Rumination, Perceived Stress, and Sleep Quality in Primary Care Nurses: A Cross‐Sectional Network Analysis

BACKGROUND: Sleep problems are common among primary care nurses and are closely associated with psychological stress and maladaptive cognitive processing. Understanding the complex interplay among these psychological factors is critical for improving health outcomes and care quality. OBJECTIVE: This study aimed to examine the relationships between perceived stress, rumination (both positive and negative), and sleep quality in primary care nurses using a network analysis approach. METHODS: A cross-sectional study was conducted among 316 primary care nurses in public primary healthcare institutions in Shapingba District, Chongqing, China. Participants completed standardized self-report measures assessing perceived stress, rumination tendencies, and sleep quality. Network analysis was used to model the associations between these variables and to identify the most influential components. RESULTS: Approximately 64.6% of participants reported poor sleep quality. Network analysis revealed that sleep latency and perceived tension were the most central nodes within the network. Sense of tension and enjoy happiness showed the highest bridge strength, indicating their roles in connecting different psychological domains. Negative rumination-particularly suppression of positive emotions and negative attribution-showed strong links to sleep-related variables, suggesting its importance in the network structure. CONCLUSION: Perceived stress and negative rumination were closely related to sleep problems among primary care nurses. The findings suggest that stress reduction and cognitive-emotional interventions targeting maladaptive rumination may be effective strategies to improve sleep quality and overall well-being in this population. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.