The Effect of Acupressure on Sleep Quality and Daytime Sleepiness of Surgical Nurses During the COVID-19 Pandemic Process: A Single-Blind Randomized Controlled Study Protocol

Öz

Objective: This study was planned to determine the effect of self-acupressure on the sleep quality and daytime sleepiness of surgical nurses during the COVID-19 pandemic. Subjects and Method: This is a prospective, two-armed (1:1), randomized controlled single-blind study. SPIRIT 2013 checklist and CONSORT flowchart were used in the preparation of the protocol. The sample of the study will consist of 60 surgical nurses working in shifts in the surgical clinics of a university hospital in Turkey between March 2021 and June 2021. Nurses will be randomly assigned to the acupressure (study) and placebo acupressure (control) groups. The acupressure group (n:30) will be applied pressure to the HT7 and SP6 points, while the placebo acupressure group (n:30) will be applied lighter pressure to the points 1.5 cm around the same points. Acupressure will be applied one hour before going to sleep, 3 times a week for 4 weeks. Sleep quality, which is the primary outcome of the research, with the Pittsburg Sleep Quality Index (PSQI); Daytime sleepiness, which is the secondary outcome, will be evaluated with the Epworth Sleepiness Scale (ESS). Blinded nurses will complete the PSQI and ESS before and after acupressure/placebo acupressure. Result: It is known that health professionals working during the COVID-19 pandemic have sleep problems. Although it is known that acupressure improves sleep quality, it is not known whether it is effective in surgical nurses working in shifts during the pandemic. In this study, it is expected to obtain high-proof results for determining the effect of acupressure, which is a non-pharmacological method, in increasing the sleep quality of surgical nurses and reducing daytime sleepiness. Conclusion: The results of the study will help nurses cope with the sleep problems experienced during the period when they are exposed to extreme stress, such as the COVID-19 pandemic, and will guide new research. Registration number: It was registered at ClinicalTrials.gov in March 2021 (NCT04800939).

Anahtar Kelimeler

• Acupressure
• surgery
• nursing
• sleep
• sleepiness

COVID-19 Pandemi Sürecinde Akupresürün Cerrahi Hemşirelerinin Uyku Kalitesi ve Gündüz Uykululuğuna Etkisi: Tek Kör Randomize Kontrollü Çalışma Protokolü

Öz

Amaç: Bu araştırma, COVID-19 pandemisinde kendi kendine uygulanan akupresürün cerrahi hemşirelerinin uyku kalitesi ve gündüz uykululuklarına etkisini belirlemek amacıyla planlandı. Örneklem ve Yöntem: Bu çalışma, prospektif, iki kollu (1:1), randomize kontrollü tek kör çalışmadır. Protokolün hazırlanmasında SPIRIT 2013 kontrol listesi ve CONSORT akış şeması kullanılmıştır. Çalışmanın örneklemini, Mart 2021-Haziran 2021 tarihleri arasında Türkiye’de bir üniversite hastanesinin cerrahi kliniklerinde vardiyalı çalışan 60 cerrahi hemşiresi oluşturacaktır. Hemşireler, akupresür (çalışma) ve plasebo akupresür (kontrol) gruplarına randomizasyonla atanacaktır. Akupresür grubuna (n:30) HT7 ve SP6 noktalarına basınç uygulatılırken, plasebo akupresür grubuna (n:30) aynı noktaların 1.5 cm çevresindeki noktalara daha hafif basınç uygulanması sağlanacaktır. Akupresür 4 hafta boyunca haftada 3 kez uyumadan bir saat önce yaptırılacaktır. Araştırmanın primary outcome olan uyku kalitesi Pittsburg Uyku Kalitesi İndeksi (PUKİ) ile; secondary outcome olan gündüz uykululuk durumu ise Epworth Uykululuk Ölçeği (EUÖ) ile değerlendirilecektir. Körlenmiş hemşireler PUKİ ve EUÖ’ni, akupresür/plasebo akupresür öncesi ve sonrası dolduracaktır. Bulgular: COVID-19 pandemisinde çalışan sağlık profesyonellerinin uyku problemleri yaşadığı bilinmektedir. Akupresürün uyku kalitesini arttırdığı bilinmesine karşın pandemide vardiyalı çalışan cerrahi hemşirelerinde etkili olup olmadığı bilinmemektedir. Bu çalışmada cerrahi hemşirelerinin uyku kalitesinin arttırılması ve gündüz uykululuğunun azaltılmasında nonfarmakolojik bir yöntem olan akupresürün etkisinin belirlenmesine yönelik kanıt düzeyi yüksek sonuçlar elde edilmesi beklenmektedir. Sonuç: Çalışma sonuçları, COVID-19 pandemisi gibi sağlık profesyonellerinin aşırı strese maruz kaldıkları dönemde hemşirelerin yaşadıkları uyku sorunlarıyla baş etmesine yardımcı olabilecek ve yeni araştırmalara rehberlik edebilecektir. Kayıt numarası: Bu çalışma ClinicalTrials.gov’a Mart 2021 tarihinde kaydedilmiştir (NCT04800939).

