研究背景：因長時間臥床休息且活動量減少，大部份住院安胎孕婦都有睡眠品質不佳的困擾。但過去卻少有研究探討住院安胎孕婦睡眠品質。故本研究的目的為探討高危險妊娠住院安胎婦女之睡眠品質及睡前接受輕撫按摩對其總睡眠時數、自覺睡眠品質、與睡眠後日間功能狀態之影響。

研究方法：本研究以自我交叉試驗研究設計，探討睡前給予20 分鐘輕撫按摩對住院安胎婦女睡眠品質之影響。以立意取樣，選擇36 位年滿20 歲、妊娠週數20 週以上之南部某醫學中心住院安胎孕婦。在連續四天的研究期間，每位孕婦連續兩日夜眠前均接受輕撫按摩，另二日則無接受輕撫按摩，接受按摩與否的順序以重覆區集排列之隨機分派來決定。按摩方式為睡前給予研究對象20 分鐘之輕撫按摩，部位包含背部、未施打靜脈注射針之手臂及小腿，每個部位5 分鐘。研究期間研究對象持續配戴腕動計（iHealth）以監測睡眠時數，並於隔日睡前填寫維辛氏睡眠品質量表監測自覺睡眠品質與日間功能狀態。研究資料以描述性統計、成對樣本t 檢定及魏可遜配對符號等級考驗進行分析。

研究結果：整體而言住院安胎婦女進入研究前其夜間睡眠品質平均得分為
623.61±85.06 分，不及滿分的一半。睡前接受20 分鐘輕撫按摩者其夜間睡眠總時數（小時）較未接受者長（6.95±0.56 v.s. 6.41±0.48，p <.001）；第一次警醒時間（小時）較未接受者長（2.40±0.69 v.s. 1.73±0.66，p <.001）；睡眠中警醒次數較未接受者少（2.94±1.01 v.s. 3.92±1.16，p <.001）；夜間睡眠潛伏期時間（分鐘）較未接受者短（16.54±5.60 v.s. 28.03±9.82，p <.001）；在自評睡眠品質部份，接受輕撫按摩者其整體睡眠品質得分較未接受者高，清醒後日間功能活動狀態品質較未接受者高，自覺睡眠潛伏期品質得分較未接受者高。

結論與建議：研究結果顯示高危險妊娠住院安胎婦女的睡眠品質普遍不佳，睡前20分鐘之輕撫按摩，可協助住院安胎婦女增加總睡眠時間，縮短睡眠潛伏期使其僅早進入睡眠週期，並且拉長睡眠中第一次警醒時間使睡眠週期較完整，進而改善自覺睡眠品質。建議未來可將「輕撫按摩法」加入住院安胎衛教中，由護理人員協助，並可指導配偶或家屬執行方式與注意事項，幫助住院安胎婦女改善睡眠品質，提升照護品質。

INTRODUCTION
Sleep is a complex physiological process to restore physical agility and energy, and poor sleep quality will affect physical, emotional, cognitive, behavioral and social functioning. Since pregnant women play a key role in fetal growth and development, their sleep quality not only affects their own health, but also that of the fetus.

Pregnant women who are hospitalized for tocolysis usually experience poor sleep quality , and this has been shown to increase inflammatory markers and negative pregnancy outcomes (Okun & Coussons-Read, 2007). Women who are hospitalized for tocolysis are thus usually advised to stay in bed and limit the amount of activities. However, the resulting immobilization might induce muscle tightness, back pain, sleep disturbances, and other symptoms. Although this is an obvious problem, relatively little research has been carried out that aims to improve the sleep quality of high-risk pregnant women.

Many methods such as massage, music therapy, meditation, relaxation could improve quality of sleep. Worth mentioning that massage has been used for improve the sleep quality of ICU bed-ridden patients. Massage can have positive effects by lowering the amount of stress hormones and helping them to relax. Field, Deigo, & Hernandez-Reif (2007) reviewed 6 studies that assessed a theoretical model in which massage therapy increases serotonin and decreases cortisol and depression. In addition, massage therapy is shown to increase dopamine and, in turn, decrease norepinephrine and anxiety. Massage can also facilitate the EEG rhythmic transmit α wave, which means that it can improve the quality of sleep (Field et al., 2004b; Glover et al., 1999; Lundy et al., 1998; Wadwha et al., 1998).

