老年脑卒中幸存者团体接纳承诺疗法干预方案构建与应用  

Construction and application of group-based acceptance and commitmenttherapy for elderly stroke survivors

作　　者：周巧 吴俊琪 张翠娥 游君 许湘华 ZHOU Qiao;WU Jun-qi;ZHANG Cui-e;YOU Jun;XU Xiang-hua(The Third Hospital of Changsha,Changsha 410015,China;Hunan Cancer Hospital,the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013,China)

机构地区：[1]长沙市第三医院,湖南长沙410015 [2]湖南省肿瘤医院/中南大学湘雅医学院附属肿瘤医院,湖南长沙410013

出　　处：《护理学报》2023年第19期7-12,共6页Journal of Nursing（China）

基　　金：湖南省卫生健康委科研计划项目(B202314016750);湖南省中医药大学项目(2022XYLH152)。

摘　　要：目的构建适用于老年脑卒中幸存者的团体接纳承诺疗法干预方案并评价其应用效果。方法通过文献查阅,基于Hexaflex模型,结合质性研究结果,通过小组讨论,形成老年脑卒中幸存者团体接纳承诺疗法干预方案初稿。邀请14名专家进行2轮德尔菲专家咨询,形成修订稿。通过预实验对方案进一步完善,形成方案终稿,在66例老年脑卒中幸存者中进行验证。结果2轮函询的专家积极系数分别为70%、100%。专家判断依据(Ca)为0.95,熟悉程度(Cs)为0.87,权威系数(Cr)为0.91,Kendall’s W系数分别为0.130、0.126(P<0.05)。老年脑卒中幸存者团体接纳承诺疗法方案共包括8个模块,分别为:破冰之旅(建立关系)、正视欣赏(接纳)、不再纠结(认知解离)、此时此刻(活在当下)、扩大背景(以己为景)、点石成金(明确价值)、迈出一步(承诺行动)、化冰为水(分享体验),每个模块40~60 min。干预前、干预结束时及干预后1个月,2组接纳与行动问卷第2版、汉密尔顿抑郁量表得分的干预效应、时间效应、交互效应均有统计学意义(P<0.001)。结论老年脑卒中幸存者团体接纳承诺疗法干预方案具有科学性和适用性,可以降低经验性回避,有效缓解患者卒中后抑郁情绪。Objective To construct a group-based acceptance and commitment therapy(ACT)for elderly stroke survivors and to evaluate its application effect.Methods After literature review and group discussion,the draft of the group-based ACT intervention program for elderly stroke survivors was formed based on the Hexaflex model and qualitative findings.Fourteen experts were invited for 2 rounds of Delphi expert consultation to form a revised version.The program was further refined through pre-testing to form the final version,and it was validated in 66 elderly stroke survivors.Results The positive coefficient of experts in the two rounds of correspondence was 70%and 100%.The Ca,Cs and Cr was 0.95,0.87,0.91,respectively,and the Kendall’s W coefficient was 0.130 and 0.126,respectively(P<0.05).The group-based ACT for elderly stroke survivors consisted of 8 modules,namely:ice-breaking journey(establishing the relationship),appreciation(acceptance),no tangle(cognitive dissociation),focus on the moment(being present),expanding the background(self-as-context),turning a stone into gold(self-approval),taking a step(committing action),and turning ice into water(sharing experience),with 40~60 min for each module.The main intervention effect,time effect,and interaction effect of the score of the Acceptance and Action Questionnaire(Second Edition),and Hamilton Depression Scale before and at the end of the intervention,and 1 month after the intervention were statistically significant in the two groups(P<0.001).Conclusion The group-based ACT for elderly stroke survivors is scientifical and applicable to reduce empirical avoidance and effectively alleviate patients’post-stroke depression.

关 键 词：老年 脑卒中幸存者 接纳承诺疗法 方案构建 应用 

分 类 号：R473.59[医药卫生—护理学]