| Objective: 1.Construct a group cognitive behavioural intervention programme for patients with neurogenic bladder(NB)after spinal cord injury(SCI)based on cognitive-behavioural theory through evidence retrieval,qualitative interviews,and expert meetings.2.A quasi-experimental study was conducted to evaluate the effects of the programme on negative affect,self-efficacy,social support,and bladder symptoms in post-SCI NB patients,to provide clinical evidence for the development of psychological interventions for this population.Methods: 1.Literature analysis was conducted based on evidence-based nursing theory,integrating domestic and foreign clinical guidelines,systematic reviews,expert consensus,and high-level evidence level intervention strategies in the original literature,and then qualitative interviews were conducted for NB patients after SCI to deeply understand their existing health problems and rehabilitation needs,and determine the basic framework and specific content of the programme.Develop the first draft of the Group Cognitive Behavioural Intervention Programme.Afterwards,an expert meeting was held to invite clinical medicine and nursing experts from rehabilitation,urology,psychiatry,and orthopedics to evaluate the framework,structure,and specific content of the program,and modify and optimize the programme based on experts’ opinions,developing the final draft of group Cognitive Behavioural Intervention Programme.2.Using a quasi-experimental study design,60 post-SCI NB patients from the Department of Rehabilitation Medicine,Zhongda Hospital affiliated with Southeast University were selected from June to December 2021 through the purposive sampling method.The quasi-random grouping method was adopted and the patients were numbered according to the order of admission and treatment.The first 30 patients were assigned to the intervention group,and the last 30 patients were assigned to the control group.Empirical application of group cognitive behavioural intervention program constructed in the early stage.The subjects in the control group were given routine rehabilitation nursing of rehabilitation medicine,and the subjects in the intervention group were given a group cognitive-behavioural intervention program based on the intervention program in the control group,and Group Cognitive behavioural Intervention was issued.The intervention lasted for 4 weeks.The two groups used the Hospital Anxiety and Depression Scale(HADS),the General Self-Efficacy Scale(GSES),and the Social Science Research Solution(SSRS)before,after the intervention,and 4 weeks after the intervention,respectively.The Social Science Research Solution(SSRS)and the Group Cognitive Behavioral Intervention Feedback Form were used to evaluate the effectiveness of the program on patients’ negative mood,self-efficacy,social support level,and bladder status.The general demographic and clinical data of the two groups were compared by two independent samples t-test,rank-sum test,and chi-square test,the data of the two groups at each time point were compared by repeated-measures ANOVA,the two independent samples t-test and rank-sum test were used for comparison between the two groups at different time points,and the paired t-test and paired rank-sum test were used for intra-group comparison between the two groups at different time points.Results: 1.After literature search and screening,a total of 16 pieces of literature were included for evidence summary,including 10 randomized controlled trials and 6 quasi-experimental studies.A total of 18 pieces of evidence related to psychological intervention were collected,and 4 intervention themes were extracted: screening and assessment,health education,social support,psychological education,and follow-up.Among them,10 pieces of evidence were recommended as grade A,and 8 pieces were recommended as grade B.Based on the previous literature and consultation with spinal cord injury rehabilitation and nursing experts,an interview outline was developed for the existing health problems and rehabilitation needs of SCI patients,and 12 SCI patients were interviewed qualitatively using the purposive sampling method.Three themes related to patients’ rehabilitation needs were summarized: sickness discomfort,negative psychological experience,and the need for external support.On this basis,the first draft of the Group Cognitive Behavioural Intervention Programme was developed based on cognitive-behavioural theory.2.12 clinical medicine and nursing experts from the departments of rehabilitation medicine,urology,orthopedics,and psycho-psychiatry were selected for an expert meeting to discuss and revise the feasibility and scientificity of the framework,structure,and specific contents of the program.The coefficient of experts’ judgment basis of the program was 0.91,the coefficient of familiarity was 0.85,and the coefficient of authority was 0.88.The experts had a higher degree of authority and were more familiar with the content of the intervention program.Finally,the group cognitive behavioural intervention program of NB patients after SCI was formed,and the four goals of cognitive behavior theory(changing wrong cognition and other biases,correcting irrational self-dialogue,enhancing decision-making and problem-solving ability,strengthening self-control and self-management ability)were taken as the principles.The program consisted of 8 activities,each 45-60 minutes,twice a week,and the intervention lasted for 1 month.3.A total of 60 subjects completed data collection,including 30 in the intervention group and 30 in the control group.There was no significant difference in baseline data between the two groups(P>0.05).4.The baseline data showed that all subjects had a HADS-A score of(9.70±3.38)and a HADSD score of(9.95±3.27).The GSES score was(1.85±0.52).SSRS was(32.12±6.06)points,subjective support dimension was(17.18±4.47)points,objective support dimension was 8.00(6.00,9.75)points,and utilization dimension of support was 6.00(5.00,8.00)points.Intervention results:(1)The HADS scores of the study subjects in the intervention group at the end of the intervention and 4 weeks after the intervention decreased to a greater extent than those of the control group during the same period,with significant differences(P < 0.05),and the HADS scores of the study subjects in the intervention group before the intervention and at the end of the intervention were compared with significant differences(P < 0.05)(2)The GSES scores of the study subjects in the intervention group were higher after the intervention and four weeks after the intervention than before the intervention,and were higher than those of the control group during the same period,with no significant difference(P > 0.05)(3)There were significant differences in SSRS scores of subjects in the intervention group before the intervention,at the end of the intervention,and 4 weeks after intervention(P < 0.05),and significant differences in subjective support dimension and utilization of support dimension before intervention and 4 weeks after intervention(P < 0.05).(4)Subjects in the intervention group had good feedback on the effect of the group cognitive-behavioural intervention program.In terms of disease knowledge,76.67% of patients had a certain degree of understanding of disease knowledge,and 83.33% of patients believed that they could carry out rehabilitation training according to the behaviour record book.In terms of coping with stress,participants in the intervention group(100%)believed that they had the support of family and friends and would seek help when they encountered difficulties.Conclusions: 1.Based on literature review,evidence-based nursing,qualitative interview,and expert meeting method,this study constructed a group cognitive and behavioral intervention program from the perspective of correcting patients’ wrong cognition,establishing positive cognition,and acquiring and consolidating rehabilitation skills.2.Preliminary clinical application via a quasi-experimental study verified the application of the program in improving negative emotions,increasing self-efficacy and social support levels in NB patients after SCI.Patients’ satisfaction with group cognitive-behavioural intervention evaluations was high,and disease knowledge and stress coping levels reached high levels.Group cognitive behavioural intervention program provides a reference for emotional management of NB patients after SCI,which can be used as psychological nursing to be added into clinical rehabilitation nursing of NB patients after SCI and can also provide a theoretical and practical basis for the intervention research of emotion management of NB patients after SCI. |
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