Effect of Acupressure at ShenMen Acupoint on the Sleep Quality of Nurses in Emergency Departments and Intensive Care Units

* Corresponding Author: Mahdieh Saberi, PhD. Address: Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran. Tel: +98 (913) 2606413 E-mail: dsabery@yahoo.com 1. Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran. 2. Department of Biostatistics, School of Health, Kashan University of Medical Sciences, Kashan, Iran. Sajjad Abbasi Tadi1 , *Mahdieh Saberi1 , Hossein Akbari2


Introduction
leep as an important and influential factor in health status, plays an important role in improving the quality of life such that its impairment can have severe negative effects on physical and mental health and, thus, increase healthcare costs. Sleep disorders lead to increased S fatigue and drowsiness during the day, which in turn reduces a person's daily functioning. Nurses are exposed to relatively high stress when providing care to the patient, due to high patient care responsibility and factors associated with their sleep disorders such as long hours of working that put them under emotional and psychological pressure. The effect of patient care necessity can increase their stress, fatigue, and sleep disturbance and may lead to errors that can adversely affect the patient's recovery or lead to adverse consequences such as their death. The results of some studies have indicat-ed an unsatisfactory level of sleep quality among nurses. For example, Bozorg Sohrabi et al. reported a low level of sleep quality in 84% of nurses [6]. In recent years, the interest of people in using complementary medicine has increased due to its positive effects on the some disorders. Acupressure is a form of complementary medicine with an easy technique that has received a lot of attention.

Materials and Methods
The present study is a controlled randomized clinical trial with a pre-test-post-test design. The study population consisted of all nurses working in the emergency departments and Intensive Care Units (ICUs). Samples were divided into two groups of intervention (n=40) and control (n=40) using the block randomization method. A demographic form and Pittsburgh Sleep Quality Index (PSQI) questionnaire were used for collecting data before and after the intervention. First, for 15 minutes, face-to-face training on how to apply acupressure, finding the desired points and applying pressure on them was presented to the nurses by a researcher who had a certificate in acupressure. The nurses were asked to perform the acupressure intervention once in the presence of the researcher to ensure their learning. They were then asked to perform the intervention twice a day for 4 weeks in both hands at short intervals using a pressure of 3-5 kg; once during work shift breaks or rest at home or anywhere else, and once at night 30 minutes before going to bed or in bed for 5 minutes. Nurses in the control group did not receive any intervention.

Results
The Mean±SD age of nurses in the intervention and control groups were 28.55±4.01 and 28.68±3.40 years, respectively, but there was no statistically significant difference between the two groups in terms of age (P=0.58). The mean of shift work per month of nurses in the intervention and control groups were 26.7±2.12 and 26.92±2.41, respectively. There was no statistically significant difference between the two groups in any demographic characteristics which indicates the homogeneity of samples in the two groups (Table 1). Within-group comparison using independent ttest in the intervention group showed a statistically signifi- tween-group comparison of sleep quality in the intervention group showed that the mean score of overall sleep quality increased but the scores of all subscales (except in use of sleep medication) decreased significantly after the intervention (P<0.05), while the mean score of overall PSQI and its subscales in the control group did not show a statistically significant difference compared to the scores of baseline (P<0.05) ( Table 2).

Conclusion
According to the results of the present study, the use of acupressure at Shenmen acupoint (HT7) for 4 weeks is effective in reducing sleep disorders in nurses working in emergency and ICUs. Therefore, due to the very high prevalence of insomnia and its complications in nurses, acupressure can be suggested as a non-pharmacological treatment in the management of nurses' sleep disorders and consequently the quality of life, due to ease of use and not having side effects.

Compliance with ethical guidelines
This study was approved by Kashan University of Medical Sciences (Code: IR.KAUMS.NUHEPM. REC.1399.025) and has been registered by Iranian Registry of Clinical Trials.

Funding
This study was supported by the Deputy for Research of Kashan University of Medical Sciences.

Conflicts of interest
The authors declared no conflict of interest.