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

The majority of RNs in the U.S. work in hospitals and post-acute care centers where their sleep could be compromised as a result of shift work (i.e., work outside 7 a.m. to 6 p.m.) and long work hours. RNs also face tremendous job stress when caring for critically ill patients, which can disrupt sleep. Sleep health is defined by multiple components including sleep timing, regularity, efficiency, duration, quality, and daytime sleepiness. When RNs experience poor sleep they are at increased risk for outcomes that have negative health and safety concerns for the RNs (e.g., fatigue, chronic disease development, on-the-job injuries) and for their patients. Despite these risks, RNs are reporting poor sleep quality and shorter sleep duration than what is recommended 7-9 hours/24-hour. Some research has been conducted that shows when RNs obtain training on sleep strategies (e.g., pre-shift naps) related to working shift work, they see an improvement in their sleep. While helpful, RNs may further benefit from a more holistic training approach to address the wider barriers to sleep, such as job stress. A holistic sleep approach can provide RNs with evidence-based skills to cope with shift adaptation and psychological sleep barriers while motivating RNs with encouraging behavior change strategies (e.g., goal setting). As a result, RNs may see an improvement in sleep health and decreased fatigue.

This project proposes to develop a sleep training program designed to meet the needs of RNs working shift work. As such, the training program, RN-SLEEP, would include shift work strategies, basics of sleep science and physiology, behavior change components, and strategies found in an effective behavioral sleep medicine treatment known as cognitive behavioral therapy for insomnia (CBT-I). The candidate, Dr. Hittle, has expertise in occupational health and safety, including sleep and shift work in the healthcare industry. Dr. Hittle has assembled a mentoring team of experts to guide her training in cognitive-behavioral sleep methods for integration into worker sleep interventions, intervention research with a focus on mHealth, and implementation science using a Total Worker Health approach. Dr. Hittle's short-term goal is to become an independent occupational health and safety scientist skilled in the use of methodologies and techniques required for intervention research and successful implementation in the workplace. This K01 proposal serves as an opportunity for Dr. Hittle to gain these skills and build a body of research focused on sleep training for workers. The resources, time, and, materials needed for this project are available through the University of Cincinnati (UC), the College of Nursing, and resources from Dr. Wong (Primary Mentor) at the National Institute for Occupational Safety and Health. Other UC-based resources include UCIT which will support Dr. Hittle's mobile application development and the Center for Clinical & Translational Training and Science which offers services for K01 awardees in an effort to foster junior researchers.

This project has two aims:

1. To refine a mobile application, RN-SLEEP, to determine the training components of most interest to RNs when looking to improve their sleep.
2. To pilot test RN-SLEEP with a pretest-posttest, repeated measure study design to measure RN participant engagement with RN-SLEEP, appeal (e.g., aesthetics, ease of use), and the usefulness of the training contents to improve RN sleep over the study period versus an educational training on healthy living. This pilot test will also help the researchers better understand the functionality of study activities.

For aim 1, RN-SLEEP content refinement: