The Impact of Sleep Health Promotion on Physiologic Stress Responses and Mental Health Risk among Nurses: A Study Protocol (Preprint)

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BACKGROUND Nurses globally have a disproportionate risk for suboptimal mental health, including suicide. Organizations and policymakers have called for increased investigation of occupational and personal factors that may precipitate mental health risk among nurses. Further, an exploration of protective interventions is critical to help mitigate such risk. However, the majority of existing studies have relied primarily on self-report measures or postmortem data. OBJECTIVE The purpose of this study is to generate longitudinal pilot data via physiologic measures (sensor technology in a wearable device, called Oura Ring©) that investigates 1) which factors (stressful life events, psychiatric characteristics, and work environment characteristics) are associated with stress and subsequent suicidal ideation in nurses; and 2) to explore the preliminary impact of an evidence-based sleep intervention, Pure Somni©, on stress, psychological health, sleep (quality and duration) and suicidal ideation in nurses. METHODS Guided by the Stress-Diathesis Model for Suicide Behavior, we will implement a prospective pragmatic pilot trial design and recruit a convenience sample of registered nurses working in an acute care facility. First, participants will complete a Structured Clinical Interview for DSM-5 disorders. Next, electronic surveys will consist of demographic questions and validated measures for personal characteristics, sleep, stressful life events, psychiatric characteristics, work environment factors, and all psychological health outcomes. Heart rate variability and sleep data (e.g., duration, rapid eye movement (REM) sleep duration) will be collected using a wearable device, Oura Ring©, that uses sensor technology and records data 24 hours a day. Participants will be asked to wear the Oura Ring© for 8 weeks while completing the surveys at baseline, week 4 and week 8. In Weeks 5-8 only, we will implement a sleep kit, called Pure Somni©. The kit consists of evidence-based devices (e.g., blue light blocking glasses, aromatherapy, white noise machine) known to improve sleep hygiene. We will explore the feasibility and acceptability of the individual devices, comparing the weeks 1-4 and 5-8. We will use mixed effects models to explore the impact of each occupational and personal factor on mental health outcomes via physiologic data for stress and sleep. Next, we will fit conditional latent growth curve models using 3 data points to determine the impact of Pure Somni© kit on all mental health outcomes. RESULTS Results will analyzed at the individual and group level. CONCLUSIONS This paper presents a study protocol aimed at testing the impact of a sleep health promotion intervention, using physiologic measures, on nurses’ mental health risk. CLINICALTRIAL This protocol has been registered at clinicaltrials.gov (number NCT06079853).