Effect of a structured Orem’s self-care model nursing intervention on sleep quality and academic self-efficacy in nursing students

Starting university is a significant milestone in one’s life [1]. However, research indicates that many students struggle to maintain healthy lifestyle habits during this transition. The rigorous demands of academic life can disrupt daily routines, leading to poor lifestyle choices [2]. Student life often comes with increased freedom and less supervision, which can result in lower physical activity and the adoption of unhealthy habits like smoking and drinking, all while juggling numerous leisure activities [3, 4].

Poor sleep quality is prevalent for students as they adapt to the academic environment [4]. Despite sleep’s critical role in academic success and overall well-being, many students prioritize studying and completing assignments over getting enough rest [5]. This neglect often results in sleep disturbances, which can lead to symptoms of anxiety and depression, diminish the quality of life, foster negative views of the educational experience, and increase the risk of burnout syndrome [6].

Nursing students, in particular, experience sleep disturbances due to academic pressures, long study hours, and stressful clinical situations [7]. Research indicates that these disruptions negatively affect their daily behaviors and quality of learning [8]. Insufficient and poor-quality sleep can lead to decreased concentration, memory issues, and reduced problem-solving abilities [9]. Additionally, lack of sleep contributes to increased anxiety, depression [7], and decreased motivation [10], which can have long-term negative consequences on mental and physical health. Various studies have shown that self-care intervention programs can help improve sleep quality [3, 11, 12] and reduce stress [13‐15] in university students, including nursing students.

Self-efficacy beliefs, as introduced by Bandura, play a vital role in influencing students’ quality of life and academic performance [16]. Essentially, self-efficacy refers to an individual’s confidence in their ability to succeed in specific tasks [17]. In an academic context, academic self-efficacy pertains to a student’s belief in their capacity to learn, solve problems, and achieve success [18]. This belief serves as a strong motivator, encouraging students to perform at their best and pursue positive outcomes [19]. Higher levels of academic self-efficacy are associated with improved academic performance and greater resilience, often referred to as academic buoyancy [20].

Despite the motivating influence of academic self-efficacy, nursing students face significant hurdles in cultivating this essential belief, particularly in balancing the academic pressures and emotional demands of clinical training [21, 22]. The intense workload, combined with high expectations in clinical settings, often leaves little room for students to practice self-care or effectively manage their well-being. Insufficient support [23] and the struggle to maintain a balance between academic responsibilities and personal health can contribute to low self-efficacy among nursing students [24, 25]. Additionally, the fear of making mistakes in clinical settings can undermine their confidence, leading to anxiety that hinders performance and overall learning [26].

Self-care is a successful method for increasing sleep quality and self-efficacy [27, 28]. However, many students struggle to maintain healthy behaviors such as physical activity, nutrition, and sleep [29, 30]. The Orem Self-Care Model offers a structured framework for addressing these concerns [31], emphasizing the need to educate people about self-care activities, developing tailored care plans, and cultivating supportive relationships [32]. Interventions based on Orem’s approach have been proven to help people manage stress, reduce anxiety and exhaustion, and improve sleep quality [27, 29‐33].

This study looks at how a structured nursing intervention based on the Orem Self-Care Model affects nursing students’ sleep quality and academic self-efficacy. It covers both the physical and psychological elements that affect their overall health.

This study revealed that the average sleep quality score in both the control and test groups was greater than 5, indicating poor sleep quality. These findings are consistent with previous studies that have reported unfavorable sleep quality among students in Iran [39, 40] and outside Iran [41, 42]. For example, a study by Ali Mirzaei et al. revealed that 71% of nursing students had poor sleep quality [39].

The average academic self-efficacy score in the test group before the intervention was average. Previous studies conducted in Iran [43‐45] and outside Iran [18, 46] have also reported that academic self-efficacy among students is average. For instance, a study by Farghedani et al. reported that 57.4% of medical students had moderate academic self-efficacy [44].