Effleurage massage is the most important techniques of relaxation, which can also promote blood circulation and lymphatic drainage (Field et al., 2007), and it is commonly used with pregnant women. While few studies have used massage to improve pregnant women’s sleep, effleurage massage has been used with ICU patients. Chen (2002) studied the use of effleurage massage for bed-ridden ICU patients, and showed that the patients who received massage therapy had more stable physiological indexes (i.e., heartbeat, blood pressure, and blood oxygen) and longer sleep times that those who did not receive it.

MATERIALS AND METHODS
Design and Sample
This randomized control trial with a cross-over design study was conducted from July 2013 to September 2013. Subjects were recruited from the tocolysis ward in a University-affiliated hospital. High-risk pregnant women were eligible for participation if they were over 20 years old and their gestation periods were between 20 to 36 weeks. The following exclusion criteria were applied : diagnosis of depression, major mental disorder, taking of any medications known to affect sleep patterns, diagnosis of spine or back disease, skin of the back, arms or legs suffering from lesions or allergies or in the first active phase of labor. Subjects were allocated to the earlier-massage group (n=18) or later-massage group (n=18) by permuted block randomization with block size of 4.

Procedure
This study was approved by the hospitals’ institutional review board. Subjects who were eligible for participation and complete a consent form. They were allocated to earlier- and later-massage groups in four consecutive days. Effleurage massage was given with the center of the palm to slowly and softly massage from distal ends to proximal ends, applied at back, arms and legs. The earlier-massage group received effleurage massage for 20 minutes on the first and second nights before sleep, and not receive effleurage massage on third and fourth nights, while the reverse was true for the later-massage group.

Measurement
The demographic information that was collected included age, gestational age, pregnancy history, diagnosis, medication, and previous quality of sleep. The subjects’ previous quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989).

Subjective sleep quality was measure by the 15-item Verran and Snyder-Halpern Sleep Scale (VSH; Snyder-Halpern & Verran, 1987). The VSH sleep scale is a visual analogue instrument, in which the subjects are asked to answer each question about their previous night’s sleep by placing a vertical mark on a 100 mm line at a point between the verbal end statements. A higher total score means a better quality of sleep. Objective sleep time was measured by the actigraphy monitor (iHealth; Wang et al., 2011). iHealth is a portable watch-type sensor module that uses a small accelerometer to record a person’s speed and degree of motion, thus detecting their sleep/ wakefulness status. iHealth is worn on the non-dominant hand or ankle to record the total sleep time, duration of sleep latency, first wake after sleep onset, and frequency of waking up.

Analysis
Data were analyzed using the Statistical Package for the Social Sciences program (SPSS) for Windows 17.0 (SPSS Inc., Chicago, IL). Sample characteristics and variables of interest were summarized by descriptive statistics. The research questions were answered by paired-t tests and Wilcoxon matched-pairs signed ranks tests. A value of p <.05 was considered statistically significant.

RESULTS
The final analyses were based on the data obtained from the thirty-six women who completed the four-day study. Forty-three women were initially recruited, but four withdrew from the study after having been discharged and three entered the active phase of labor, and so were excluded from the sample. The women’s mean age was 32.4±2.9 years (range=27 to 39) and their mean gestation was 29.4±2.6 weeks, with a range of 24-35 weeks. Most of the women (63.9%) were multipara, and length of hospital stay was 2.6±1.2 days (range=2 to 6) before intervention. Twenty-three women (63.9%) had a global score of >5 on the PSQI.

In total quality of sleep and subscale of quality of day-time function, quality of sleep undisturbed, quality of sleep latency measured by VSH were all less then one-half of total score.

The effect of effleurage massage on quality of sleep
The results of the paired-t test showed that women who received massage had a higher total sleep quality score compared to those who did not receive it(p <.001). Similar results were found for the three subscales of sleep quality (p <.001).

The effect of effleurage massage on total sleep time
The results of the paired-t test showed that the mean total sleep time for the massage group was 6.9±0.6 hours, longer than that for the group that did not receive a massage (6.4±0.5, p <.001). A subgroup analysis was conducted based on the subjects’ previous quality of sleep, as measured by the PSQI. No matter whether the subjects were in the good or poor PSQI groups, the total sleep time in the massage group was longer than that in the non-massage group (p <.001).

The effect of effleurage massage on sleep latency
The results of the paired-t test showed that the massage group had a shorter duration of sleep latency than the non-massage group ( p <.001). First wake time after sleep onset was also longer in the massage group compared to the non-massage group ( p <.001).

