| ObjectiveCognitive processing is one of key influencing variables of the posttraumaticgrowth (PTG), if guiding the traumatic patients to think positively about the eventwhich would promote the PTG. So this study was to focus on revising the cognitiveprocessing assessment tool and explore the influencing factors of the cognitiveprocessing. And then this assessment tool was used to evaluate the effcectivess ofcognitive behavioral group intervention on the accidentally injured patients, so thatproviding an empirical evidence and guidance for the clinical nurses and researchers.MethodThis study was composed of four parts which were integrated used of thefollowing research strategy.1. Chinesization of the ERRI. Authorized by the author, the channelization wasstrictly followed by the principles of translation and back translation processing.After cultural adaptation and validation, the simplified Chinese version of ERRI wasformed. A simple sample of130accidentally injured patients was investigated bygeneral information questionnaire, the first edition of Simplified Chinese EventsRelated Rumination Inventory, Simplified Chinese Post-traumatic Growth Inventory.An exploratory factor analysis（EFA）2. Application and analysis of the affecting factors.320accidentally injuredpatients from Jiangsu, Zhejiang and Shanghai were investigated by C-ERRI,demographic questionnaire and C-PTGI. These data would be verified the reliabilityand validity of C-ERRI, and signile factor analsis and parallel stepwise regressionanalysis to explore the relationship between the PTG and rumination.3. The intervention study: The group cognitive behavior intervention trial wasconducted by using a quasi-experimental design in a community rehabilitationhospital in Nanjing. All participants met inclusion criteria, and22patients wereassigned into intervention group and another20patients in control group. Theadmission of the patients in intervention group was earlier than control group. Allparticipants in the both group received conventional rehabilitative training andnursing care, while the intervention group would receive more than six-week groupcognitive behavior intervention. C-PTGI and C-ERRI was to be the evaluation tool for the intervention groups combined process on video analysis, and semi-structuredinterviews in10participants were performed to evaluate the intervention effect.Results1. Cultural adaptation: cultural relevance evaluation was conducted by expertgroup meeting composed of five clinical psychology and nursing experts. As a result,9items were modified slightly according to using understandable language.2. The reliability and validity of the C-ERRI: The C-ERRI was comprised bytwo dimensions of20items. The internal consistency reliability of C-ERRI:Cronbach’s α of the total was0.93, and the two dimensions of Cronbach’s αrespectively were0.93and0.87. EFA showed that first factor ananlysis of rotating3factors, explaining67.72%of total variance, and the second2factors rotationresults explain56.13%of total variance, which revealed the same structure as theprimary inventory.3. The application and influence factors analysis of C-ERRI:①The internalconsistency reliability of C-ERRI: Cronbach’s α of the total was0.92, and the twodimensions of Cronbach’s α respectively were0.93and0.85. The CFA confirmed the2factors model better than3factors model, and the MSEA is0.046; GFI, CFI, NFIwere0.931,0.936and0.915, which proved a good model fit of the questionnaire.②320patients reported low level of ruminations, and Correlation analysis of twotypes of ruminations showed intrusive rumination was positively related to deliberaterumination (r=0.34, p=0.000).③I ntrusive rumination was inversely predictiongthe level of PTG (β=-0.13, p=0.02), while deliberate rumination could positivelypredicet the level of PTG (β=0.47, p <0.001).④Patients’ educationalbackground(β=0.27), family economic status(β=0.24), traumatic subjectiveseverity(β=0.13) can explain the deliberate ruminations13.2%of the total variance,which means with more higer level of educational background and mor severe of thefamily economy, the patients would appear more higher level of deliberateruminations. In addition, traumatic subjective severity was positively related withdeliberate ruminations.4. The results of intervention study:①t test: Two groups of their owncross-references results showed that the intervention group’s PTG and its subscalesscores and the score of intrusive ruminations significantly higher than the baselinelevel and the differences were statistically significant (p <0.05). While the controlgroup reported lower scores of PTG and its subscales appreciation of life and relating to others than the baseline.②T wo-way ANOVA results show that: groupcognitive behavior intervention can improve significantly patients’ PTG anddeliberate rumination (p <0.05). The interaction effect of intervention and time wassignificant on these PTG and its five sub-dimensions and deliberate rumination (p<0.05). The intervention can promote PTG and enhance patients’ positive reflectionon the traumatic experience. And intervention had no effect on intrusive rumination(p>0.05).③Q ualitative research showed that after six weeks intervention, theparticipants in group cognitive-behavior intervention can improve their moods andpromote their personal growth.Conclusion1. C-ERRI has good psychometric properties and it is suitable to assess thecognitive processing and to predict the level of PTG after traumatic growth.2. C-ERRI can be used to distinguish between the intrusive and deliberateruminations. Doctors or nurses from clinic can provide some individualpsychological interventions according to the accidentally injured patients’educational background, subjective severity of the traumatic event and the economicburden.3. Group cognitive-behavior intervention can promote accidentally patients’personal growth by encouraging positive reflection of the traumatic event and theinteraction among the participants in the group. |
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