| Objectives1. To explore the risk factors (biological、psychosocial factors) that predict insomnia in hospitalized patients with CHD, and analyze the characteristics of sleep quality and related factors in patients with CHD.2. To establish the quality of sleep structural equation model, and make the relationships between the measurements variables and latent variables clearly so as to explain the psychological mechanism of insomnia occurring in hospital.3. On basis of the quality of sleep structural equation model in elderly patient with CHD, to construct the model of psychological and behavior intervention for insomnia occurring in hospital.4. To test the clinical effectiveness of model of psychological and behavior intervention for insomnia in patients with CHD during hospitalization.Methods1. Bibliography retrospection study was used to identify the risk factors of insomnia occurring in hospital.2. The corss-sectional study was used. A convenience sample of152patients with CHD was recruited. Sociodemographic、biological and psychosocial data were collected by the related scales and questionnaires. The structural equation model was used to set up the quality of sleep structural equation model.3. The stress theory and the hierarchy theory of psychological nursing were used to construct the model of psychological and behavior intervention for insomnia in elderly patients with CHD.4. The semi-experimental study was used.64elderly CHD patients with insomnia were recruited and separated into two groups randomly. Sleep indicators and related psychosocial indicators were measured before and after intervention. Two-way ANOVA and simple effect analysis were used to evaluate the effectiveness.Results1. The global scores of PSQI in patients were significantly higher than domestic norm (P<0.001); subjective support in patients was higher, but the utilization of support was low; the gross scores of HSRS were279.15±137.58, severity of disease was the most important source of stress (72.19±45.38); the coping style of the patients was negative; the proportion of anxiety was49.3%as well as depression was above50%; patients who was in rehospitalization had more serious problems.3. From the structural equation model, biological、psychosocial factors played important roles in sleep quality of patients by direct and indirect path.4. main effect of group factor for indicators, including SOL、PSQI、HSRS、 MCMQ、subjective support、utilization of support、SSRS、HADS, had statistical significances (P<0.05); exception for objective support, main effect of time factor in each indicator had a statistical significance (P<0.05); simple effect analysis demonstrated the extent of amelioration for each indicators in intervention group after intervention was superior than control group (P<0.01)5. Symptoms of anxiety and depression were related to sleep quality, scores of anxiety and depression could predict sleep quality by71.6%.6. Dosage of sleep medication patients used in two group was different significantly (t=-4.296, P＜0.001).Conclusions1. The elderly CHD patients with insomnia in hospital had high level of stress with symptoms of anxiety and depression, the style of coping they had was negative, and social support they perceived was not sufficient.2. Biological and psychosocial factors impact on sleep quality of patients by direct and indirect path. The effect of hospital stress was great and had more paths, while social support mediated by mood disorders was more effective.3. Model of psychological and behavior intervention for insomnia occurring in hospital played a important role on improving the sleep quality, alleviating the hospital stress, changing the negative style of coping, strengthening social support, mediating the anxiety and depression and lessening the sleep medication used positively.4. Mood disorders had relationships with sleep quality and played a powerful prediction of insomnia occurring in hospital on the elderly CHD patients. |
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