DISCUSSION AND CONCLUSION
Our results showed that 63.9% of the pregnant women had poor sleep quality (PSQI ≧5), echoing previous studies (Ko, Chang, & Chen, 2010). The results also showed that effleurage massage can improve the perceived sleep quality and sleep time for women with tocolysis. This is similar to the findings of Cheng (2002), which examined the effects of effleurage massage on sleep quality for bed-ridden ICU patients, who had similar levels of mobility to the subjects examined in this work.

We also found that sleep latency (time to fall asleep) was significantly shorter for the effleurage massage group. This may be because effleurage massage can facilitate the production of α waves, and thus subjects will easily move into NREM sleep (Ujhely, 1979; Rowen, 2002; Moyer et al., 2004; Löken et al., 2009). In addition, slow effleurage massage can increase dopamine levels whole decreasing norepinephrine and anxiety, and so it is not surprising that the women in this study who received massage found it easier to relax and fell asleep faster (Field, Deigo, & Hernandez-Reif, 2007).

Limitations
The findings of this study are limited by the fact that it was not possible to carry out a blind intervention, and so the Hawthorne effect could not be avoided. However, this study, did use an objective method to assess sleep quality, and this may increase the credibility of its findings.

Clinical Applications
The findings of this study suggest that clinical health professionals can use effleurage massage for women with tocolysis in order to improve sleep quality. In addition, we also suggest adding effleurage massage into the health education programs that are offered to such women. Effleurage massage is a basic relaxation technique that ordinary people should be able to learn and apply after it has been demonstrated by healthcare professionals, and so the partners of pregnant women should be shown how to do this. In this way, we cannot only help women with tocolysis to have better sleep, but also promote bonding between the women and their partners, which is also helpful clinically.