Anahtar Kelimeler

• Akupresür
• cerrahi
• hemşirelik
• uyku
• uykululuk

Kaynakça

1. Abbasi Tadi, S., Saberi, M., & Akbari, H. (2021). Effect of acupressure at shenmen acupoint on the sleep quality of nurses in emergency departments and intensive care units. Complementary Medicine Journal, 10(4), 380-395. https:// doi.org/10.32598/cmja.10.4.1025.1
2. Ağargün, M., Kara, H., & Anlar, O. (1996). Pittsburgh Uyku Kalitesi İndeksi’nin geçerliği ve güvenirliği. Turk Psikiyatri Dergisi, 7(2), 107-115. https://www.turkpsikiyatri.com/turkceOzet?Id=327
3. Arab, Z., Shariati, A. R., Asayesh, H., Vakili, M. A., Bahrami-Taghanaki, H., & Azizi, H. (2016). A sham-controlled trial of acupressure on the quality of sleep and life in haemodialysis patients. Acupuncture in Medicine, 34(1), 2-6. https://doi.org/10.1136/acupmed-2014-010369
4. Asgari, M. R., Vafaei-Moghadam, A., Babamohamadi, H., Ghorbani, R., & Esmaeili, R. (2020). Comparing acupressure with aromatherapy using Citrus aurantium in terms of their effectiveness in sleep quality in patients undergoing percutaneous coronary interventions: A randomized clinical trial. Complementary Therapies in Clinical Practice, 38, 1-7. https://doi.org/10.1016/j.ctcp.2019.101066
5. Aydin Sayilan, A., Kulakaç, N., & Uzun, S. (2021). Burnout levels and sleep quality of COVID-19 heroes. Perspectives in Psychiatric Care, 57(3), 1231-1236. https://doi.org/10.1111/ppc.12678
6. Aygin, D., & Şen, S. (2019). Acupressure on anxiety and sleep quality after cardiac surgery: A randomized controlled trial. Journal of PeriAnesthesia Nursing, 34(6), 1222-1231. https://doi.org/10.1016/j.jopan.2019.03.014
7. Buysse, D., & Reynolds, C. (1989). The pittsburgh sleep quality index: A new instrument for psychiatric research and practice. Psychiatry Research, 28(2), 193-213. https://doi.org/10.1016/0165-1781(89)90047-4
8. Candaş Altınbaş, B., & Ertürk Yavuz, M. (2020). Roadmap: Precautions to be taken in the operating room during the COVID-19 pandemic (1 st.ed.). In A. Gürsoy, (Eds.), Surgical nursing and COVID-19 (pp. 46-51). Turkey Clinics.