The results of this study suggest that teaching self-care activities based on the Orem model to nursing students can significantly improve sleep quality. While no studies have precisely measured the effect of Orem’s self-care model on the sleep quality of healthy individuals, studies on the effect of self-care on the sleep quality of sick individuals have shown promising results. For instance, Dahmardeh et al. reported that self-care interventions based on Orem’s model improved sleep quality in patients with multiple sclerosis (MS) [47]. Similarly, Aliakbari et al. reported that an intervention based on Orem’s self-care model improved the sleep quality of patients with MS [39]. Furthermore, Benedetto et al.‘s study showed that individuals with better self-care behaviors had better sleep quality [3].

Although studies using educational interventions based on different approaches have shown the ability of such interventions to improve sleep quality, self-care training can be instrumental in improving the hours and quality of sleep by facilitating the planning of daily activity schedules, providing a suitable sleeping environment, and managing stress. This study’s “balance between activity and rest” dimension included instructions for creating a suitable sleeping environment. Li M. et al.‘s study showed that interventions targeting the dormitory environment can improve students’ sleep quality [5]. Additionally, Hershner and O’Brien’s study revealed that a sleep training program significantly improved sleep quality in students [48].

This research indicates that teaching nursing students’ self-care activities based on the Orem model can significantly improve their academic self-efficacy, as observed in other studies. Although researchers have not found a study that measured the effect of Orem’s self-care model on sleep quality and academic self-efficacy, other studies have demonstrated the positive impact of Orem’s self-care model on self-esteem and self-efficacy in various populations. For example, Hashemlo et al. [49] showed that the implementation of Orem’s self-care program improved the self-esteem of older adults living in nursing homes, while Masoudi et al. found that using a self-care program designed based on Orem’s self-care model improved the self-esteem of patients with MS [50]. Additionally, Bozoergzadeh et al. found that using the Orem self-care model improved the self-efficacy of hemodialysis patients [28]. Although different educational interventions, such as group training and short-term educational interventions, have also been shown to improve academic self-efficacy, studies have linked high-stress levels to low academic self-efficacy. Self-care training can help improve academic self-efficacy through the planning of stress management programs. In this study, students were taught ways to reduce stress in the form of developmental needs, such as by “predicting and providing care in order to prevent the occurrence of complications and destructive and harmful conditions that are effective in human development, or by overcoming and eliminating these complications according to different circumstances.” Like this study, Şenocak et al. found that teaching problem-solving solutions to nursing students increases their academic self-efficacy [30]. The study also highlighted solutions related to time management and educational planning in the dimension of “establishing and maintaining conditions that support life processes and promote evolutionary processes that lead to the promotion and advancement of humans to higher levels of human structure.” Additionally, Wernersbach et al. showed that implementing a study skills course increases students’ academic self-efficacy [51].

Additional subgroup analyses by age, gender, and semester were carried out to acquire a better understanding of the intervention’s impact. The data revealed that younger students (ages 20–22) and those in earlier semesters (third and fourth) benefited more significantly from the intervention, notably in terms of improved sleep quality. This means that these groups are more receptive to self-care education because they are more adaptable and open to behavioral change. These findings are consistent with prior research, which found that younger students are more open to lifestyle changes [52, 53].

In comparison to similar research, the outcomes of this intervention are consistent with prior findings that highlight the usefulness of structured self-care programs in improving sleep quality and self-efficacy. For example, Hershner and O’Brien found that focused treatments meant to establish a favorable sleep environment resulted in considerable improvements in student sleep quality [48]. Similarly, Şenocak and Demirkıran found that developing problem-solving abilities among nursing students improved academic self-efficacy, which aligns with our study’s self-care practices [30].

This study showed that training based on the Orem self-care model had significant positive effects on sleep quality and academic self-efficacy of nursing students. After the intervention, the experimental group exhibited significant improvements in sleep quality and academic self-efficacy scores, confirming the effectiveness of the intervention. These changes may be attributed to the students’ heightened awareness of self-care principles and the cultivation of healthy habits related to rest and activity, which ultimately resulted in better sleep quality and increased academic self-confidence. The study clearly demonstrated that self-care training can serve as an effective tool for enhancing students’ mental health and academic performance. These findings emphasize the importance of including self-care training in nursing education programs and suggest that this type of training be offered more widely in different academic courses.