| Objective:(1)To understand the current situation of clinical learning environment,psychological stress and sleep quality among internship nurses in China,and analyze their relationship and interaction degree by establishing structural equation model;(2)Based on the results of previous research and cross-sectional study,and literature review,this paper constructed the building group cognitive behavior intervention for internship nurses,and explored the effect of cognitive behavior intervention strategy on improving psychological stress and sleep quality of internship nurses;Methods:(1)This study included a cross-sectional study and a randomized controlled trial.The clinical learning environment(CLES+T),psychological stress(SRS)and sleep quality(PSQI)of 553 internship nurses in China were investigated by cross-sectional study,which was to explore the current situation of psychological stress and sleep quality among internship nurses and analyze their influencing factors.(2)According to the results of previous research and cross-sectional study,and literature review,the cognitive behavior intervention measures were formulated and implemented.The internship nurses in a tertiary first-class hospital in Changsha City were selected,and they were divided into experimental group and control group according to their wishes.There were 37 in the experimental group and 67 in the control group.In the middle of the internship(From November 1,2020 to January 31,2021),the experimental group was given group cognitive intervention and behavioral intervention for 8 weeks,while the control group was given group cognitive intervention only.One week before intervention and the second week after intervention,Stress Rating Scale for practicing nurses(SRS)and Pittsburgh Sleep Quality Index(PSQI)were used to test the effect of the experimental group and the control group.Results:(1)The results of Cross-sectional study among internship nurses in China: A total of 553 valid questionnaires were collected from10 provinces in China.The average age was 20.61±1.55 years old,including 497 female(89.87%),325(58.77%)with college degree,383(69.26%)with voluntary choice of nursing major,and 310(56.06%)with the willingness to engage in nursing after graduation.The average scores of CLES+T,SRS,and PSQI were 163.00(145.00,185.00),56.00(39.00,72.50),10.00(8.00,12.00),respectively.A total of 508(91.86%)internship nurses’ PSQI scores were greater than five.Multiple linear stepwise regression analysis showed that pedagogical atmosphere in the ward,conflicts between study and work,the willingness to engage in nursing after graduation,and uncertain of engaging in nursing after graduation could explain 19.2% of the total variation of PSQI score of internship nurses.The structural equation model showed a negative correlation of the PSQI with the CLES+T(r =-0.28,p < 0.001),a positive correlation of the PSQI with the SRS(r = 0.43,p < 0.001),and a negative correlation of the SRS with the CLES+T(r =-0.19,p < 0.001).(2)Data analysis after the intervention:(1)After the intervention,the experimental group’s scores of subjective sleep quality and sleep latency of PSQI were lower than those before the intervention(p<0.05).However,there was no significant difference in PSQI scores and SRS scores before and after intervention(p > 0.05).(2)After the intervention,the control group’s scores of sleep latency were lower than that before the intervention(p <0.05).There was no significant difference in PSQI total score and SRS total score before and after intervention(p >0.05).(3)Comparison the difference of pre-intervention and post-intervention in two groups: The experimental group’s score of subjective sleep quality was lower than that of the control group,and the difference was statistically significant(p < 0.05).However,there was no significant difference in SRS score and its dimensions between the two groups(p > 0.05).Conclusion:(1)Sleep quality problems are common among internship nurses.(2)Sleep quality of internship nurses was negatively correlated with clinical learning environment and positively correlated with psychological stress.(3)Professional identity of internship nurses was negatively correlated with sleep quality and psychological stress.(4)Cognitive behavior intervention can help internship nurses to reduce psychological stress level and improve their sleep quality and sleep time,to a certain extent. |
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