The Study On The Acceptance Of Disability And Related Factors Among Patients With Brachial Plexus Injury And Nursing Intervention

Background The acceptance of disability,which is defined the extent to which individuals demonstrates an accepting attitude toward their disability,has an important effect on their physical and mental wellbeing.Unfortunately,there has been no study on acceptance of disability of Patients with Brachial Plexus Injuries(BPI) in china and abroad.This study was conduct to describe the level of acceptance of disability,explore the influenced and related factors,introduce and develop the Acceptance of Disability Scale,develop and implement the short term psychological nursing intervention for BPI patients to effectively strengthen the level of acceptance of disability,encourage rational beliefs and enhance active coping strategies with the hope of decreasing posttraumatic stress and finnally hastening holistic rehabilitation.Objective The objective of this study was to investigate the level of acceptance of disability and psychological factors related of BPI patients and to evaluate the effectiveness of the cognitive intervention programe on acceptance of disability,posttraumatic stress response and coping of BPI patients.Methods This research was conducted in two consecutive phases. Phase 1:A descriptive and correlative design was employed.The ADS (Acceptance of disability scale),IES-R(Impact of Event Scale Revised),MCMQ(Medical Coping Modes Questionnaire),VAS(Visual Analogue Scale)and general information questionnaire were used to survey 305 BPI patients in Huashan hospital of Shanghai to assess the level of acceptance of disability and its influenced factors,posttraumatic stress response,and coping style.Phase 2:A quasi-experimental design was conducted.Sixty-eight BPI patients were recruited from those who met the inclusion criteria and divided in to an intervention group(n=34) and a control group(n=34) respectively according to the time segment.There were no statistical difference in age,gender,education level,marital status,side of plexus injury,the types of brachial plexus injury and so on between the two groups (p＞0.05 ).Patients in the intervention group attended a one-month cognitive intervention program guided by the Rational Emotion Behavior Therapy Theory and the routine nursing care of hand surgery,while the control group received the routine care only.The intervention program consisted of three-time group psychological health education,seven-time individual supportive-and-cognitive intervention,whole-course hotline for mental assistance and one visiting tour to post hand surgery rehabilitation department.The ADS,IES-R,MCMQ and general information questionnaire were administered to evaluate effects of the intervention program at the end of the intervention and 3 months after the intervention respectively.The change of them were compared and analyzed by the repeated-measure ANOVA.Results Phase 1 The level of acceptance of disability was below the average with the mean of total score at 79.00,standard deviation was 12.29 (44～116).The influenced factors of acceptance of disability in BPT patients were gender,side of plexus injury,pain,financial condition and post-injury period.The level of confidence in surgery was positively correlated with acceptance of disability(r=0.126,p＜0.05 ) Posttraumatic stress response and resignation were significantly and negatively correlated with acceptance of disability(r=-0.455,p＜0.001; r=-0.353,p＜0.001).Negative correlations were also found between avoidance coping and the containment of disability domain(r=-0.148,p＜0.05).Phase 2 There were no statistically significant differences in baseline between the intervention and control groups.The results of repeated-measures ANOVA showed that scores of acceptance of disability and its subscores except for enlargement domain were statistically significant higher in the intervention group patients than in the control group(p＜0.01;p＜0.05).The intervention group patients showed lower scores of the IES-R total score and its subscores compared with the control group patients.The intrusion domain was statistical differences(p＜0.05),but there was no statistical difference in the IES-R total score and avoidance as well as hyperarousal domain between the two groups, (p＞0.05).The intervention group showed higher scores of confrontation and lower scores of avoidance than the control group,however there was no statistical difference between the two groups,(p＞0.05).It is evident that resignation subscores of coping in the intervention group statistically decreased compared with the control group(p＜0.05).Conclusion The level of acceptance of disability was below the average. There were relationships among acceptance of disability,confidence in surgery,posttraumatic stress response and coping in BPI patients.The short term cognitive intervention programme improved the level of acceptance of disability and reduced posttraumatic stress response as well as resignation coping of BPI patients.Further study is needed to examine effects of the cognitive intervention on posttraumatic stress response and coping of BPI patients.