Construction Of A Narrative Nursing Intervention Program For Posttraumatic Growth In Patients With Inflammatory Bowel Disease

[Objective]The purpose of this study is to construct a narrative nursing intervention program to promote posttraumatic growth in patients with inflammatory bowel disease(IBD),with expectations to guide patients to view the disease rationally and reduce their negative emotions,so as to provide thoughts and references for psychological nursing work of clinical nursing staffs.[Methods]1.Literature analysis:The literature about the effects of narrative nursing on posttraumatic growth,anxiety and depression in patients with chronic diseases were searched in the Chinese and English database,and the draft intervention plan was formed through literature analysis and discussion of the research group.2.Structured interview:The purposive sampling method was adopted to select IBD patients for interview to understand their opinions and suggestions on the draft intervention plan.The draft intervention plan was initially revised by the research group based on the results of the interview.3.Expert meeting:Experts in the fields of medical treatment,nursing,psychology,narrative nursing and public welfare organizations in IBD were invited to conduct expert meeting about the issues in the intervention program,and the intervention program was revised according to the opinions of the experts and the discussion of the research group.4.Preliminary experiment:In a randomized controlled trial,patients with inflammatory bowel disease in the gastroenterology department of a tertiary hospital in Hangzhou were randomly divided into intervention group and control group.Among them,the control group was given routine nursing,and the intervention group was given narrative nursing intervention once a week,each time 40～60mins for a total of 5 weeks.Patients in both groups were evaluated utilizing the ChinesePosttraumatic Growth Inventory(C-PTGI),Patient Health Questionnaire-9(PHQ-9),Generalized Anxiety Disorder 7-items(GAD-7),Mainland Chinese Version of the Inflammatory Bowel Disease Questionnaire(MCIBDQ)before and after the intervention.Meanwhile,semi-structured interviews were used to understand the experience of patients’ participation in narrative intervention and their opinions on the modification of the intervention program.The intervention program was refined based on pretest results and group discussions.[Results]1.Literature analysis:A total of 26 articles were included,including 21 RCT studies,3 quasi-experimental studies,1 research protocol and 1 case study.In a part of studies,mental state screening was carried out when patients were included,and the majority of studies were implemented with individualized intervention to determine whether they were enrolled in the group according to the screening results,with the frequency of interventions mainly ranging from 2～3 times per week,the length of each intervention from 20～120 minutes,and the total length of interventions ranging from 2 weeks～24 weeks.The intervention results showed that narrative nursing could not only improve patients’ anxiety and depression,but also promote their posttraumatic growth and improve their quality of life.2.Structured interview:A total of 12 patients were included in the interview,and the intervention program was initially revised,including shortening the duration of intervention,increasing the interval of intervention,adjusting the order of intervention themes and revising the approach to delivering family support in the process of intervention.And the content of intervention could be enriched with health education to strengthen peer support.3.Expert meeting:A total of six experts were included to review the intervention program.The revised contents included the use of the posttraumatic growth inventory for patients screening,a single intervention of 40～60 minutes each session,and a total intervention duration of 5 weeks.And the theme of the first intervention was revised to "building relationships and listening to stories",while adding "reshaping dialogue techniques",standardizing volunteer training,issuing electronic awards as treatment documents,and replacing evaluation tools of anxiety and depression with more sensitive scales.4.Preliminary experiment:A total of 29 patients were included,and there was no significant difference in the basic information and scores of each scale before intervention between the two groups(P>0.05)and indicated comparable.There were significant differences in GAD-7 scores between and within groups after intervention(P<0.05).The findings of semi-structured interviews showed that the narrative nursing program to promote patients’ posttraumatic growth can make patients feel cared about,provide patients with an outlet for emotional catharsis and enhance their confidence.At the same time,it was of great help to promote patients to reflect and promote patients to bravely try more things to enrich their non-disease life.At the same time,it was also found that the intervention program faced challenges in clinical practice,therefore the intervention program was further adjusted based on the findings of patient interviews.[Conclusions]This study finally constructed a narrative nursing intervention program for posttraumatic growth of patients with inflammatory bowel disease in line with the cultural background of our country through literature analysis,patient interviews,expert meetings and preliminary experiment,which is scientific,feasible and effective.Future studies need to conduct clinical trial with large samples to further explore the effects of narrative nursing intervention on posttraumatic growth,anxiety and depression of patients with inflammatory bowel disease.