Chamberlain Diane J
Critical Care Studies, School of Nursing and Midwifery, Flinders University, Adelaide, Australia.
J Adv Nurs. 2006 May;54(4):407-17. doi: 10.1111/j.1365-2648.2006.03840.x.
This paper reports a study describing the experience of surviving traumatic brain injury as narrated by individuals 1 year after injury.
The experience of surviving traumatic brain injury is an individual and invisible experience. Healing and resolution of grief is still problematic for many years after injury. This experience includes those with severe injury. There is limited literature focusing on the survivor.
Sixty people with hospital admission diagnoses of traumatic brain injury were interviewed 1 year after injury using the Extended Glasgow Outcome Score questionnaire. Survivors then described their experiences of recovery. Data were collected through unstructured in-depth interviews, transcribed from audio-tapes and analysed into references. Qualitative content analysis was used to compile their frequencies from recurring themes.
Sixty survivors with a median age of 35 years were enrolled in the study, with 100% follow-up. Twelve per cent returned to full preinjury functioning, 35% had residual psychosocial and physical sequelae, 38% had significant restrictions in lifestyle and work capacity, and 15% were unable to care for themselves throughout the 24-hour period. The common narratives were classified into five categories: 'regret and grief within self'; 'insensitivity of health professionals'; 'invisibility of self'; 'stranded self'; and 'recovery in self'. These self-narratives reflected renewed ways to view the self, which were conceptualized to be intact 'in spite of' or to be worthwhile 'because of' the traumatic brain injury.
Self-narratives could be a worthwhile focus of psychological intervention by substituting positive narratives for negative ones, demonstrating hope and a positive outlook on life in order to enhance self-reflection and improve mental health. They can assist people to minimize, avoid or overcome devaluation and, as such, provide a basis for considerable nursing rehabilitation practice, even in those with severe injury.
本文报告一项研究,描述创伤性脑损伤幸存者受伤1年后所讲述的经历。
创伤性脑损伤幸存者的经历是一种个体的、无形的体验。受伤多年后,悲伤的治愈和化解仍然存在问题。这种经历包括重伤患者。关注幸存者的文献有限。
对60名入院诊断为创伤性脑损伤的患者在受伤1年后使用扩展格拉斯哥预后评分问卷进行访谈。幸存者随后描述了他们的康复经历。通过非结构化深度访谈收集数据,从录音带转录并分析成参考文献。采用定性内容分析法从反复出现的主题中统计其出现频率。
60名幸存者参与了该研究,中位年龄为35岁,随访率为100%。12%的人恢复到受伤前的全部功能,35%有残留的心理社会和身体后遗症,38%在生活方式和工作能力方面有显著限制,15%在24小时内无法自理。常见的叙述分为五类:“自我内的遗憾和悲伤”;“医护人员的冷漠”;“自我的无形”;“孤立的自我”;“自我的恢复”。这些自我叙述反映了看待自我的新方式,被概念化为尽管有创伤性脑损伤但仍完整或因创伤性脑损伤而有价值。
自我叙述可以成为心理干预的一个有价值的重点,用积极的叙述取代消极的叙述,展现希望和积极的人生观,以增强自我反思并改善心理健康。它们可以帮助人们尽量减少、避免或克服自我贬低,因此,即使对重伤患者,也为大量的护理康复实践提供了基础。