9. Chan, A. W., Tetzlaff, J. M., Gotzsche, P. C., Altman, D. G., Mann, H., Berlin, J. A., Dickersin, K., Hrobjartsson, A., Schulz, K. F., Parulekar, W. R., Krleza-Jeric, K., Laupacis, A., & Moher, D. (2013). SPIRIT 2013 explanation and elaboration: Guidance for protocols of clinical trials. BMJ, 346, e7586. https://doi.org/10.1136/bmj.e7586
10. Çam Yanık, T., & Altun Uğraş, G. (2020). The effect of acupressure use on sleep quality after surgery. University of Health Sciences Journal of Nursing, 2(2), 105-112. https://dergipark.org.tr/en/pub/sbuhemsirelik/issue/56609/721957
11. Çetinol, T., & Özvurmaz, S. (2018). Hemşirelerde uyku kalitesi ve ilişkili faktörler. Medical Sciences, 13(4), 80-89. https://dergipark.org.tr/en/pub/nwsamed/issue/39586/453064
12. Çevik Aktura, S., & Özden, G. (2020). Psychological effects of the pandemic: COVID-19 nurses. Journal of International Social Research, 13(73), 1147-1151. http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=0&sid=58ca3ad9-5d77-407e-b440-ec667f7cff1b%40pdc-v-sessmgr03
13. Çevik, B., & Taşcı, S. (2017). Effects of acupressure application on pain management. Journal of Health Sciences, 26(3), 257-261. https://dergipark.org.tr/en/pub/eujhs /issue/44570/553112
14. Eser, B., Özer, M., & Çiçek, T. E. (2021). COVID-19 pandemic management and results of Turkey. City Health Journal, 2(1), 26-34. http://cityhealthj.org/index.php/cityhealthj/article/view/10/13
15. Evans, J. D. (1996). Straight forward statistics for the behavioral sciences. Brooks/Cole Publishing.
16. Gündüz Oruç, F. (2020). Akupresur uygulamasının tip 2 diyabet hastalarında polinöropati ile ilişkili ağrı ve uyku kalitesine etkisi (publication No. 635485) [Yayımlanmamış Doktora Tezi, Atatürk Üniversitesi].
17. Hmwe, N. T. T., Subramaniam, P., & Tan, L. P. (2016). Effectiveness of acupressure in promoting sleep quality: A systematic review of randomized controlled trials. Holistic Nursing Practice, 30(5), 283-293. https://doi.org/10.1097/HNP.0000000000000165
18. Huong, H. T. X., Alex, M., Wan, C. C., Anh, V. H., & Phuc, B. T. (2021). Pilot randomized sham-controlled trial of self-acupressure to manage the symptom cluster of insomnia, depression, and anxiety in cancer patients undergoing chemotherapy. Sleep & Breathing, 26, 445-456. https://doi.org/10.1007/s11325-021-02370-8
19. İster, E. D., & Karaca, T. (2019). Investigation of nursing thesis by applying acupressure in Turkey. Sakarya University Holistic Health Journal, 2(1), 22-31. https://dergipark.org.tr/en/pub/sauhsd/issue/45374/510752
20. İzci, B., Ardıç, S., Fırat, H., Şahin, A., Altınörs, M., & Karacan, I (2008). Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath, 12(2), 161-168. https://doi.org/10.1007/s11325-007-0145-7
21. Jahrami, H., BaHammam, A. S., AlGahtani, H., Ebrahim, A., Faris, M., AlEid, K., Saif, Z., Haji, E., Dhahi, A., Marzooq, H., Hubail, S., & Hasan, Z. (2021). The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19. Sleep Breath, 25, 503-511. https://doi.org/10.1007/s11325-020-02135-9
22. Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14(6), 540–545. https://doi.org/10.1093/sleep/14.6.540
23. Karaman, A. (2019). Akupresürün laparoskopik kolesistektomi sonrası gastrointestinal fonksiyonlara etkisi (publication No. 628999) [Yayımlanmamış Doktora Tezi, İstanbul Üniversitesi].
24. Khajeh, H. S., Sayadi, A., Mobini, L. M., & Heidari, S. (2020). The effect of Benson’s relaxation technique on sleep quality among shift-working nurses in hospitals. Journal of Hayat, 25(4); 415-428.
25. Kim, W. I., & Youn, H. M. (2004). The effects of self-acupressure of wan-gol (G12), shinmun (H7), samumgyo (SP6) on clinical nurses' sleep pattern disturbance and fatigue. The Korean Journal of Meridian & Acupoint, 21(2), 81-93. https://www.koreascience. or.kr/article/JAKO200403036919444.page
26. Kiyat, İ., Karaman, S., Ataşen, G. İ., & Kiyat, Z. E. (2020). Nursing in fight against new coronavirus (COVID-19). Journal of the Turkish Nurses Association, 1(1), 81-90. https://dergipark.org.tr/en/pub/thdd/issue/56182/713498
27. Köken, Z. Ö., Savaş, H., Çelik, S. Ş., & Eroğlu, D. (2020). COVID-19 pandemic process: cardiovascular surgery nurses association. Koç University Nursing Education and Research Journal, 17(4), 365-368. https://doi.org/10.5222/KUHEAD.2020.88785
