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Kim and Kim: The Effects of Mobile Social Networking Service-Based Cognitive Behavior Therapy on Insomnia in Nurses
Original Article

Journal of Korean Academy of Nursing 2017; 47(4): 476-487.

Published online: 31 August 2017

DOI: https://doi.org/10.4040/jkan.2017.47.4.476

The Effects of Mobile Social Networking Service-Based Cognitive Behavior Therapy on Insomnia in Nurses

Ji Eun Kim1, 2, Suk-Sun Kim1

1College of Nursing, Ewha Womans University, Seoul, Korea.

2Nursing Department, National Center for Mental Health, Seoul, Korea.

Address reprint requests to: Kim, Suk-Sun. College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-2885, Fax: +82-2-3277-2850, suksunkim@ewha.ac.kr

Received 18 December 2016       Revised 29 May 2017       Accepted 3 July 2017

© 2017 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to examine the effects of cognitive behavior therapy for insomnia (CBT-I) based on the mobile social networking service (SNS) on dysfunctional beliefs and attitudes about sleep, sleep quality, daytime sleepiness, depression, and quality of life among rotating-shift nurses in a hospital in Korea.

Methods

A nonequivalent control group pre-post test design was used. The participants included 55 nurses with rotating three-shift work (25 in the experimental group and 30 in the control group). For the experimental group, CBT-I using mobile SNS was provided once a week for 60 minutes over six weeks. Data were analyzed using descriptive statistics, χ2-test, independent samples t-test, and Mann-whitney U test with the SPSS 21.0 program.

Results

In the homogeneity test of the general characteristics and study variables, there were no significant differences between the two groups. Nurses in the experimental group had significantly lower scores on dysfunctional beliefs and attitudes regarding sleep and sleepiness than nurses in the control group. Nurses in the experimental group had significantly higher scores on sleep quality and quality of life than nurses in the control group.

Conclusion

These findings indicate that using the mobile SNS-based CBT-I is feasible and has significant and positive treatment-related effects on rotating-shift nurses' irrational thoughts and beliefs in association with sleep, sleep quality, daytime sleepiness, and quality of life. These contribute to expanding our knowledge of rotating-shift nurses' sleep issues and their preferences for intervention.

Keywords: Cognitive therapy, Nurses, Sleep, Quality of life

Figures and Tables

Figure 1

Flow of participants.

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Table 1

CBT-I Intervention Program

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Session Subject Contents Time (mins) Tools & Method
1 Orientation sleep assessment Introduction to CBT-I program 10 Smart phone SNS application
Insomnia Quiz (yes or no) 35 Smart phone messenger (group therapy)
Treatment insomnia
Comprehensive insomnia assessment 15 Homework (daily sleep diary)
2 Sleep education Daily sleep diaries & identify extent of sleep hygiene 15 Sleep logs: previous week
10 rules for improving sleep hygiene 35 Smart phone messenger (group therapy)
Stimulus control PPT slide
Stress management
Watching a video (a guide to sleep hygiene) 10 Video
Homework (daily sleep diary)
3 Sleep titrate Daily sleep diaries & identify extent of sleep hygiene 10 Sleep logs: previous week
Sleep restriction (time in bed=total sleep time) 40 Smart phone messenger (group therapy)
Maintain sleep efficiency between 85~90% Calculator application (sleep time/time in bed ×100%)
Watching a video (sleep scheduling) 10 Video
Homework (daily sleep diary)
4 Sleep titrate & cognitive behavior therapy 1 Daily sleep diaries & identify extent of sleep hygiene 10 Sleep logs: previous week
Review sleep efficiency
Sleep restriction 40 Smart phone messenger (group therapy)
Cognitive behavior therapy for dysfunctional beliefs about sleep and insomnia: worrying & catastrophic thinking Cognitive restructuring worksheet
Watching a video (cognitive model & cognitive restructuring exercise) 10 Video
Homework (daily sleep diary)
5 Sleep titrate & cognitive behavior therapy 2 Daily sleep diaries & identify extent of sleep hygiene 10 Sleep logs: previous week
Sleep restriction 40 Smart phone messenger (group therapy)
Trace: cognitive behavior therapy for dysfunctional beliefs about sleep and insomnia
Watching a video (relaxation training) 10 Video
Homework (daily sleep diary)
6 Sleep evaluation Daily sleep diaries & identify extent of sleep hygiene 10 Sleep logs: the effect of sleep before and after the CBT-I
Insomnia relapse prevention 35 Smart phone messenger (group therapy)
Summary and plan for the future 15 “Do It Yourself” CBT-I counseling
Table 2

