Objective:To analyze the development trajectory of sleep quality in patients with insomnia after cognitive behavioral therapy (CBT-I), and to explore the influencing factors of different development trajectories.Methods:A total of 418 patients with insomnia who received CBT-I at the Sleep Medicine Center of Xiamen Xianyue Hospital from February 2019 to June 2023 were recruited using convenience sampling. All patients completed the Pittsburgh sleep quality index (PSQI) at five time points: before CBT-I initiation (T1), at the end of treatment (T2), and at 3 months (T3), 6 months (T4), and 12 months (T5) post-treatment. At T1, all patients were evaluated by the insomnia severity index (ISI), Flinders fatigue scale (FFS), Beck depression inventory-Ⅱ (BDI-Ⅱ), Beck anxiety inventory (BAI), and dysfunctional beliefs and attitudes about sleep scale (DBAS). Latent class growth modeling (LCGM) was constructed and employed to analyze the development trajectories of sleep quality post-CBT-I using Mplus 8.0 software. Univariate analysis and Logistic regression analysis were conducted by SPSS 26.0 software to explore influencing factors of the sleep quality trajectories.Results:The PSQI scores of insomnia patients at T1, T2, T3, T4 and T5 were 15(12, 18), 8(6, 11), 5(3, 7), 5(3, 7) and 5(2, 7), respectively. Three distinct development trajectories were identified. Based on these trajectories, 418 patients were categorized into fluctuating development group ( n=44, 10.53%), slow improvement group ( n=193, 46.17%), and sustained improvement group ( n=181, 43.30%). Logistic regression analysis revealed that depressive symptom severity, anxiety symptom severity, family history of insomnia, and use of hypnotic medications were significant influencing factors for the sleep quality trajectories after CBT-I treatment (all P<0.05). Conclusion:The sleep quality of insomnia patients after CBT-I treatment shows different development trajectories, and its influencing factors are depression, anxiety, family history of insomnia and the use of hypnotic medications.

Objective:To analyze the development trajectory of sleep quality in patients with insomnia after cognitive behavioral therapy (CBT-I), and to explore the influencing factors of different development trajectories.Methods:A total of 418 patients with insomnia who received CBT-I at the Sleep Medicine Center of Xiamen Xianyue Hospital from February 2019 to June 2023 were recruited using convenience sampling. All patients completed the Pittsburgh sleep quality index (PSQI) at five time points: before CBT-I initiation (T1), at the end of treatment (T2), and at 3 months (T3), 6 months (T4), and 12 months (T5) post-treatment. At T1, all patients were evaluated by the insomnia severity index (ISI), Flinders fatigue scale (FFS), Beck depression inventory-Ⅱ (BDI-Ⅱ), Beck anxiety inventory (BAI), and dysfunctional beliefs and attitudes about sleep scale (DBAS). Latent class growth modeling (LCGM) was constructed and employed to analyze the development trajectories of sleep quality post-CBT-I using Mplus 8.0 software. Univariate analysis and Logistic regression analysis were conducted by SPSS 26.0 software to explore influencing factors of the sleep quality trajectories.Results:The PSQI scores of insomnia patients at T1, T2, T3, T4 and T5 were 15(12, 18), 8(6, 11), 5(3, 7), 5(3, 7) and 5(2, 7), respectively. Three distinct development trajectories were identified. Based on these trajectories, 418 patients were categorized into fluctuating development group ( n=44, 10.53%), slow improvement group ( n=193, 46.17%), and sustained improvement group ( n=181, 43.30%). Logistic regression analysis revealed that depressive symptom severity, anxiety symptom severity, family history of insomnia, and use of hypnotic medications were significant influencing factors for the sleep quality trajectories after CBT-I treatment (all P<0.05). Conclusion:The sleep quality of insomnia patients after CBT-I treatment shows different development trajectories, and its influencing factors are depression, anxiety, family history of insomnia and the use of hypnotic medications.

Objective To investigate the use of fishbone diagram analysis on the causes of violent attacks among psychiatric inpatients .Methods Totals of 327 cases of violent attacks psychiatric inpatients were analyzed in order to find the reasons for violent attacks using the fishbone diagram .Results The causes of violent attacks could be summarized as patient factors , family factors, staff factors, environmental factors and management factors . Patient factors according to the previous history of violent attacks were the highest , accounting for 64 .5%.Then the family factors due to blunt attitude of family members accounted for 19 .6%. The highest reason of staff factors was bad service attitude , accounting for 30.0%.The highest nursing management factor was closed-end management, accounting for 61.8%.The highest environment factor was because the wards were too crowded and noisy , accounting for 30.9%.Conclusions Fishbone diagram, used for analysis the causes violent attacks of psychiatric inpatients , is simple and practical .It provides a basis and a strong guarantee for the further implementation of continuous quality improvement in nursing safety .