ARTICLE INFO

Article Type

Original Research

Authors

Rahnama   A. (*)
Hossein Sabet   F. (1)






(*) General Psychology Department, Psychology Faculty, Allameh Tabataba’i University, Tehran, Iran
(1) Clinical Psychology Department, Psychology Faculty, Allameh Tabataba’i University, Tehran, Iran

Correspondence

Address: Allameh Tabataba’i University, Dehkadeh-ye-Olympic, Tehran, Iran
Phone: +98 (45) 33816533
Fax: -
rahnama.abasalt@gmail.com

Article History

Received:  October  21, 2018
Accepted:  January 20, 2019
ePublished:  March 19, 2019

BRIEF TEXT


... [1, 2]. Sleep and awakening cycle is one of the biological cycles that is affected by the physiological function of light and darkness, care programs and other activities, and human biological clock plays an important role in this cycle [3]. If the natural cycle of sleep and awakening is disrupted for reasons such as illness, occupational programs, etc., there are disturbances in the normal process of sleep and awakening [4].

... [5]. Nurses are among those who are prone to insomnia, and some studies have reported that irregular patterns of sleep and awakening can reduce sleep quality, and quality of life, and cause mental disorders, reduce sleep time and reduce job performance in them [6]. ... [7-11]. Today, in the systems of presenting health services, patient safety is a key concept and as a factor in his survival [12]. Certainly, nurses who do not have good health cannot take good care of the patients. On the other hand, sleep deprivation during the day, which is a component of the inherent complications of various work shifts, especially the shift in the night, affects the time to respond in critical situations, the level of nurses' attention and concentration, and may even cause occupational accidents [13]. Most of the nurses' occupational injuries are due to fatigue caused by insomnia and the most common fatigue is in turnaround nurses [11]. Currently, the main treatment for reducing symptoms of sleep disorders is drug therapy [14]. However, several studies have shown that psychological treatment has a beneficial effect on reducing the symptoms of sleep disorders [15]. In this regard, cognitive-behavioral therapy has been more in the interest of researchers and therapists than other treatments in recent years [16]. The main goal of cognitive-behavioral therapy is to reduce psychological stress and improve the functions that are impaired by psychiatric disorders. The thoughts, beliefs and images that patients experience is the core of cognitive-behavioral therapy [17]. The content of the treatment involves identifying thoughts and beliefs, reviewing evidence and exploring cognitions and thoughts that are relevant to mood and behavior. This form of treatment can result in a significant and long-term improvement in all types of sleep problems and can be used as an alternative to drug therapy [9]. In this regard, cognitive-behavioral therapy has been widely used to treat various mental disorders [18, 19]; however, so far, few quantitative studies have been conducted on the effectiveness of cognitive-behavioral therapy on the reduction of sleep disorders in nurses, especially the turnaround shift nurses [20].

The purpose of this study was to investigate the effectiveness of cognitive-behavioral group therapy on treatment of primary sleep disorders and quality of life of nurses in the Vali-e-Asr Hospital.

This experimental study was carried out with a pre-test-post-test design with control group under the supervision of the Department of Health, Rescue And Treatment of I.r.iran Police Force, Applied Research Center.

All 258 turnaround nurses in Vali-e-Asr Hospital in 2017 were selected as the statistical population.

Of the 83 patients who had the conditions of the study (aged 23 to 48 years, score 5 and above 5 in Pittsburgh Sleep Quality Index, no significant anxiety and depression based on Beck anxiety and depression questionnaire, rotational shift, at least one year nursing work experience in the turnaround shift in the 6 months leading to the research period, and the willingness and ability to attend the treatment sessions), 30 were selected randomly and randomly divided into two groups of experimental and control groups each with 15 participants[20].

