Digital health interventions for promoting physical activity among adolescents: a systematic review.

Nightshift nurses are nursing staff who work night shifts in healthcare institutions. Compared to dayshift nurses, nightshift nurses experience both poorer sleep quality and higher levels of occupational stress (). Long-term night shift work results in a reduction in sleep duration of approximately 3.5%, manifested as prolonged sleep onset latency, reduced sleep efficiency, and increased nighttime sleep fluctuations (). In addition, nightshift nurses suffer from high psychological demands, heavy workloads, and low perceived workplace fairness, making them more susceptible to occupational burnout and psychological distress, including anxiety and depression. These factors severely impair their physical and mental health as well as the quality of their work (, ). A systematic review and meta-analysis (2023) () has confirmed a significant association between nightshift work and the incidence of depression among nurses. These compounding impairments—sleep disturbances, elevated stress, and psychological deterioration—highlight an urgent need for effective intervention strategies targeting this population. Pharmacological treatment has traditionally been the first-line option for the clinical management of sleep disorders, yet it has inherent limitations among nightshift nurses. Long-term medication use carries risks of dependence and withdrawal, and the efficacy of melatonin supplements varies among nurses with different shift schedules. Moreover, pharmacological treatment targets only the symptoms, without addressing the root causes of occupational stress, such as an excessively high nurse-to-patient ratio, emotional labor, and irregular shift schedules (). These limitations have prompted researchers and clinical administrators to turn their attention to non-pharmacological alternatives. In recent years, a wide range of non-pharmacological interventions for nightshift nurses have emerged, which can be classified into five major categories: light therapy [bright light exposure (BLE) and wearable light devices (WLD)], cognitive behavioral therapy (CBT), mindfulness interventions (mindfulness-based stress reduction and mindfulness training), traditional Chinese medicine (TCM) [auricular plaster therapy (APT) and acupressure], and aromatherapy (essential oil inhalation). Several systematic reviews (–) have demonstrated that these interventions have a certain beneficial effect on sleep and stress, but the reported efficacy varies significantly across studies. Light therapy showed significant effects in some trials, but the illuminance and light doses were not standardized. While CBT has proven effective in dayshift workers, its efficacy in shift workers remains questionable due to irregular sleep-wake patterns that hinder the implementation of key therapeutic components. Mindfulness interventions exhibit high heterogeneity in effect sizes. TCM therapies showed positive results in a single trial but lack cross-cultural replication. Studies on aromatherapy lack standardized protocols and have low methodological quality. Although the aforementioned reviews have made important contributions, there remain critical gaps in the existing evidence base. First, most reviews included heterogeneous shift-work populations, with few focusing specifically on nurses (). Second, there was considerable inconsistency in the measurement tools used across studies [the Pittsburgh Sleep Quality Index (PSQI), actigraphy, and interchangeable use of self-developed scales], severely compromising comparability across studies (). Third, the most critical gap is that existing reviews are limited to paired comparisons of a single intervention versus standard care and have failed to compare and rank multiple non-pharmacological interventions. No study has yet assessed the comparative efficacy of the five categories of interventions on sleep and psychological outcomes within a unified framework (). Fourth, the lack of formal comparisons between culture-specific interventions (such as those based on TCM) and Western derivative therapies [e.g., cognitive behavioral therapy for insomnia (CBT-i) and light therapy] has led to an asymmetry in the evidence (). The urgency of addressing these gaps is driven by a threefold crisis. The global nursing shortage is projected to reach 10 million in 2030, according to the World Health Organization (). Moreover, the persistently rising turnover rate among nightshift nurses due to sleep deprivation and occupational stress has accelerated the vicious cycle of understaffing. Furthermore, sleep deprivation among nurses significantly increases the risk of medication errors and adverse events, directly threatening patient safety (, ). Our review is expected to provide individual nightshift nurses with a basis for selecting evidence-based interventions, offer nursing managers a reference for prioritizing resource allocation in employee health programs, and furnish comparative efficacy data to support the development of o