【作者】 王艳波；

【导师】 刘晓虹；

【作者基本信息】 第二军医大学 ， 护理学， 2011， 博士

【摘要】 【目的】以意外创伤者(车祸及工伤)为研究对象,深入了解伤者的创伤后成长体验、发生过程及创伤后成长现象在此人群中的发生情况,并分析其成长的主要影响因素及策略,提出可能的促进此类伤者创伤后成长的干预模式,为开展临床心理干预提供依据。【方法】1、应用文献分析,描述国内外创伤后成长的研究进展及关注热点,总结归纳影响创伤后成长发生的主要因素。应用理论分析,探讨创伤后成长可能的发生机制及用于指导本研究的理论依据。2、采用横断面研究设计,以量性与质性研究相结合的方法收集资料。量性研究采用问卷调查法,以修订后的创伤后成长量表,大五人格量表,事件影响程度量表修订版及特质应对方式问卷为测评工具,收集180例意外创伤者创伤后成长、人格特质、创伤后情绪痛苦、应对方式等资料。采用SPSS16.0软件对调查性研究数据进行统计分析。应用相关分析探讨创伤后成长与人口统计学及创伤相关特征变量、不同人格特质、创伤后情绪痛苦变量及不同应对方式的相关性。应用阶层多元线性回归分析探讨相关变量对伤者创伤后成长总分的解释力。质性研究采用诠释现象学分析法,对10位意外创伤者进行深入访谈,探讨其创伤后成长体验、内涵、发生历程及影响创伤后成长发生的主要因素与策略。3、基于理论研究,量性研究及质性研究结果,初步构建适合临床护士操作的促进意外创伤者创伤后成长的干预模式。【结果】1、在文献分析及理论研究基础上形成指导本研究的理论框架。2、量性研究结果:①本研究意外创伤者报告了较高的创伤后成长水平。其中以“我能更好地珍惜每一天(91.11%)”;“我对他人有了更多的同情(88.89%)”;“我体会到人是多么美好(87.22%)”三项成长水平最高。②意外创伤者的年龄、婚姻、文化程度、创伤类型、创伤客观严重性,主观的痛苦程度、大五人格中的外倾性、责任感、宜人性、开放性,反应情绪痛苦的侵入、逃避及高唤醒维度及积极应对和消极应对方式均会不同程度影响意外创伤者的创伤后成长。③在回归分析中,各相关变量对创伤后成长总分的总解释力达24.1%,其中人口统计学及创伤特征相关变量贡献9.1%的解释力,人格特质变量贡献7.8%的解释力,情绪痛苦及应对方式变量贡献7.2%的解释力。3、质性研究结果:①意外创伤者的创伤后成长主要表现在“存在意义的积极构建、自我认知的转变、与他人关系的转变及人生哲学的转变”四个主题。②勾画出伤者创伤后成长发生的时间轨迹为“毁灭期、接受期、重建与整合期”三阶段,其对应的主要心理体验为“深陷痛苦,努力成长及实现成长”。③伤者创伤后成长的主要促进因素涉及个人资源、对创伤信息的认知加工、应对和环境资源。4、基于质性研究,辅以量性研究,提出意外创伤者创伤后成长的发生过程模型。5、结合理论研究及创伤后成长发生过程模型,初步形成意外创伤者创伤后成长的干预模式:①强调意外创伤者是实现创伤后成长的主体,伤者的个人资源(人格特质及既往经历)、对创伤的认知加工、应对及环境资源(家庭、医院、社区背景下的人际互动)可促进其成长。②干预目标可聚焦于提升“自我、与他人关系、人生哲学”三方面的成长。③干预原则依据“毁灭、接受、重建与整合”三阶段,分别采取“感知判断、参与分享、挑战学习”的原则。③干预策略可着重提升伤者对个人资源的认知;紧扣认知加工关键期促进有效应对;营造利于成长的人际氛围,提升对社会支持的感知与满意度。【结论】1、本研究意外创伤者报告了较高的成长水平,其创伤后成长主要表现在自我、与他人关系及人生哲学三方面,但对创伤后成长内涵的理解需结合特定背景与文化。2、本研究提出创伤后成长发生过程模型,将为临床实践者了解意外创伤者创伤后成长发生过程提供参考。3、本研究初步构建了意外创伤者创伤后成长的干预模式,明确了促进此类伤者创伤后成长的干预目标、原则及临床干预切入点和策略,具有科学性和临床实用性,可指导临床护士将创伤后成长理念与临床心理护理有效整合。4、干预模式应用中需注意,创伤后成长干预重在理念更新而非干预方法的创新;伤者本人是实现其成长的主体;相信每个人皆有成长可能,但不易均以创伤后成长做为伤者心理康复的目标。5、后续研究可着手针对临床伤者的干预试验及干预后效果评价,以验证干预模式效用,并论证创伤后成长对提升意外创伤者远期生存质量的贡献。更多还原

