Iranian Journal of Rehabilitation Research in Nursing
نشریه پژوهش توانبخشی در پرستاری
IJRN
Medical Sciences
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تأثیر آموزش گروهی مدیریت استرس به شیوهی شناختی - رفتاری بر اضطراب، افسردگی، استرس و بستری مجدد بیماران مبتلا به آسم
The Effect of Cognitive-Behavioral Stress Management Group Training on Anxiety, Depression, Stress and Readmission in Asthma Patients
پژوهشي
Research
<strong><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">چکیده</span></span></strong><br>
<strong><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مقدمه:</span></span></strong><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"> بیماران مبتلا به آسم درجات بالایی از استرس را تجربه می­ نمایند. </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آموزش­های</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">روان­شناختی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">می ­توانند</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">سهم</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بسزایی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">در</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بهبود اضطراب، افسردگی و استرس در</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بیماران</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مبتلا به</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آسم</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">داشته</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">باشند</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">. </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">هدف</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">از</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">انجام</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">این</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">پژوهش،</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بررسی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">اثربخشی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آموزش گروهی </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مدیریت</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">استرس به شیوه شناختی</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">-</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">رفتاری</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بر</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">اضطراب، افسردگی و استرس</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بیماران</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مبتلا به</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آسم بود.</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"></span></span><br>
<strong><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">روش کار:</span></span></strong> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">در</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">این</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مطالعه نیمه­</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">­</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"> تجربی،</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">38</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بیمار</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مبتلا به</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آسم </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">به صورت در دسترس</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">انتخاب</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">و</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بهصورت</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">تصادفی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">به</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">دو</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">گروه</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مداخله</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">و</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">شاهد</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">تخصیص</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">داده</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">شدند</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">. </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">برای</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">جمع ­آوری</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">داده­ ها</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">از</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">پرسشنامه</span></span> <span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">DASS-21</span></span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">استفاده</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">شد</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">که</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">در</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">پیشآزمون</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">،</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">پسآزمون</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">و</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">پیگیری،</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">توسط</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">افراد</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">تکمیل</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">گردید</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">. </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">درمان</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">شناختی</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">-</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">رفتاری</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مدیریت</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">استرس،</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">طی</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"> ده </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">جلسه</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بر</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">روی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">گروه</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مداخله</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">انجام</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">گرفت</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">، اما </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">برای</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">گروه</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">شاهد هیچ مداخله ­­ای انجام نگرفت</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">. دادههای به دستآمده</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">با</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">استفاده</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">از نرم ­افزار </span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">SPSS</span></span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"> نسخه 25 </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آزمون</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">تحلیل</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">کوواریانس</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"> آنکوا، آنووا و اندازه­ های تکرار</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مورد</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">تجزیه وتحلیل</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آماری</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">قرار</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">گرفت. </span></span><strong><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"></span></span></strong><br>
