Effects of Auricular Acupressure on Sleep Quality, Anxiety, and Depressed Mood in RN-BSN Students With Sleep Disturbance

10.1097/jnr.0000000000000209

Ke-Hsin Chueh；Chia-Chuan Chang；Mei-Ling Yeh

RN-BSN students ； sleep quality ； anxiety ； depression ； auricular acupressure

The Journal of Nursing Research

26卷1期（2018 / 02 / 01）

10 - 17

英文

Background: Students in 2-year registered nurse to Bachelor of Science in nursing (RN-BSN) programs usually work full-time and study part-time. Sleep disturbance, anxiety, and depression are known to be common health problems among these students. Prior research has described the effectiveness of auricular acupressure (AA) in reducing sleep disturbance and improving mood. Purpose: The aim of this study was to evaluate the effect of using a 4-week AA program that adheres to a magnetic pellet on the shenmen acupoint on sleep quality, anxiousness, and depressed moods in nursing students with sleep disturbance. Methods: This study used a one-group, quasi-experimental design with repeated measures. Eligible students were recruited from an RN-BSN program offered by a university in northern Taiwan, and all were currently experiencing sleep disturbance. A 4-week AA intervention that applied a magnetic pellet on the shenmen acupoint was used. The Pittsburgh Sleep Quality Index, Beck Anxiety Inventory, and Beck Depression Inventory-II were used to measure sleep quality and mood outcomes each week during the 4-week intervention. Improvements in sleep quality, anxiety, and depressed moods were analyzed using the generalized estimating equation. Results: Thirty-six participants with a mean age of 32 years were enrolled as participants. After adjusting for confounding factors, continuous and significant improvements in sleep quality, anxiety, and depressed mood (p G .05) were observed throughout the intervention, with 4-week improvements in sleep quality, anxiety, and depressed mood averaging 26.7%, 43.5%, and 25%, respectively. Conclusions/Implications for Practice: This study showed the efficacy of using a 4-week AA that applies a magnetic pellet on the shenmen acupoint in terms of improving sleep quality, anxiousness, and depressed mood in RN-BSN students experiencing sleep disturbances. Especially, the emotional mood of participants improved significantly as early as the first week. The 4-week AA for reducing sleep disturbance, and improving students' anxiety, and depressed moods may be applied on primary healthcare.