【Abstract】 [Objectives]To understand the level of posttraumatic growth (PTG) in accidentally injured patients after Motor vehicle accidents and work-place accidents, their posttraumatic growth experiences and process. To identify factors and strategies that influence PTG of the patients and to develop an appropriate intervention model to facilitate PTG of the accidentally injured patients.[Methods]1. Literatures analysis was conducted to describe the research progress and hot spots of PTG, and summarize the influencing factors of PTG. Theoretical analysis was used to explore the appropriate process of posttraumatic growth and the theoretical foundation of this study.2. By using mixed methods design, a cross-sectional study was conducted. The quantitative study was conducted in 180 accidentally injured patients. The instruments include the revised posttraumatic growth inventory(PTGI), the big five inventory(BFI),the impact of event scale-revised(IES-R), and the trait coping style questionnaire(TCSQ) to measure PTG, personality trait, emotional distress and coping style, respectively. Pearson correlations were used to examine the relationships between PTG and demographic and injured characteristics, personality characteristics, emotional distress and coping style. A hierarchical multiple regression analysis was performed to examine the contribution of correlated variables to the report of growth. The qualitative study by using semi-structured in-depth interview was conducted in 10 accidentally injured patients. Transcripts were analyzed using interpretative phenomenological analysis to explore the experiences, process and main influencing factors of patients’posttraumatic growth.3. An initial intervention model to facilitate PTG of accidentally injured patients was developed based on theoretical analysis, quantitative study and qualitative study.[Results]1. By literature review and theoretical analysis, an initial conceptual framework to guide the whole research was developed.2. Quantitative study results:①A ccidentally injured patients in this study reported higher prevalence of PTG compared with other reports. Top three of the most frequently reported growth experience were‘I can better appreciate each day (91.11%)’,‘I have more compassion for others (88.89%)’, and‘I learned a great deal about how wonderful people are (87.22%)’.②M arital status, age, educational level, type of traumatic event, injury severity, and subjective distress of demographic and injured characteristics were positively correlated with PTGI and its subscales. Extraversion, agreeableness, conscientiousness, openness of the BFI , negative coping and positive coping of TCSQ, and inversion, avoidance and hyperarousal of IES-R were all positively correlated with PTGI and its subscales.③All the variables entering the model could explain 24.1% of the variance of posttraumatic growth. Variables of demographical and injured characteristics accounted for 9.1% of the variance of posttraumatic growth. Additionally variables of personality trait explained an additional 7.8% of the variance of growth while variables of emotional distress and coping style explained an additional 7.2% of the variance of growth.3. Qualitative study results:①PTG experiences in accidentally injured patients can be included into four themes which were positive construction of meaning, perception of self, perception of connection and perception of life philosophy.②Trajectory of PTG occurred can be generalized to three stages which were devastation, acceptation, rebuilding and integration. The psychological experiences of injured patients could be described as‘deeply distress, growth effort, and approaching growth.’③T he main influencing factors of PTG included personal resources, cognitive progress about traumatic information, coping and environmental resources.4. Based on qualitative results, comparing quantitative results, a stage model of PTG in accidentally injured patients were developed.5. An initial intervention model to facilitate PTG of accidentally injured patients was developed.①The model highlighted the growth as the injured patients approached it. Personal resources (such as personality trait and pre-trauma experiences), cognitive processing about traumatic information, coping strategies and environmental resources were the main factors influencing PTG in accidentally injured patients.②In terms of intervention goals, clinicians should focus on‘perception of self, perception of relationship with others and perception of life philosophy’to foster PTG in injured patients,③According to the psychological process of the injured patients including‘devastation, acceptation, rebuild and integration’, nurses should follow the interventional principles of perception and judgments, engagement and share, challenge and study’, respectively.④In terms of strategies, nurses should focus on increasing the perception of personal resources, promoting the cognitive processing and effective coping, and establishing an atmosphere perception and safety of social support.[Conclusion]1. Accidentally injured patients in this study reported high level of posttraumatic growth. Their posttraumatic growth includes three dimensions which were perception of self, perception of relationship with others and perception of life philosophy. But how to understand the meaning of PTG should based on particular background and culture.2. The stage model of posttraumatic growth developed in this study could be the evidence for clinical works to understand the posttraumatic growth in accidentally injured patients.3. The intervention model in this study, including intervention goals, intervention principles, and the key points and strategies of facilitating PTG of accidentally injured patients, is scientific and practicable for clinical work.It could instruct nurses how to integrate the new perspective of PTG into clinical psychological practice.4. There’re some critical aspects and concerns about the clinical utility of this developed intervention model. First, the concept of PTG adds a new perspective, not a new treatment, into psychotherapy. Second, notice growth as the injured patients approaches it. Third, believe that PTG is possible for all injured patients but remember that the presence of growth should not be regard as goals of psychological well beings.5. Further interventional study should be done to examine the effective of the intervention model, to determine the contribution of posttraumatic growth to long-term quality of life in accidentally injured patients.更多还原