Homogeneity Test of General, Health-related Characteristics between the Two Groups (N=55)

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Characteristics Categories Exp. (n=25) Cont. (n=30) Total (n=55) χ2 or t p
n (%) or M±SD
Gender Female 25 (100.0) 30 (100.0) 55 (100.0)
male 0 (0.0) 0 (0.0) 0 (0.0)
Age (yr)† 27.20±3.27 27.77±3.67 27.21±3.47 -0.59 .552
Marital status* Single 23 (92.0) 22 (73.3) 45 (81.8) 3.19 .092
Married 2 (8.0) 8 (26.7) 10 (18.2)
Religion Yes 14 (56.0) 15 (50.0) 29 (52.7) 0.20 .788
No 11 (44.0) 15 (50.0) 26 (47.3)
Education level Three-year college 7 (28.0) 20 (66.7) 27 (49.0) 8.16 .007
Bachelor & Master 18 (72.0) 10 (33.3) 28 (51.0)
Total career in present unit (month)† 47.40±34.20 53.43±35.17 50.69±34.54 -0.64 .524
Work place* Inpatient ward 15 (60.0) 19 (63.4) 34 (61.8) 0.47 .841
Special department (ER, ICU, OR) 7 (28.0) 9 (30.0) 16 (29.1)
Others 3 (12.0) 2 (6.6) 5 (9.1)
Perceived health Good 8 (32.0) 9 (30.0) 17 (30.9) 0.03 .873
Average & Bad 17 (68.0) 21 (70.0) 38 (69.1)
Caffeine drinker* No 7 (28.0) 5 (16.7) 12 (21.8) 1.03 .345
Yes 18 (72.0) 25 (83.3) 43 (78.2)
Alcohol drinker No 25 (100.0) 30 (100.0) 55 (100.0)
Yes 0 (0.0) 0 (0.0) 0 (0.0)
Regular exercise* 30 minutes 16 (64.0) 24 (80.0) 40 (72.7) 1.76 .231
40~60 minutes 9 (36.0) 6 (20.0) 15 (27.3)

Exp.=Experimental group; Cont.=Control group.

*Fisher's exact test; †t-test.

Table 3

Homogeneity Test for Outcome Variables between the Two Groups (N=55)

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Variables Exp. (n=25) Cont. (n=30) t/z p
M±SD
Dysfunctional beliefs and attitudes about sleep 83.08±28.80 80.27±29.56 0.35 .724
Sleep quality 11.80±3.11 11.77±3.42 0.03 .970
Daytime sleepiness 9.72±5.65 8.50±4.41 0.90 .372
Depression* 17.72±9.78 21.30±15.87 -0.49 .624
Quality of life 3.28±0.41 3.21±0.58 0.54 .587

Exp.=Experimental group; Cont.=Control group.

*Mann-Whitney U test.

Table 4

Comparison of Outcome Variables between the Two Groups (N=55)

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Variables Groups Pretest Posttest Difference t/z p
M±SD
Dysfunctional beliefs and attitudes about sleep Exp. (n=25) 83.08±28.80 62.40±22.48 −20.68±33.27 2.80 .007
Cont. (n=30) 80.27±29.56 81.77±36.15 1.50±25.48
Sleep quality Exp. (n=25) 11.80±3.11 8.20±3.19 −3.60±3.11 3.34 .002
Cont. (n=30) 11.77±3.42 10.90±3.19 −0.87±2.96
Daytime sleepiness Exp. (n=25) 9.72±5.65 6.08±3.79 −3.64±4.87 2.24 .029
Cont. (n=30) 8.50±4.41 7.37±4.90 −1.13±3.41
Depression* Exp. (n=25) 17.72±9.78 11.56±6.69 −6.16±8.73 −1.12 .264
Cont. (n=30) 21.30±15.87 18.13±13.67 −3.17±7.89
Quality of life Exp. (n=25) 3.28±0.41 3.60±0.44 0.32±0.46 −2.36 .021
Cont. (n=30) 3.21±0.58 3.26±0.66 0.06±0.36

Exp.=Experimental group; Cont.=Control group.

*Mann-Whitney U test.

Notes

This manuscript is a condensed form of the first author's master's thesis from Ewha Womans University.

This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and future Planning (No. 2015R1A2A2A01004575).

CONFLICTS OF INTEREST The authors declared no conflict of interest.

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