Pittsburgh sleep quality questionnaire and World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) were used to collect data. Pittsburgh Sleep Quality Questionnaire (PSQI): it has 19 items. Questions 1 and 3, Questions 2 and 4, and Questions 5 to 9 are scored in different ways [21]. Bois et al., who made this questionnaire for the first time, obtained the reliability of the questionnaire by using Cronbach's alpha as 0.83. In the Iranian version, the validity of the questionnaire was 0.86 and the reliability was 0.89 [22]. Cronbach's Alpha Coefficient of Pittsburgh Test was 0.81 in this study. World Health Organization Quality of Life Questionnaire: this questionnaire has 26 questions [23] that measures the overall and general life quality of a person. This scale was developed in 1996 by a group of experts from the World Health Organization and adjusted from a questionnaire with 100 items. The questionnaire has 4 subscales (physical health, mental health, social relationships, and environmental health) and an overall score. In the results reported by the World Health Organization's Quality of Life Score Builders Group, which has been conducted in 15 international organizations of this organization, the Cronbach's alpha coefficient has been reported as 0.73 to 0.89 for the four subscales and the total scale [24, 25]. In Iran, Nassiri also used three test-retest methods with interval of 3 weeks, split-half method and Cronbach alpha method and the reliability of the scale was equal to 0.67, 0.84, and 0.88, respectively. A higher score indicates a higher quality of life [26]. Cronbach's alpha coefficient for the quality of life test was 0.72. At first, in the pre-test stage, which was performed before the beginning of the sessions, both groups of the control and experimental, completed the questionnaires of sleep disorder and quality of life. The experimental group was then subjected to 7 sessions of cognitive-behavioral psychotherapy. During this period, the control group did not receive any special treatment. In the post-test phase, again, two groups completed the two questionnaires. In order to analyze the data, covariance analysis was used in SPSS 19 software.

17 (56.7%) of the subjects were female and 24 (80%) were married. 25 (76.7%) were undergraduate and 5 (23.3%) were graduate students. In the experimental group, the mean post-test score was significantly decreased in the sleep disturbance index (P = 12.26, P = 0.002) and it was significantly increased in the quality of life index (P = 0.003, F = 15.9). (Table 1).

Several studies have shown that cognitive-behavioral therapy is effective in treating sleep disorder [9]. In a study on the effectiveness of cognitive-behavioral group therapy on reducing insomnia syndrome in male prisoners, the cognitive-behavioral group therapy was effective in treating insomnia, which is in line with the results of this study [16]. Also, Johnflet et al. [27] in an experimental study with 56 people in two groups, entitled “the effect of cognitive-behavioral therapy on the chronic insomnia of professional health care workers with follow-up 24 months after treatment revealed that after treatment, 62% of participants in the treatment were recovered, while the pattern group showed a slight improvement. Ben Brooke et al. in a study that used cognitive-behavioral therapy to improve the quality of life in patients with inflammatory bowel disease, showed that this method is effective in improving the quality of life [12], which is consistent with the results of this study. Cognitive-behavioral therapists believe that by knowing inappropriate thoughts, practicing appropriate behaviors, and replacing them to remove problems, appropriate behaviors and cognition are formed [20].

It is suggested that the effects of intrusive variables be considered in future research. It is also recommended that cognitive-behavioral therapy sessions be held for nursing sleep disorders.

There were limitations in this study, including the existence of security issues in police stations that made the implementation of the research more difficult and prolonged. Another was the change of nurses' shift during the sessions, which involved the scheduling of meetings, as well as the existence of intruder variables, including the use of prescription drugs among some subjects.

Cognitive-behavioral intervention is effective in reducing sleep disturbance and improving nurses` quality of life.

The researchers expressed their gratitude and appreciation for the cooperation and encouragement of the staff of Department of Health, Rescue And Treatment of I.r.iran Police Force, Applied Research Center, in particular Dr Reza Mohammadi, and the experts of the research projects, Mr. Metaji and Mr. Gravand and the staff of the Department of Nursing in Valiasr Hospital (NAJA) and the nurses participating in the this research, who helped us with this work..

This research has been carried out under the supervision of the Department of Health, Rescue And Treatment of I.r.iran Police Force, Applied Research Center and is based on the research project of the deduction of the military service and there are no conflicts of interest.

In this research, nurses were given enough information on the goals and treatment of information and the consent was received for attending the sessions.

This research was conducted at the expense of the first author.

TABLES and CHARTS

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