Research On The Gratitude Model Of Health Promotion In Patients After Coronary Artery Stent Implantatation

【Objectives】Taking patients after coronary artery stent implantatation as research object，this papertries to gain an intimate knowledge of the related mechanism between the gratitude and itshealth correlated variables;explore how the patients after coronary artery stentimplantatation apply the gratitude to build the capital of the patients’ psychologicalgrowth,relieve the depression and anxiety,and raise the feeling of happiness as well as theability of health behavior ability; and then explores the interaction mechanism of thegratitude on its health correlated variables to construct the gratitude model of healthpromotion of post-operation patients after coronary artery stent implantatation.The studyaimed to help clinical nurses and community nurses have a better understanding of theprotection mechanism that gratitude plays its role in promoting the health of patients aftercoronary artery stent implantatation,further to provide evidence and proof to the implementof psychological intervention program on gratitude.【Methods】1. Based on literature review,the paper describes the research progress and theconcern of the gratitude at home and abroad and summerizes the health variables thatgratitude can influence.Using theory analysis this study explores the possible interactionmechanism of the gratitude on its health correlated variables and the theoretical frameworkthat can guide this research.2. By the questionnaire survey,carrying out a cross-sectional study,the paper tests theapplicability of the gratitude scale in older age groups of China.To collect the data such asgratitude,personality traits,depression and anxiety,social support,coping styles,Subject WellBeing (SWB),health behavioral competence,etc,175patients after coronary artery stentimplantatation were tested by assessment tools such as modified gratitude questionnairesurvey,NEO PI-R,the revised edition of the mental toughness scale,hospital anxiety anddepression scale (HADS),traits coping styles questionnaire (TSCQ),Newfoundlandhappiness scale,understanding social support scale(PSSS),and health behavioralcompetence scale,etc. Data were analyzed by SPSS18.0(Statistic Package for SocialScience).The correlation of the gratitude and human demography,the correlatedcharacteristic variables of intervention operation,different personality traits,toughness,depression and anxiety,social support,different coping styles,SWB,and health behavioralcompetence were analyzed by correlation analysis.The effects of the gratitude on the correlated variables of health promotion were determined by the hierarchical analysis.3. Through the longitudinal study design,the data were collected by both qualitativeand quantitative stusy.Based on the literature review,the theory analysis and the outcome ofquestionnaire survey,we continued to explore the track and dynamic changes of healthcorrelated variables,such as gratitude,resilience,depression,and wellbeing during the periodfrom discharging and three months after returning back to the community;a gratitudepromotion model of patients after coronary artery stent implantatation in both the hospitaland community were also built.4. Narrative analysis was used in Qualitative study, and8Coronary artery stentingpatients was in-depth interviewed to explore their experience and understanding ofgratitude and the affection of gratitude to the postoperative mentality course,the perceptionof life and their postoperative life when they returned to communities and families.Itclarified the role of gratitude in health promotion process of coronary artery stentingpatients and made the further interpreting of gratitude model which built on quantitativeresearch.5.Localization gratitude intervention framework was build based on literature research,theoretical research, qualitative interviews, as well as the expert panel for somemodification.Then Triangulation method was used for the both in-depth interviewed andgratitude diary analyse of13Coronary artery stenting patients who had alreadyexperienced the whole process of gratitude intervention. It aims to explore psychologicalexperience and the influence on the post-operative life, to get aware of their life attitude,health awareness as well as the change of cognition and behavior during the process ofpost-operative rehabilitation and health promotion after gratitude intervention so that tofurther explore the more suitable strategies of gratitude interventions for health promotionfor the Chinese patients with coronary stenting implanted.【Results】1. Forming a theoretical framework to guide the study on the basis of the literaturerevivew and theory analysis.2. Achievements of cross-sectional study:①The Cronbach’s alpha for the totalrevised Chinese version of GQ-6was0.651(N=261),0.737(N=175).The test-retestreliability of the total scale was0.971.The content validity index of the Chinese version ofGQ-6were item-CVI,I-CVI0.850-1.000; In the exploratory factor analysis,a two-factorsolution was found to be reasonable with the subdimensions gratitude which accounted for total66.513%of the variance in the the Chinese version of the Revised GQ-6.Using theNewfoundland Happiness Scale (MUNSH) as criterion validity,the score of Chineseversion of GQ-6are relate to the total score of MUNSH.②The general level of gratitude inpatients after coronary artery stent implantatation in this study is not high with the score of27.25±4.32. It is related to the medicare(F=2.729,P＜0.05),drinking (F=5.862,P＜0.01),exercises(F=2.839,P＜0.05) and medication compliance(F=3.062,P＜0.05) ofdemographic characteristics.The gratitude of Coronary artery stenting patients has relationswith different personal traits.The more affinity and sense of responsibility and the lessnervousness the patients have,the more gratitude they tend to show,and patients who havethe sense of responsibility (r=0.360,P＜0.01) and agreeableness personality (r=0.322,P＜0.01),show the strongest correlation.The gratitude among patients with coronary arterystenting also has correlations with anxiety and depression,subjective well-being,socialsupport,coping and health behavior ability.