1. Lee, C. Y.,Chen, H. C.,Meg Tseng, M. C.,Lee, H. C.,Huang, L. H.(2015).The relationships among sleep quality and chronotype, emotional disturbance, and insomnia vulnerability in shift nurses.The Journal of Nursing Research,23(3),225-235.
   連結：
2. Wu, S.C.、Li, M. H.、Chang, S. P.(2015)。Investigation of the sleep quality in the Ling Tung University。Journal of Sport, Leisure and Hospitality Research，10(2)，60-72。
   連結：
3. Yao, K. W.,Yu, S.,Cheng, S. P.,Chen, I. J.(2008).Relationships between personal, depression and social network factors and sleep quality in community-dwelling older adults.The Journal of Nursing Research,16(2),131-139.
   連結：
4. American Psychiatric Association(2013).Diagnostic and statistical manual of mental disorders.Washington, DC:Author.
5. Arai, Y. C.,Sakakima, Y.,Kawanishi, J.,Nishihara, M.,Ito, A.,Tawada, Y.,Maruyama, Y.(2013).Auricular acupuncture at the "shenmen" and "point zero" points induced parasympathetic activation.Evidence-Based Complementary and Alternative Medicine,945063.
6. Beck, A. T.,Epstein, N.,Brown, G.,Steer, R. A.(1988).An inventory for measuring clinical anxiety: Psychometric properties.Journal of Consulting and Clinical Psychology,56(6),893-897.
7. Beck, A. T.,Steer, R. A.,Ball, R.,Ranieri, W.(1996).Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients.Journal of Personality Assessment,67(3),588-597.
8. Buysse, D.J.,Reynolds, C. F., III,Monk, T. H.,Berman, S. R.,Kupfer, D. J.(1989).The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research.Psychiatry Research,28(2),193-213.
9. Cheng, Y. Y. (2002). A study on quality of sleep of Taiwanese from the survey of social development trends. Retrieved from http://www.stat.gov.tw/public/Data/4122719141571.pdf
10. Cheung, M. C.,Chan, A. S.,Yip, J.(2015).Microcurrent stimulation at shenmen acupoint facilitates EEG associated with sleepiness and positive mood: A randomized controlled electrophysiological study.Evidence-Based Complementary and Alternative Medicine,2015,182837.
11. Chien, P. L.,Su, H. F.,Hsieh, P. C.,Siao, R. Y.,Ling, P. Y.,Jou, H. J.(2013).Sleep quality among female hospital staff nurses.Sleep Disorders,2013,283490.
12. Cho, H. S.,Kim, Y. W.,Park, H. W.,Lee, K. H.,Jeong, B. G.,Kang, Y. S.,Park, K. S.(2013).The relationship between depressive symptoms among female workers and job stress and sleep quality.Annals of Occupational and Environmental Medicine,25(1),12.
13. Chueh, K. H.、Chang, C. C.(2014)。Relationship between presleep arousal status and sleep quality among the female RN-BSN nursing students。Fu-Jen Journal of Medicine，12(4)，253-262。
14. Chung, K. F.,Tang, M. K.(2006).Subjective sleep disturbance and its correlates inmiddle-aged Hong Kong Chinese women.Maturitas,53(4),396-404.
15. Feng, S. W.、Zeng, F.、Ren, Y. L.、Liang, F. R.(2014)。Discussion on disease spectrum treated with acupuncture at shenmen (HT 7) and its compatibility based on bibliometrics。Chinese Acupuncture & Moxibustion，34(6)，561-564。
16. Freeman, D.,Sheaves, B.,Goodwin, G. M.,Yu, L.M.,Harrison, P. J.,Emsley, R.,Espie, C. A.(2015).Effects of cognitive behavioural therapy for insomnia on the mental health of university students: Study protocol for a randomized controlled trial.Trials,16,236.
17. Ibrahim, N.,Al-Kharboush, D.,El-Khatib, L.,Al-Habib, A.,Asali, D.(2013).Prevalence and predictors of anxiety and depression among female medical students in King Abdulaziz University, Jeddah, Saudi Arabia.Iranian Journal of Public Health,42(7),726-736.
18. Klausenitz, C.,Hesse, T.,Hacker, H.,Hahnenkamp, K.,Usichenko, T.(2016).Auricular acupuncture for pre-exam anxiety in medical students: A prospective observational pilot investigation.Acupuncture in Medicine,34(2),90-94.
19. Kuo, S. Y.,Tsai, S. H.,Chen, S. L.,Tzeng, Y. L.(2016).Auricular acupressure relieves anxiety and fatigue, and reduces cortisol levels in post-caesarean section women: A single-blind, randomised controlled study.International Journal of Nursing Studies,53,17-26.
20. Lan,Y.,Wu, X.,Tan, H. J.,Wu, N.,Xing, J. J.,Wu, F. S.,Liang, F. R.(2015).Auricular acupuncture with seed or pellet attachments for primary insomnia: A systematic review and meta-analysis.BMC Complementary and Alternative Medicine,15,103.
21. Lee, M. S.,Shin, B. C.,Suen, L. K.,Park, T. Y.,Ernst, E.(2008).Auricular acupuncture for insomnia: A systematic review.International Journal of Clinical Practice,62(11),1744-1752.
22. Léger, D.,Bayon, V.(2010).Societal costs of insomnia.Sleep Medicine Reviews,14(6),379-389.
23. Lian, N.,Yan, Q.(1990).Insomnia treated by auricular pressing therapy.Journal of Traditional Chinese Medicine,10(3),174-175.
24. Lin, Y. H.、Chueh, K. H.、Lin, Y. N.(2015)。Work stress and anxiety among clinical female nurses with sleep disturbance。VGH Nursing，32(5)，154-165。
25. Rab, F.,Mamdou, R.,Nasir, S.(2008).Rates of depression and anxiety among female medical students in Pakistan.Eastern Mediterranean Health Journal,14(1),126-133.
26. Rosner, B.(2006).Fundamentals of biostatistics.Belmont, CA:Thomson Brooks.
27. Samaranayake, C. B.,Arroll, B.,Fernando, A. T., III.(2014).Sleep disorders, depression, anxiety and satisfaction with life among young adults: A survey of university students in Auckland, New Zealand.The New Zealand Medical Journal,127(1399),13-22.
28. Sawah, M. A.,Ruffin, N.,Rimawi, M.,Concerto, C.,Aguglia, E.,Chusid, E.,Battaglia, F.(2015).Perceived stress and coffee and energy drink consumption predict poor sleep quality in podiatricmedical students: A cross-sectional study.Journal of the American Podiatric Medical Association,105(5),429-434.
29. Shanahan, L.,Copeland, W. E.,Angold, A.,Bondy, C. L.,Costello, E. J.(2014).Sleep problems predict and are predicted by generalized anxiety/depression and oppositional defiant disorder.Journal of the American Academy of Child & Adolescent Psychiatry,53(5),550-558.
30. Suen, L. K.,Wong, T. K.,Leung, A. W.(2002).Effectiveness of auricular therapy on sleep promotion in the elderly.The American Journal of Chinese Medicine,30(4),429-449.
31. Tavernier, R.,Willoughby, T.(2014).Bidirectional associations between sleep (quality and duration) and psychosocial functioning across the university years.Developmental Psychology,50(3),674-682.
32. Wang, H. H.、Kuo, Y. L.、Lee, H. T.、Chung, U. L.、Wu, S. M.、Sun, J. L.(2005)。The effectiveness of auricular-acupuncture in the treatment of insomnia in nurses at a regional hospital。Journal of Evidence-Based Nursing，1(4)，283-291。
33. Wang, H. H.、Yeh, M. L.、Chung, U. L.、Yang, C. H.(2008)。Improving sleep quality: The efficacy of auricular acupressure。Journal of Evidence-Based Nursing，4(3)，243-250。
34. Wang, Y. Z.,Chen, H. H.,Yeh, M. L.,Lin, S. D.(2010).Auricular acupressure combined with multimedia instruction or alone for quitting smoking in young adults: A quasi-experimental study.International Journal of Nursing Studies,47(9),1089-1095.
35. Wewers, M. E.,Lowe, N. K.(1990).A critical review of visual analogue scales in the measurement of clinical phenomena.Research in Nursing & Health,13(4),227-236.

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