28. Lai, F. C., Chen, I. H., Chen, P. J., Chen, I. J., Chien, H. W., & Yuan, C. F. (2017). Acupressure, sleep, and quality of life in institutionalized older adults: A randomized controlled trial. Journal of the American Geriatrics Society, 65(5), e103-e108.
29. Ma, X., Vervoort, D., Reddy, C. L., Park, K. B., & Makasa, E. (2020). Emergency and essential surgical healthcare services during COVID-19 in low-and middle-income countries: A Perspective. International Journal of Surgery, 79, 43-46. https://doi.org/10.1016/j.ijsu. 2020.05.037
30. Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., Elbourne, D., Egger, M., & Altman, D. G. (2010). CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. BMJ, 340, c869. https://doi.org/10.1136/bmj.c869
31. Movahedi, M., Ghafari, S., Nazari, F., & Valiani, M. (2017a). The effect of acupressure on fatigue among female nurses with chronic back pain. Applied Nursing Research, 36, 111-114. https://doi.org/10.1016/j.apnr.2017.06.006
32. Movahedi, M., Ghafari, S., Nazari, F., & Valiani, M. (2017b). The effects of acupressure on pain severity in female nurses with chronic low back pain. Iranian Journal of Nursing and Midwifery Research, 22(5), 339-342. https://doi.org/10.4103/ijnmr.IJNMR_108_16
33. Najafabadi, M. M., Ghafari, S., Nazari, F., & Valiani, M. (2020). The effect of acupressure on quality of life among female nurses with chronic back pain. Applied Nursing Research, 51, 151175. https://doi.org/10.1016/j.apnr.2019.05.020
34. Pala, S. Ç., & Metintaş, S. (2020). Healthcare workers in the COVID-19 pandemic. ESTÜDAM Journal of Public Health, 5(COVID-19 Special Issue), 175-187. https://doi.org/10.35232/estudamhsd.789806
35. Salari, N., Khazaie, H., Hosseinian-Far, A., Ghasemi, H., Mohammadi, M., Shohaimi, S., Daneshkhah, A., Khaledi-Paveh, B., & Hosseinian-Far, M. (2020). The prevalence of sleep disturbances among physicians and nurses facing the COVID-19 patients: A systematic review and meta-analysis. Globalization and Health, 16(1), 1-14. https://doi.org/10.1186/s12992-020-00620-0
36. Shreffler, J., Petrey, J., & Huecker, M. (2020). The impact of COVID-19 on healthcare worker wellness: A scoping review. Western Journal of Emergency Medicine, 21(5), 1059. https://doi.org/10.5811/westjem.2020.7.48684
37. Sun, J.L., Sung, M.S., Huang, M.Y., Cheng, G.C., & Lin, C.C. (2010). Effectiveness of acupressure for residents of longterm care facilities with insomnia: A randomized controlled trial. International Journal of Nursing Studies, 47(7), 798-805. https://doi.org/10.1016/j.ijnurstu.2009.12.003
38. Şenol Çelik, S., Atlı Özbaş, A., Çelik, B., Karahan, A., Bulut, H., Koç, G., Çevik Aydın, F., & Özdemir Özleyen, Ç. (2020). COVID-19 pandemic process: Turkish nurses association. Koç University Nursing Education and Research Journal, 17(3), 279-283. https://avesis.gazi.edu.tr/yayin/5eb6adcf-0d6d-4c0b-94db-ae1a3cb3cc08/covid-19-pande mi-sureci-turkhemsireler-dernegi
39. Tu, Z. H., He, J. W., & Zhou, N. (2020). Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: A cross-sectional study. Medicine, 99(26), 1-5. https://doi.org/10.1097/MD.0000000000020769
40. Wang, W., Song, W., Xia, Z., He, Y., Tang, L., Hou, J., & Lei, S. (2020). Sleep disturbance and psychological profiles of medical staff and non-medical staff during the early outbreak of COVID-19 in Hubei Province, China. Frontiers in Psychiatry, 11(733), 1-8. https://doi.org/10.3389/fpsyt.2020.00733
41. Wiyatno, E. R., Pujiastuti, R. S. E., Suheri, T., & Saha, D. (2017). Effect of accupressure on quality of sleep and pulse rate in patients with acute myocardial infarction. Belitung Nursing Journal, 3(4), 360-369. https://doi.org/10.33546/bnj.162
42. World Health Organization (WHO). (2020). Mental health and psychosocial considerations during the COVID-19 outbreak. https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf.
43. World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191-2194. https://doi.org/10.1001/jama.2013.281053
44. Yuan, S., Liao, Z., Huang, H., Jiang, B., Zhang, X., Wang, Y., & Zhao, M. (2020). Comparison of the indicators of psychological stress in the population of Hubei province and non-endemic provinces in China during two weeks during the coronavirus disease 2019 (COVID-19) outbreak in February 2020. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 26, e923767 1-10. https://doi.org/10.12659/MSM.923767