Date of Award

Spring 5-22-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Autumn Roque, DNP, APRN, PMHNP-BC

Abstract

Objective: This evidence-based practice project aims to increase provider implementation of gold standard insomnia treatment, Cognitive Behavioral Therapy for Insomnia (CBT-I), by integrating CBT-I Coach app education into initial psychiatric evaluations within a VA psychiatric emergency clinic (PEC).

Background: Insomnia is highly prevalent among veterans and commonly co-occurs with PTSD, depression, and anxiety. National guidelines from the VA, DoD, and American Academy of Sleep Medicine endorse CBT-I as first-line treatment. Despite this, pharmacotherapy is the dominating intervention in psychiatric emergency settings. The CBT-I Coach app offers evidence-based CBT-I as a free, VA-developed digital tool, but it remains underutilized in acute psychiatric settings. This project addresses gaps in guideline adherence, provider education, digital health integration, and veteran access to insomnia care.

Methods: A brief provider in-service on CBT-I Coach app and documentation was integrated into intake workflows. Providers administered the Insomnia Severity Index (ISI), app education, and a VA-approved handout to veterans with ISI scores ≥15, with a planned two-week follow-up. Outcomes included provider acceptability, appropriateness, feasibility, CBT-I offers, app acceptance, and app utilization rates.

Results: Findings included CBT-I app offer and acceptance rates, reasons for refusal, and provider feasibility and acceptability ratings before and after implementation. Although significant improvement was defined as an ISI reduction of ≥8 points, follow-up ISI data was not obtained. Additional findings included patient-level barriers, clinic challenges, and provider confidence with implementation.

Conclusion: This project evaluated the feasibility of integrating digital CBT-I into routine psychiatric visits to support greater alignment with VA guidelines and expand access to evidence-based insomnia treatment.

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