Using Cognitive-Behavioral Change and Mobile Technology to Improve RN Sleep and Fatigue

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Project Summary The U.S. registered nurse (RN) workforce is one of the largest in the Healthcare and Social Assistance Sector, and at high risk for injuries and errors due to poor sleep and fatigue. Shift work (i.e., nights, evenings, rotating shifts) can contribute to RNs not obtaining adequate, restful sleep. Work intensity, including heavy physical and emotional workloads of caring for critically ill patients, can contribute to job stress, resulting in spill-over effects at home when RNs experience difficulties falling and staying asleep. To address work and home sleep barri- ers, this project proposes the development and pilot testing of RN-SLEEP, skill-building mobile application designed to improve sleep. RN-SLEEP will provide a convenient, flexible space for RNs to learn evidence- based shift work specific strategies, and cognitive-behavioral methods, (e.g., goalsetting, relaxation training) to enhance sleep. Using NIOSH’s Research 2 Practice (R2P) approach, the study team will collaborate with par- ticipants (N=18-24) from an RN union to refine RN-SLEEP content, integrating current sleep literature (includ- ing National Institute for Occupational Safety and Health [NIOSH] material) with cognitive-behavioral based training. RN-SLEEP will be pilot-tested using a two-group pretest-posttest study design, comparing sleep out- come measures (duration, quality) of RN-SLEEP participant users’ (n=35) with participants from an education control group (n=35). Data trends on behavior change (beliefs and self-efficacy) and other sleep outcome measures (timing, regularity, efficiency, daytime sleepiness) will be explored. RN-SLEEP goals align with Healthy People 2030, NIOSH strategic goal to promote safe and healthy work design and well-being, through two NIOSH Healthcare and Social Assistance Sector/Healthy Work Design Cross-Sector (HCSA/HWD) intermediate goals. HWD goal 7.2A is to conduct intervention research addressing fatigue (poor sleep sequala) due to suboptimal work designs (shift work) in the healthcare industry. HCSA/HWD goal 7.12A prioritizes interventions designed to impact work and non-work contributors to safety and health. This RN-SLEEP intervention aims to improve sleep through building skills that help RNs overcome obstacles to sleep from work and home, thus improving health and safety. Immediate outputs include a mobile app, de- signed and tested in collaboration with RNs, to improve sleep. Study results will be disseminated through our union collaborators, nursing conferences and journal publications, and our University’s NIOSH sponsored Edu- cation and Research Center social media outlets. Intermediate outcomes include enhancing RN sleep through training rarely available in nursing school and traditional health and safety training programs. Improv- ing sleep can reduce fatigue and may decrease occupational injuries and errors. RN-SLEEP is adaptable, where future versions could be modified to meet the needs of other HCSA workers (i.e., nursing aides) and workers in other industries (e.g., oil and gas) scheduled to work non-standard work hours. End outcomes in- clude integrating RN-SLEEP into a broader hospital organization intervention to mitigate fatigue risks.