王潤清（2003）．慢性疼痛對情緒狀態及睡眠品質之影響：慢性癌痛與慢性每日頭痛之比較（未發表的碩士論文）．台北醫學大學護理研究所。
戈依莉（2010）．安胎孕婦壓力與護理．早產兒基金會會訊，76，5-12
方妙君、杜玲（2012）．心臟血管系統疾病病人之護理．於胡月娟總校閱，內外科護理學（下）（四版，393-553頁）．臺北市：華杏。
李美玉（2006）．人性化的安胎照護模式．中華民國早產兒基金會會訊，58，5-9。
李家儀（2008）．癌痛病患主要照顧者之疲倦、睡眠、照顧負荷及其相關因素（未發表的碩士論文）．台北：國立臺灣大學護理研究所。
李佳晏、張秉宜、梁幸如（2009）．一位糖尿病婦女住院安胎及待產之護理經驗．長庚護理，20（1），113-121。
何瑞麟、何邦立（1988）．睡眠與睡眠醫學簡介．中華民國航空醫學會刊，2，67-72。
何惠娟、蕭淑代（2008）．運用羅氏理論於一位高齡初孕婦住院安胎的護理經驗．新臺北護理期刊，10（2），69-79。
林淑玲（2010）．高危險妊娠的護理．於余玉眉總校閱，產科護理學（六版，425-486頁）．新北市：新文京。
林軍廷、洪志秀（2006）．應用羅氏理論照顧一位慢性高血壓初產婦之護理經驗．高雄護理雜誌，23（1），33-44。
林立寧、張妍怡、何曉旭、李蘭（2012）．青少年之睡眠問題．台灣醫學，16（1），72-83。
林小玲、蔡欣玲（2003）．維辛式睡眠量表中文版之信效度．榮總護理，20（1），105-106。
洪淑真（2005）．機構老人白天睡眠行為之因素及其與睡眠品質之相關性探討（未發表的碩士論文）．高雄：輔英科技大學護理研究所。
胡雅玲（2006）．住院安胎孕婦之家庭的壓力與因應行為之探討．護理雜誌，53（6），45-52。
胡蓮珍、曹慈翠、宋玟錡、詹晴卉、王奕凌（2011）．醫療機構從業人員之睡眠品質及其影響因素探討．榮總護理，28（1），55－63。
紀櫻珍、吳振龍、李諭昇（2010）．影響睡眠品質之職場相關因子研究．健康促進暨衛生教育雜誌，30，35-62。
馬素華（2005）．穴位按壓於臨床護理實務之應用．護理雜誌，52（4），5-10。
教育部異體字字典（2004年，1月）．睡眠．取自http://dict.revised.moe.edu.tw/cgi-bin/newDict/dict.sh?cond=%BA%CE%AFv&pieceLen=50&fld=1&cat=&ukey=-1584068506&serial=1&recNo=0&op=f&imgFont=1
張文薰（1993）．早產及安胎產婦護理．榮總護理，10（3），265-270。
張文蓓、林佳靜（2010）．失眠之概念分析．新臺北護理期刊，12（1），63-70。
許秀彩、楊金寶、黃芳銘、黃玉書（2011）．台北縣市國小高年級學童生活習慣與睡眠品質之關係探討．幼兒教保研究期刊，7，77-93。
曾銀貞（2007）．社區老人睡眠品質及其相關因素探討（未發表的碩士論文）．臺中市：中山醫學大學護理學系。
邱曉彥、邱艷芬（2010）．睡眠品質之概念分析．護理雜誌，57（4），106-111。
郭素珍（1994）．有早產現象的產婦週產期內家庭功能的改變．護理研究，2（2），106-114。
郭仲宇（2010）．可攜式睡眠品質評估系統（未發表的碩士論文）．桃園：中原大學生物醫學工程學系研究所。
郭貞君、黃美智（1996）．孕期臥床休息的功效與副作用．護理雜誌，43（2），43-87。
陳維玲（2002）．背部按摩於心臟衰竭病患焦慮、舒適及生理指標之成效－Rogers護理（未發表的碩士論文）．高雄醫學大學護理研究所。
陳秀貞（2007）．影響大學生睡眠品質相關因素之研究-以某技術學院為例（未發表的碩士論文）．臺北市：臺灣師範大學衛生教育學系。
黃介良（2004）．穴位按摩圖典．台北：三采文化。
黃秀琴、郭憲華（2008）．一位雙胞胎孕婦安胎之護理經驗．領導護理，9（1），31-43。
黃素珍、張世沛(2012)．蘭陽地區大學生睡眠總分與運動參與行為差異比較．運動休閒餐旅研究，7(3)，65 -77。
楊慧貞、陳彰惠（2007）．經歷重複性妊娠失敗再度懷孕的高齡孕婦於住院安胎期間之行為表現．護理雜誌，54（3），53-59。
臺大醫院母胎兒醫學中心（2009）．高危險妊娠-臺灣現況．取自http://www.ntuh.gov.tw/obgy/us/service-fmc.pdf
廖士程、李明濱、李宇宙（2000）．睡眠的生物學基礎及臨床的意義．臺灣醫學，4（6），652-664。
蔡孟書、吳英黛、高宓憶（2008）．運動訓練改善過重／肥胖兒童或青少年血壓的效果：統合分析．物理治療，33（3），161-167。
劉引玉、周桂如、謝佳容（2009）．老人睡眠品質與相關測量問題之探討．長期照護雜誌，13（2），231-242。
龔麗、李麗君（2012）．照顧一位新移民婦女早期破水的安胎護理經驗．領導護理，13（1），46-56。
Akerstedt, T. , Hume, K. , Minors, D. , & Waterhouse, J. (1994). The subjective meaning of good sleep, an intraindividual approach using the Karolinska sleep diary. Perceptual Motor Skills, 79(1), 287-296.
Brown, F. C., Buboltz, W. C., & Scoper, B. (2002). Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behavioral Medicine, 28(1), 33-39.
Bolge, S. C. , Doan, J. F. , Kannan, H. , & Baran, R.W. (2009). Association of insomnia with quality of life, work productivity, and activity impairment. Quality of Life Research, 18(4), 415-422.
Becker, P. M., & Jamieson, A. O. (1992). Common sleep disorder in the elderly: Diagnosis and treatment. Geriatrics, 47(3), 41-48.
Beebe, K. R. , & Lee, K. A. (2007). Sleep disturbance in late pregnancy and early labor. Journal of Perinatal & Neonatal Nursing, 21(2), 103-108.
Buysse, D. J. , Reynolds, C. F. III, Monk, T. H. , Berman, S. R. , & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.
Clare, M.H. (2004)．世紀按摩全書：各國按摩技巧指南（林瑞瑛譯）．臺北市：新女性。（原著出版於2001）
Evans, M. L. , Dick, M. J. , Shields, D. R. , Shook, D. M. , & Smith, M. B. (1998). Postpartum sleep in the hospital: Relationship to taking-in and Taking-hold. Clinical Nursing Research, 7(4), 379-389.
Ellis, V. , Hill, J. & Campbell, H. (1995). Hospice techniques: Strengthening the family unit through the healing power of massage. The American Journal of Hospice & Palliative Care, 12(5), 19-21.
Field, T. , Diego, M. , & Hernandez-Reif, M. (2007). Massage therapy research. Developmental Review, 27, 75-89.
