Yoshinaga Naoki, Obara Yoko, Kawano Naohisa, Kondo Kazuki, Hayashi Yuta, Nakai Michikazu, Takeda Ryuichiro, Tanoue Hiroki
School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki City 889-1692, Miyazaki, Japan.
Graduate School of Nursing Science, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki City 889-1692, Miyazaki, Japan.
Behav Sci (Basel). 2024 Jul 16;14(7):604. doi: 10.3390/bs14070604.
The importance of nurses integrating effective psychological techniques into their clinical practice is widely recognized. Nevertheless, further evidence from real-world settings is needed to establish nurse-led cognitive behavioural therapy (CBT) as an effective approach in clinical practice. This study aimed to examine the clinical effectiveness and predictors of individual CBT for mental disorders delivered by nurses in various routine clinical settings. This pragmatic retrospective cohort study collected data from participants who received nurse-led individual CBT at four institutions from different prefectures in Japan between April 2015 and March 2023. During the study period, 280 clients were referred to nurses for CBT, 240 of whom received nurse-led individual CBT of at least one session. The common primary diagnoses among participants were major depressive disorder (33.8%), social phobia (12.9%), and obsessive-compulsive disorder (10.0%). Of these, 23 participants were ongoing cases at the end of the observation period, and 217 who had completed the course of therapy or discontinued/dropped out from the therapy were included in the analysis (173 completed and 44 discontinued/dropped out (i.e., dropout rate = 20.3%)). Based on the clinical significance definition (primary outcome), 62.4% of the participants who completed the therapy were judged to demonstrate positive clinical significance (recovered or improved), with only a few participants (6.9%) demonstrating deterioration. Significant improvements were observed before and after nurse-led individual CBT across all secondary outcomes, including depression and anxiety symptoms, health-related quality of life, and functional disability (all ps ≤ 0.001). Univariate logistic regression revealed that clients with higher baseline severity of depression and anxiety symptoms were less likely to achieve positive clinical significance following nurse-led individual CBT. The real-world evidence gained through this study will encourage frontline nurses and motivate institutional/organizational leaders and policymakers to employ nurse-led individual CBT, especially for depression and anxiety-related disorders.
护士将有效的心理技术融入临床实践的重要性已得到广泛认可。然而，需要来自现实环境的进一步证据，以确立护士主导的认知行为疗法（CBT）在临床实践中是一种有效的方法。本研究旨在探讨在各种常规临床环境中，护士提供的针对精神障碍的个体CBT的临床效果及预测因素。这项务实的回顾性队列研究收集了2015年4月至2023年3月期间在日本不同县的四家机构接受护士主导的个体CBT的参与者的数据。在研究期间，有280名客户被转介给护士进行CBT，其中240人接受了至少一次护士主导的个体CBT。参与者中常见的主要诊断为重度抑郁症（33.8%）、社交恐惧症（12.9%）和强迫症（10.0%）。其中，23名参与者在观察期结束时仍在治疗中，217名完成治疗疗程或停止/退出治疗的参与者被纳入分析（173名完成治疗，44名停止/退出治疗（即退出率 = 20.3%））。根据临床意义定义（主要结局），完成治疗的参与者中有62.4%被判定具有积极的临床意义（康复或改善），只有少数参与者（6.9%）病情恶化。在所有次要结局中，包括抑郁和焦虑症状、健康相关生活质量和功能残疾，在护士主导的个体CBT前后均观察到显著改善（所有p值≤0.001）。单因素逻辑回归显示，抑郁和焦虑症状基线严重程度较高的客户在接受护士主导的个体CBT后，获得积极临床意义的可能性较小。通过本研究获得的现实证据将鼓励一线护士，并激励机构/组织领导人和政策制定者采用护士主导的个体CBT，特别是针对与抑郁和焦虑相关的疾病。