③In the regression analysis,by the action ofthe controlling the demographic variables,NEO PI-R and others correlation,theindependent predictive power of gratitude to the overall grade ofdepression,toughness,SWB,social support,health behavior ability is25.0%,13.9%,5.1%,1.8%and2.5%respectively.3. Achievements of longitudinal study: the scores of anxiety of patients after coronaryartery stent implantatation in there days after surgery and three months after surgery were13.36±4.87and13.70±4.96,and the scores of depression were13.12±5.09and13.52±5.12.Although the anxiety and depression declined three months after surgery compared withthree day after surgery,however,the decline was sligh and the symptoms appares noobvious ease.The patients after operation mainly adopted negative copping strategy;theSWB of patients three days and three months after operation were not high; and the overallgrade of the health behavioral competence,nutrition,exercises and health responsibility ofpatients declined compared with that of three days after operation.4. On the basis of the results of the above studies,three models were built,namelygratitude model of health promotion when patients discharging from the hospital,afterdischarge and the longitudinal pathway model of patients’ gratitude with resilience,depression,wellbeing when discharging from the hospital and three months after thedischarge.5. Qualitative study results:①G ratitude experience ofpatients with coronary arterystenting can be included into four themes which were acceptance of life,positive self strength,taste happiness and the interaction of love.②U nder the Chinese culture outlinethe gratitude interpretation of patients with coronary stent placement,the gratitude objectsmainly include the party,country,family,friends,and doctors and nurses,etc,and the gratitudefor god,nature,and themselves were not included.③P atients with high gratitude was goodat developing his or her potential to deal with the stressful events in the life effectively andwith less negative emotions; they can achieve good social adaptation and interpersonalsupport,perceive happiness in the life,and act health behavior by themselves.④Threemonths after discharge,patients with high gratitude have interpersonal interaction which isspontaneous expression of gratitude,and express experience of happiness,satisfaction morelove others in the interaction.6.Result of the effect on gratitude intervention for qualitative evaluation：①Gratitudeexperience of13patients with coronary artery stenting can be included into four themeswhich were life attitude change, interrelationships change, cognition and beliefs change aswell as the life style change.②T hisgratitude intervention scheme was considered suitablefor patients with coronary artery stenting in China. All these patients participatedenthusiasmly in the gratitude intervention,especially during the process of the late phasefor the significant compliance enhancement for the patients.③The gratitude interventionframework which designed in this study can promote patient’s personal and socialenvironment of the utilization of resources and mining, improve their better adaptation toreturn to the community and family, imcrease their happiness and health behavior ability.Major results of the gratitude intervention lies in four aspects including promoting patients’attitude towards life, cognitive beliefs, interpersonal relationship and life style change.【Conclusion】1. The revised Chinese version of the gratitude scale has good internal consistency,test-retest reliability,content validity,construct validity,criterion validity. Each term has abetter discrimination and higher discernment,which is suitable for the use of older agegroups under the Chinese culture.2. The gratitude theory was introduced into the chronic diseases in this study. And thestudy makes it clear that gratitude is the toughness protection factor of patients withcoronary artery stenting to adjust to the adversity. And also validates that gratitude is theindependent predictive element of toughness,post operation depression and anxiety,SWBand health behavioral competence.3. The relational model of the gratitude on its health correlated variables in patients after coronary artery stent implantatation in this study can help clinical and communitynurses have a better understanding of the gratitude on its health promotion in patients aftercoronary artery stent implantatation in a particular culture,as well as guide them tointegrate the gratitude concept with clinic psychological care effectively and provide theevidences of a better implementation of the gratitude intervention program.4. This research clarifies the independent predicative function and unidirectionalcausal relationship of gratitude in resilience.5. The study suggests that gratitude in patients after coronary artery stentimplantatation is more obvious characteristics of oriental culture. The process of patients’postoperative psychological experience,the perception of life and health promotion aredescribed and sketched out through qualitative research. It further improves and enrichesthe quantitative findings and provides an empirical basis for the construction of clinicalgratitude strategy and the psychological care of gratitude.5. The study indicate that the localization gratitude intervention framework which wasbuild based on literature research, theoretical research, qualitative interviews, as well as theexpert panel for some modification was suitable for the patients after coronary artery stentimplantatation in tranditional background in China.It actually verified the effect ofgratitude interventions for coronary stenting in patients with health promotion whichcontained promoting patients’ attitude towards life, cognitive beliefs, interpersonalrelationship and life style change.through the qualitative evaluation for13participants. Theeffective implementation of the field of gratitude intervention for health promotion isexpected to be the efficient way to improve the subject wellbeing of patients and be as thefoundation of evidenced based for psychological care which focus on gratitude.