Abstract
BACKGROUND: As a sharp increase in healthcare demand has led to a severe shortage of nurses in aging societies, international nurses become to play a crucial role in supporting healthcare systems. However, they often face immigration-specific stress that may influence their 24-hour movement behaviors, including physical activity, sedentary behavior, and sleep, as key determinants of health. Despite the importance of these behaviors, limited research has examined the complex interrelationships among 24-hour movement behaviors in this population. This study examined the interrelationships among 24-hour movement behaviors of international nurses working in Japanese healthcare organizations using wearable devices and explored the relationship between these behaviors and immigration-specific stress. The findings aim to inform interventions to promote healthier behavioral patterns and enhance patient safety within healthcare organizations. METHODS: A total of 43 international nurses working in Japanese healthcare organizations participated in this study. They wore a Fitbit Charge 5 device for 4 weeks to record their daily 24-hour movement behaviors. Upon completion of the tracking period, participants completed a questionnaire assessing immigration-specific stress. We employed network analysis to investigate the relationship between immigration-specific stress and 24-hour movement behaviors, and temporal network analysis to explore the internal interactions within 24-hour movement behaviors. RESULTS: International nurses exhibited insufficient sleep duration. Network analysis revealed that the 'Not at home' feeling (lack of sense of belonging), 'Occupation' disadvantages (occupational development inequities) and 'Novelty'-related challenges (unfamiliarity with workplace norms and tasks) negatively related to sleep duration. 'Novelty'-related challenges were also negatively related to moderate-to-vigorous physical activity (MVPA). Temporal network analysis further indicated that increased MVPA was beneficial in improving subsequent sleep duration. CONCLUSION: This study highlighted that sleep duration in international nurses may be improved by enhancing their sense of belonging, eliminating occupational development inequities, and coping with novelty-related challenges. Specific measures include developing more inclusive immigration policies, career development opportunities and continuing education to support international nurses. Additionally, physical activity programs, along with support for novelty-related challenges, can promote appropriate levels of MVPA and further improve sleep duration. TRIAL REGISTRATION: Not applicable.