title: Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial.
abstract: BACKGROUND
  Up to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients' sleep quality. An effective educational programme was important to improve patients' sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan.
  
  
  OBJECTIVE
  To examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure.
  
  
  METHODS
  randomised controlled trial.
  
  
  METHODS
  Eighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n=43) or the control group (n=41).
  
  
  METHODS
  Patients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients' enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression.
  
  
  RESULTS
  The intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p<.001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p>.05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β=-2.22, p<.001), daytime sleepiness (β=-4.23, p<.001), anxiety (β=-1.94, p<.001), and depression (β=-3.05, p<.001) after 12 weeks of the intervention.
  
  
  CONCLUSIONS
  This study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.
authors.affiliation: Community Nursing Center, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Yia-Ling
authors.initials: YL
authors.lastname: Chang
authors.affiliation: School of Nursing, National Yang Ming University, Taipei, Taiwan. Electronic address: afchiou@ym.edu.tw.
authors.forename: Ai-Fu
authors.initials: AF
authors.lastname: Chiou
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Shu-Meng
authors.initials: SM
authors.lastname: Cheng
authors.affiliation: Institute of Hospital and Health Care Administration, National Yang Ming University, Taipei, Taiwan.
authors.forename: Kuan-Chia
authors.initials: KC
authors.lastname: Lin
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D012890:Sleep; D013315:Stress, Psychological; D013624:Taiwan
keywords: Anxiety; Depression; Heart failure; Sleep disturbance; Supportive care programme