| Objectives To explore the level of rumination and the possible variables that could predict PTG in the Percutaneous coronary intervention(PCI)patients;To analysis the role of rumination,social support,general self-effect,emotion pain and PTG so as to develop the possible mechanism of rumination on PTG;To explore the characteristics of cognitive processing for supplement information by qualitative research;To develop a intervention model of cognitive processing for PCI patients and add clinical empirical evidence to nursing theory for PCI patients.Methods1.Literatures analysis was conducted to describe the research progress of cognitive processing on PTG.Theoretical analysis was used to explore the mechanism of cognitive processing on PTG and theoretical foundation of this study.2.Using mixed methods design which is give priority to with quantitative research and the complementary of qualitative research method to collect data.A questionnaire survey of 337 Percutaneous coronary intervention patients.The instruments include the self-designed demographic and injury-related information questionnaire,Chinese version of posttraumatic growth(PTGI-C),event related rumination Inventory(ERRI),general self-efficacy scale(GSES),social support rating scale(SSRS)and impact of event scale-revised(IES-R),to measure posttraumatic growth,emotion pain,cognitive processing,self-efficacy and social support of PCI patients.Data were processed Using the SPSS19.0software.A stepwise multiple regression analysis was performed to examine the level of rumination and the possible variables that could predict PTG.A hierarchical regression analysis was performed to examine the influence of correlated variables to the report of growth.Pearson correlations were used to examine the relationship between rumination and demographic and injured characteristics,emotion pain,social support,self-efficacy and PTG.Using structural equation model(SEM)to develop the mechanism of cognitive processing on PTG.The qualitative research by using semi-structured in depth interview was conducted in 17 Percutaneous coronary intervention patients.Using interpretative phenomenological analysis to explore the characteristics of cognitive processing on the percutaneous coronary intervention patients.3.An initial cognitive processing intervention model of percutaneous coronary intervention patients was developed based on theoretical study,quantitative research and qualitative research.Results1.An initial theoretical framework in order to guide the whole study was based on literature analysis and theoretical research.2.Quantitative research results: Firstly,The average score of intrusive rumination and deliberate rumination in percutaneous coronary intervention patients was 15.25±6.30,16.56±6.14,respectively.Secondly,education level,family income and CHD history can significantly predict the level of intrusive rumination,all the variables could explain28.4%(R2=28.4,P<0.01)of the variance of intrusive rumination,Among them education level and family income were positively predict the level of intrusive rumination(β scores were 0.392 and 0.286),while CHD history could negatively predict the level of intrusive rumination(β scores was-0.136).Subjective trauma severity,education level and family income can significantly predict the level of deliberate rumination,all the variables could explain 49.3%(R2=49.3,P<0.01)of the deliberate rumination,among them subjective trauma severity was negatively predict the level of deliberate rumination(β score was-0.452),while education level and family income could positively predict the level of deliberate rumination(β scores respectively were 0.336 and 0.164).Thirdly,PTG of PCI patients was positively correlated with cognitive processing,negative correlation with emotion pain(r=-0.795,P<0.001);positively correlated with social support and general self-efficacy(r=0.451,0.294,P<0.001).Fourthly,All the variables could explain 71.9% of the variance of PTG.Variables of demography and disease characteristic accounted for26.4% of the variance PTG.Additionally variables of social support and general self-efficacy explained an additional 15.9% of the variance of PTG,while variables of emotion pain explained an additional 25.7% of the variance of PTG.Fifthly,Structural equation modeling analysis showed that cognitive processing directly positive effect PTG, meanwhile cognitive processing acts as a partial mediator in the relationship between emotion pain and PTG(deliberate rumination accounted for 3.02% of the total effects;intrusive rumination accounted for 17.6% of the total effects);Deliberate rumination directly positive effect PTG,meanwhile deliberate rumination acts as a partial mediator in the relationship between social support,general self-efficacy and PTG(the mediated effect social support accounted for 15.11% of the total effects,the mediated effect general self-efficacy accounted for 7.67% of the total effects).3.Qualitative research results: the cognitive processing in percutaneous coronary intervention patients can be summarized as three stages,that is confusion stage,coping stage and acceptance stage,meanwhile the psychological process of the PCI patients including ‘disaster-coping-growth’.4.Based on the qualitative and quantitative research results,a intervention model of cognitive processing in percutaneous coronary intervention patients was developed.Conclusions1.The average of level of cognitive processing in percutaneous coronary intervention patients was medium.2.Due to education level,family income,PCI history and subjective trauma severity can significantly predict the level of cognitive processing,clinical nursing should pay attention to lower cultural degree,lower family income,Long CHD history(1 ~ 5 years)and high scores of trauma severity subjective PCI patients,in order to facilitate patients’ rumination and then improve their level of cognitive appraisal.3.PTG of PCI patients was postively correlated with cognitive processing,social support and general self-efficacy,negatively correlated with emotion pain.Variables of demography and disease characteristic also could influence of the PTG.4.In order to promote PCI patients’ posttraumatic growth this methods can be applied by enhancing social support,improving their self-efficacy and relieving emotion pain and so on.5.The cognitive processing of Percutaneous coronary intervention patients includes:confused stage,coping stage and acceptance stage.6.An initial cognitive processing intervention model in percutaneous coronary intervention patients was developed,which can provide theoretical basis for the clinical intervention. |
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