Field, T. , Grizzle, N. , Scafidi, F. , Abram, S. & Richardson, S. (1996). Massage therapy for infants of depressed mothers. Infant Behavior and Development, 19, 107-112.
Heaman, M. (1998). Psychosocial impact of high-risk preg¬nancy: Hospital and home care. Clinical Obstertrics and Gynecology, 41(3), 626-639.
Hedmana, C. , Pohjasvaara, T. , Tolonen, U. , Suhonen-Malm, A. S. , & Myllyla , V. V. (2002). Effects of pregnancy on mothers’ sleep. Sleep Medicine, 3, 37-42.
Hoffman, B. L. , Horsager, R. , Roberts, S. W. , & Rogers, V. L. (2011). Williams Obstetrics( 23th ed). San Francisco: The McGraw-Hill.
Iliescu, E. A. , Coo, H. , McMurry, M. H. , Meers, C. L. , Quinn, M. M. , Singer, M. A. (2003). Quality of sleep and health related quality of life in haemodialysis patients. Nephrology Dialysis Transplantation, 18(1), 126-132.
Johns, M. W. (1971). Methods of assessing human sleep. Archives of Internal Medicine, 127(3), 484-492.
Ko, S. H. , Chang, S. H. , & Chen, C. H. , (2010). A comparative study of sleep quality between pregnant and nonpregnant Taiwanese women. Journal of Nursing Scholarship, 42(1), 23-30.
Koch, S., Haesler, E., Tiziani, A., & Wilson, J. B. (2006). Effectiveness of sleep management strategies for residents of aged care facilities: Findings of a systematic review. Journal of Clinical Nursing, 15(10), 1267-1275.
Krueger, P. M., & Friedman, E. M. (2009). Sleep duration in the United States: A cross-sectional population-based study. American Journal of Epidemiology, 169(9), 1052-1063.
Littner, M. , Kushida, C. A. , Anderson, W. M. , Bailey, D. , Berry, R. B. , Davila, D. G. , et al. (2003). Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: An update for 2002. Sleep, 26(3), 337-341.
Lee, A. J. , & Lin, W. H. (2007). Association between sleep quality and physical fitness in female young adults. Journal of Sports Medicine and Physical Fitness, 47(4), 462-467.
Löken, L. S. , Wessberg, J. , Morrison, I. , McGlone, F. , & Olausson, H. (2009). Coding of pleasant touch by unmyelinated afferents in humans. Journal of Nature Neuroscience, 12(5), 547-548.
Maloni, J. A. (1993). Bed rest during pregnancy: Implication for nursing. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 22(5), 422-426.
Maloni, J. A. (2010). Antepartum Bed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth. Biological Research for Nursing, 12(2), 106-124.
Maloni, J. A. , & Kasper, C. E. (1991). Physical and psychosocial effects of antepartum hospital bed rest: A review of the literature. Image, 23, 187-192.
McDowell, J. , Mion, L. , Lydon, T. , & Inouye, S. (1998). A nonpharmacologic sleep protocol for hospitalized older patients. Journal of the American Geriatrics Society, 46(6), 700-705.
Meek, S. S. (1993). Effects of slow stroke back massage on relaxation in hospice clients. Journal of Nursing Scholar¬ship, 25(1), 17-21.
Merriam-Webster. (2011). Dictionary and thesaurus - Merriam-Webster Online. From: http://www.merriam-webster.com/dictionary/disturbance.
Mitzel-Wilkinson, A. (2000). Massage therapy as a nursing practice. Holistic Nursing, 14(2), 48-56.
Moyer, C. A. , Rounds, J. , & Hannum, J. W. (2004). A meta-analysis of massage therapy research. American Psychological Association, 130(1), 3-18
Nilsson, M. E., & Berglund, B. (2006). Noise annoyance and activity disturbance before and after the erection of a roadside noise barrier. The Journal of the acoustical Society of America, 119(4), 2178-2188.
Nebes, R. D. , Buysse, D. J. , Halligan, E. M. , Houck, P. R. , & Monk, T. H. (2009). Self-reported sleep quality predicts poor cognitive performance in healthy older adults. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 64(2), 180-187.
