通过疗愈促进依附关系（PATH）：为孕妇提供创伤和暴力知情护理的回顾性可行性研究结果。

Promoting Attachment Through Healing (PATH): Results of a retrospective feasibility study providing trauma-and-violence-informed care to pregnant women.

机构信息

School of Health Studies, Western University, London, ON, Canada.

Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.

出版信息

J Adv Nurs. 2022 Feb;78(2):557-568. doi: 10.1111/jan.15117. Epub 2021 Nov 27.

DOI:10.1111/jan.15117

PMID:34837410

Abstract

AIM

To evaluate the impact of a trauma and violence-informed cognitive behavioural therapy (TVICBT) intervention, compared with standard care on mental health, coping, bonding and maternal-infant attachment among pregnant women with a history of intimate partner violence and who displayed symptomatology consistent with anxiety, depression or post-traumatic stress disorder (PTSD).

DESIGN

A mixed-methods case study design was employed, where women either received standard perinatal care or were referred to a specialized TVICBT program.

METHODS

Data were collected through a retrospective obstetric medical chart audit in 2017 at an Ontario hospital in a large urban centre. Multiple choice and 'yes/no' questions were analysed using measures of central tendency and dispersion, in addition to frequency counts. Qualitative data from clinical notes were subjected to an inductive content analysis approach to identify key concepts.

RESULTS

In total, 69 women participated (intervention group = 37, standard care group = 32). Prevalence of mental illness between groups was consistent, apart from the TVICBT group having a significant increase in PTSD. In the TVICBT group, 83.8% of women (n = 31) expressed perinatal concerns, compared with only 37.5% (n = 12) of the standard care group. More women in the intervention group (94.6%, n = 35) coped successfully in the intrapartum period than the standard care group (78.1%, n = 25). However, more women in the standard care group (97.0%, n = 31) exhibited appropriate bonding behaviours than the TVICBT group (88.6%, n = 31).

CONCLUSION

The TVICBT intervention was effective in assisting women to identify triggers during their pregnancy journey, develop appropriate coping strategies and advocate for their needs to best cope.

IMPACT

TVICBT offers an effective, individualized, trauma and violence-informed approach to optimize the health outcomes of perinatal women and their infants by promoting positive coping and maternal-infant bonding, thus filling an existing practice gap of a lack of individualized, trauma-informed care.

摘要

目的

评估创伤和暴力知情认知行为疗法（TVICBT）干预与标准护理相比，对有亲密伴侣暴力史且表现出焦虑、抑郁或创伤后应激障碍（PTSD）症状的孕妇的心理健康、应对方式、母婴联系和母婴依恋的影响。

设计

采用混合方法病例研究设计，女性接受标准围产期护理或转介至专门的 TVICBT 计划。

方法

2017 年，在安大略省一个大城市中心的一家医院，通过回顾性产科病历审核收集数据。使用集中趋势和离散度的度量以及频率计数分析多项选择和“是/否”问题。来自临床记录的定性数据采用归纳内容分析方法，以确定关键概念。

结果

共有 69 名女性参与（干预组 37 名，标准护理组 32 名）。除了 TVICBT 组 PTSD 显著增加外，两组的精神疾病患病率一致。在 TVICBT 组中，83.8%（n=31）的女性表达了围产期担忧，而标准护理组只有 37.5%（n=12）。干预组中有更多的女性（94.6%，n=35）在分娩期间成功应对，而标准护理组只有 78.1%（n=25）。然而，标准护理组中有更多的女性（97.0%，n=31）表现出适当的母婴联系行为，而 TVICBT 组只有 88.6%（n=31）。