<strong><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">یافتهها:</span></span></strong><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"> نتایج نشان داد، میانگین نمره متغیر افسردگی پیش­آزمون (42/9</span></span><span style="font-family:Cambria,serif;"><span style="font-size:12.0pt;">±</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">6/7) و پس­آزمون (55/5</span></span><span style="font-family:Cambria,serif;"><span style="font-size:12.0pt;">±</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">5/5) در گروه مداخله اختلاف معناداری داشته است (0/00=</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">p</span></span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">). همچنین میانگین نمره متغیر افسردگی بین گروه­های مداخله (7/90</span></span><span style="font-family:Cambria,serif;"><span style="font-size:12.0pt;">±</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">6/42) و شاهد (55/5</span></span><span style="font-family:Cambria,serif;"><span style="font-size:12.0pt;">±</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">5/5) یک ماه پس از مداخله اختلاف معناداری داشته است (0/017=</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">p</span></span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">). میانگین نمره متغیر استرس پیش ­آزمون (74/97</span></span><span style="font-family:Cambria,serif;"><span style="font-size:12.0pt;">±</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">10/5)و پس­ آزمون (5/22</span></span><span style="font-family:Cambria,serif;"><span style="font-size:12.0pt;">±</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">9/05) در گروه مداخله اختلاف معناداری داشته است (00/0=</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">p</span></span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">). میانگین نمره متغیر اضطراب پس از مداخله بین گروه­ های مداخله (5/37</span></span><span style="font-family:Cambria,serif;"><span style="font-size:12.0pt;">±</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">4/53) و شاهد (7/90</span></span><span style="font-family:Cambria,serif;"><span style="font-size:12.0pt;">±</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">10/95) اختلاف معناداری داشته است (0/01=</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">p</span></span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">). بستری مجدد در افراد گروه مداخله و گروه شاهد پیش­ آزمون و پس ­آزمون اختلاف معناداری نداشته است.</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;"></span></span></span><br>
<strong><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">نتیجه ­گیری:</span></span></strong> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">نتایج</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مطالعه</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">حاضر</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">حاکی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">از</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">اثربخشی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">درمان</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">شناختی</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">-</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">رفتاری</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مدیریت</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">استرس</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بر</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بهبود</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">اضطراب، افسردگی و استرس</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بیماران</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مبتلا به</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آسم</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">است</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">. </span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">با</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">توجه</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">به</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بالا بودن اضطراب، افسردگی و استرس</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">در</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بیماران</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مبتلا به</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آسم</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">و</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مؤثر بودن</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">مداخله ­ی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">آموزشی به ­صورت گروهی مدیریت استرس به شیوه شناختی</span></span><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">–</span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">رفتاری و</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">لزوم</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">توجه</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">جدی</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">به</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">درمان­های</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">روان­شناختی در</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">این</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">گروه</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">بیماران</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">ضروری</span></span> <span style="font-family:B Nazanin;"><span style="font-size:12.0pt;">می­ نماید</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:12.0pt;">.</span></span></span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"></span></span>
<strong>Introduction:</strong> Psychological therapies can play an important role in the improvement of anxiety, depression and stress in patients with asthma. The purpose of this study was to investigate the effectiveness of cognitive-behavioral stress management group therapy in group therapy on anxiety, depression, stress and readmission in asthmatic patients.<br>
<strong>Methods:</strong> In this quasi-experimental study, 38 patients with asthma were selected and randomly assigned to intervention and control groups. DASS-21 questionnaire was used for data collection which was completed at pre-test, post-test and follow-up. Cognitive-behavioral stress management therapy was administered to the intervention group on 10 sessions but no intervention conducted for the control group. Data were analyzed using ANCOVA, one-way ANOVA, t-test, and repeated measures.<br>
<strong>Results:</strong> The results showed that there was a significant difference between the mean score of depression in the intervention group before (6.42±7.9) and after the intervention (5.05±5.55) (p=0.00). There was also a significant difference between the mean score of depression between the intervention (5.05±5.55) and control groups (13.47±9.49) in first month (p=0.017). There was a significant difference between the mean scores of stress before (10.5±74.97) and after (9.05±5.22) the intervention in the intervention group (p = 0.00). The mean score of anxiety variable after the intervention was significant different between the intervention group (4.53±5.37) and control groups (10.95±7.90) (p=0.01). There was no significant difference in re-admission in the intervention and control groups before and after the intervention.<br>
<strong>Conclusion:</strong> The results of the present study indicate the effectiveness of cognitive-behavioral stress management therapy in improving anxiety, depression and stress in patients with asthma. Given the high level of anxiety, depression and stress in patients with asthma and the effectiveness of cognitive-behavioral stress management training intervention and the need for serious attention to psychological therapies in this group of patients.
اضطراب, استرس, افسردگی, آسم, بستری مجدد, مدیریت استرس, شناختی- رفتاری.
anxiety, stress, depression, asthma, cognitive-behavioral, stress management
19
29
http://ijrn.ir/browse.php?a_code=A-10-450-1&slc_lang=fa&sid=1
Fatemeh
Ahmadi
فاطمه
احمدی
fatemehahmadi91@ymail.com
10031947532846006875
10031947532846006875
No
M.Sc. Student of Mental Health Nursing, Department of Nursing, Faculty of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
دانشجوی کارشناسی ارشد پرستاری بهداشت روان ، گروه پرستاری، دانشکده علوم توانبخشی، دانشگاه علوم بهزیستی و توانبخشی، تهران، ایران.
Masoud
Fallahi-Khoshknab
مسعود
فلاحی-خشکناب
msflir@yahoo.com
10031947532846006876
10031947532846006876
Yes
Professor of Nursing Department of Nursing, School of Rehabilitation Sciences Research Center in Emergency and Disaster Health University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
استاد آموزش پرستاری، گروه پرستاری، دانشکده علوم توانبخشی، مرکز تحقیقات سلامت در حوادث و بلایا، دانشگاه علوم بهزیستی و توانبخشی، تهران، ایران msflir@yahoo.com
Abolfazl
Rahgoi
ابوالفضل
رهگوی
rahgouin@yahoo.com
10031947532846006877
10031947532846006877
No
Instructor of Nursing Department of Nursing, School of Rehabilitation Sciences University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
مربی پرستاری، گروه پرستاری، دانشکده علوم توانبخشی، دانشگاه علوم بهزیستی و توانبخشی، تهران، ایران.
Farahnaz
Mohammadi-Shahboulaghi
فرحناز
محمدی-شاهبلاغی
mohammadifarahnaz@gmail.com
10031947532846006878
10031947532846006878
No
Professor of Nursing Department of Nursing, School of Rehabilitation Sciences Research Center on Aging University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
استاد پرستاری، گروه پرستاری، دانشکده علوم توانبخشی، مرکز تحقیقات سالمندی، دانشگاه علوم بهزیستی و توانبخشی، تهران، ایران.
Pouria
Rezasoltani
پوریا
رضاسلطانی
p_rsoltani@yahoo.com
10031947532846006879
10031947532846006879
No
Department of Biostatics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
گروه آمار زیستی، دانشگاه علوم بهزیستی و توانبخشی، تهران، ایران.