Oxford English Dictionary Online. (2012). Sleep. Retrieved from http://dictionary.oed.com.
Okun, M. L. , & Coussons-Read, M. E. (2007). Sleep disruption during pregnancy: How does it influence serum cytokines? Journal of Reproductive Immunology, 73, 158-165.
Parrott, A. C. , & Hindmarch, I. (1978). Factor analysis of a sleep evaluation questionnaire. Psychological Medicine, 8(2), 325-329.
Plaskota, M. , Lucas, C. , Pizzoferro, K. , Saini, T. , Evans, R. , & Cook, K. (2012). A hypnotherapy intervention for the treatment of anxiety in patients with cancer receiving palliative care. International Journal of Palliiative Nursing, 18(2), 69-75.
Pigeon, W. R. , & Perlis, M. L. (2006). Sleep homeostasis in primary insomnia. Sleep Medicine Reviews, 10(4), 247-254.
Richards, K. C. (1998). Effect of a back massage and relaxation intervention on sleep in critically ill patients. American Journal of Critical Care, 7(4), 288-299.
Richards, K. C. , Gibson, R. , & Overton-McCoy, A. L. (2000). Effects of massage in acute and critical care. American Association of Critical-Care Nurses: Clini¬cal Issues, 11(1), 77-96.
Richards, K. C. , O’Sullivan, P. S. , & Phillips, R. L. (2000). Measurement of sleep in critically ill patients. Journal of Nursing Measurement, 8(2), 131-144.
Rodriguez-Munoz, A., Moreno-Jimenez, B., Fernandez-Mendoza, J.J., Olavarrieta-Bernardino, S., de la Cruz-Troca, J.J., Vela-Bueno, A. (2008). Insomnia and quality of sleep among primary care physicians: a gender perspective. Rev Neurol, 47(3), 119-123.
Rowen, B. (2002). Massage: Touch Therapy for Relaxation. United Kingdom: New Holland Publishers.
Schweiger, M. S. (1972). Sleep disturbance in pregnancy. American Journal of Obstetrics and Gynecology, 114, 879-882.
Sadeh, A. , & Acebo, C. (2002). The role of actigraphy in sleep medicine. Sleep Medicine Reviews, 6, 113-124.
Santiago, J. R. , Nolledo, M. S. , Kinzler, W. , & Santiago, T. V. (2001). Sleep and sleep disorders in pregnancy. Annals of Internal Medicine, 134(5), 396–408.
Saleh, D. K. , Nouhi, S. , Zandi, H. , Lankarani, M. M. , Assari, S. , & Pishgou, B. (2008). The quality of sleep in coronary artery disease patients with and without anxiety and depressive symptoms. Indian Heart Journal, 60(4), 309-312.
Soden, K. , Vincent, K. , Craske, S. , Lucas, C. , & Ashley, S. (2004). A randomized controlled trial of aromatherapy massage in a hospice setting. Palliative Medicine, 18, 87-92.
Snyder-Halpern, R. , & Verran, J. A. (1987). Instrumentation to describe subjective sleep characteristics in healthy subjects. Research Nursing & Health, 10(3), 155-163.
Stewart, A. L. , & Ware, J. E. (1992). Measuring functioning and well-being: The medical outcomes study approach. Durham, NC: Duke University Press.
Tsai, S.Y. , Kuo, L. T. , Lai, Y. H. , & Lee, C.N. (2011). Factors associated with sleep quality in pregnant women. A prospective observational study. Nursing Research, 60(6), 405-412.
Ujhely, G. B. (1979). Touch: reflection & perceptions. Nursing Forum, 18(1), 19-32.
Wang, J. S., Yang, Y. T. C., Chiang, W. C., & Lin, C. W. (2011). Using a wearable physical activity sensor system for sleep/ wake states detection. Sleep and Biological Rhythms, 9(4), 378.
Yang, C. M., Spielman, A. J. & Glovinsky, P. (2006). Nonpharmacologic strategies in the management of insomnia. Psychiatric Clinics of North America, 29(4), 895-919.
Yang, Y. T. C., Wang, J. S., Lin, C. W., & Chiang, W. C. (2011). Relations between sleep activity indices and Verran and Snyder-Halpern (VSH) sleep scale using statistical analysis. Sleep and Biological Rhythms, 9(4), 377-378.