
Promot. 2014;28(5):298-305. doi: 10.4278/ajhp.120518QUAN-265.
38. Howie EK, Pate RR. Physical activity and academic
achievement in children: a historical perspective. J Sport
Health Sci. 2012;1(3):160-9. doi: 10.1016/j.jshs.2012.09.003.
39. Lindwall M, Gerber M, Jonsdottir IH, Börjesson M,
Ahlborg G, Jr. The relationships of change in physical
activity with change in depression, anxiety, and burnout: a
longitudinal study of Swedish healthcare workers. Health
Psychol. 2014;33(11):1309-18. doi: 10.1037/a0034402.
40. Burkhalter TM, Hillman CH. A narrative review of physical
activity, nutrition, and obesity to cognition and scholastic
performance across the human lifespan. Adv Nutr.
2011;2(2):201S-6S. doi: 10.3945/an.111.000331.
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