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A Caring Program for Health Promotion among Women Who Have Experienced Trauma: A Quasi- Experimental Pilot Study

  • Kim Goun (College of Nursing and Research Institute of Nursing Science, Pusan National University) ;
  • Kim, Heejung (College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University) ;
  • Park, Jeongok (College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University) ;
  • Kang, Hee Sun (Red Cross College of Nursing, Chung-Ang University) ;
  • Kim, Soojin (College of Nursing, Chonnam National University) ;
  • Kim, Sunah (College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University)
  • Received : 2022.10.04
  • Accepted : 2023.03.24
  • Published : 2023.10.31

Abstract

Purpose: Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health. Methods: This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests. Results: The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p = .004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up. Conclusion: This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.

Keywords

Acknowledgement

We acknowledge the support of Dr. Kijun Song at the Mo-Im Kim Nursing Research Institute and Yonsei University College of Nursing for reviewing and interpreting our data.

References

  1. Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. Trauma and PTSD in the WHO world mental health surveys. European Journal of Psychotraumatology. 2017;8(Suppl 5):1353383. https://doi.org/10.1080/20008198.2017.1353383
  2. American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association Publishing; 2013. p. 289-299.
  3. World Health Organization (WHO). WHO releases guidance on mental health care after trauma [Internet]. Geneva: WHO; c2013 [cited 2022 Apr 10]. Available from: https://www.who.int/news/item/06-08-2013-who-releases-guidanceon-mental-health-care-after-trauma.
  4. Olff M. Sex and gender differences in post-traumatic stress disorder: An update. European Journal of Psychotraumatology. 2017;8(Suppl 4):1351204. https://doi.org/10.1080/20008198.2017.1351204
  5. Fergusson DM, Boden JM, Horwood LJ. Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse & Neglect. 2008;32(6):607-619. https://doi.org/10.1016/j.chiabu.2006.12.018
  6. McLean CP, Rosenbach SB, Capaldi S, Foa EB. Social and academic functioning in adolescents with child sexual abuse-related PTSD. Child Abuse and Neglect. 2013;37(9):675-678. https://doi.org/10.1016/j.chiabu.2013.03.010
  7. Jung K, Steil R. A randomized controlled trial on cognitive restructuring and imagery modification to reduce the feeling of being contaminated in adult survivors of childhood sexual abuse suffering from posttraumatic stress disorder. Psychotherapy and Psychosomatics. 2013;82(4):213-220. https://doi.org/10.1159/000348450
  8. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine. 1998;14(4):245-258. https://doi.org/10.1016/s0749-3797(98)00017-8
  9. Farhood L, Dimassi H, Strauss NL. Understanding post-conflict mental health: Assessment of PTSD, depression, general health and life events in civilian population one year after the 2006 war in South Lebanon. Journal of Traumatic Stress Disorders and Treatment. 2013;2(2):1000103. https://doi.org/10.4172/2324-8947.1000103
  10. World Health Organization (WHO). Ottawa charter for health promotion [Internet]. Geneva: WHO [cited 2022 Apr 6]. Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/.
  11. Breslow L, Enstrom JE. Persistence of health habits and their relationship to mortality. Preventive Medicine. 1980;9(4):469-483. https://doi.org/10.1016/0091-7435(80)90042-0
  12. Meshberg-Cohen S, Presseau C, Thacker LR, Hefner K, Svikis D. Posttraumatic stress disorder, health problems, and depression among African American women in residential substance use treatment. Journal of Women's Health. 2016;25(7):729-737. https://doi.org/10.1089/jwh.2015.5328
  13. Comijs HC, van Exel E, van der Mast RC, Paauw A, Oude Voshaar R, Stek ML. Childhood abuse in late-life depression. Journal of Affective Disorders. 2013;147(1-3):241-246. https://doi.org/10.1016/j.jad.2012.11.010
  14. Easton SD, Roh S, Kong J, Lee YS. Childhood sexual abuse and depression among American Indians in adulthood. Health and Social Work. 2019;44(2):95-103. https://doi.org/10.1093/hsw/hlz005
  15. Lindert J, von Ehrenstein OS, Grashow R, Gal G, Braehler E, Weisskopf MG. Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: Systematic review and meta-analysis. International Journal of Public Health. 2014;59(2):359-372. https://doi.org/10.1007/s00038-013-0519-5
  16. Kim SM, Kim HR, Min KJ, Yoo SK, Shin YC, Kim EJ, et al. Resilience as a protective factor for suicidal ideation among Korean workers. Psychiatry Investigation. 2020;17(2):147-156. https://doi.org/10.30773/pi.2019.0072
  17. Keshet H, Foa EB, Gilboa-Schechtman E. Women's self-perceptions in the aftermath of trauma: The role of trauma-centrality and trauma-type. Psychological Trauma: Theory, Research, Practice and Policy. 2019;11(5):542-550. https://doi.org/10.1037/tra0000393
  18. Freedman SR, Enright RD. Forgiveness as an intervention goal with incest survivors. Journal of Consulting and Clinical Psychology. 1996;64(5):983-992. https://doi.org/10.1037//0022-006x.64.5.983
  19. Kim S, Noh D, Kim H. A summary of selective experimental research on psychosocial interventions for sexually abused children. Journal of Child Sexual Abuse. 2016;25(5):597-617. https://doi.org/10.1080/10538712.2016.1181692
  20. Schiff M, Nacasch N, Levit S, Katz N, Foa EB. Prolonged exposure for treating PTSD among female methadone patients who were survivors of sexual abuse in Israel. Social Work in Health Care. 2015;54(8):687-707. https://doi.org/10.1080/00981389.2015.1058311
  21. Swanson KM. Empirical development of a middle range theory of caring. Nursing Research. 1991;40(3):161-166. https://doi.org/10.1097/00006199-199105000-00008
  22. Adolfsson A. The EKC-model provides empathy, knowledge and care for women that encounter health issues during the reproductive life. International Journal of Gynecology & Clinical Practices. 2016;3:121. https://doi.org/10.15344/2394-4986/2016/121
  23. Shaghaghi A, Bhopal RS, Sheikh A. Approaches to recruiting 'hard-to-reach' populations into research: A review of the literature. Health Promotion Perspectives. 2011;1(2):86-94. https://doi.org/10.5681/hpp.2011.009
  24. Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Poster session presented at: Annual Convention of the International Society for Traumatic Stress Studies; 1993 Oct; San Antonio, TX.
  25. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD checklist for DSM-5 (PCL-5) [Internet]. White River Junction: National Center for PTSD; c2013 [cited 2021 Apr 3]. Available from: https://www.ptsd. va.gov/professional/assessment/adult-sr/ptsd-checklist.asp.
  26. Kim JW, Chung HG, Choi JH, So HS, Kang SH, Kim DS, et al. Psychometric properties of the Korean version of the PTSD Checklist-5 in elderly Korean veterans of the Vietnam war. Anxiety and Mood. 2017;13(2):123-131. https://doi.org/10.24986/anxmod.2017.13.2.010
  27. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement. 1977;1(3):385-401. https://doi.org/10.1177/014662167700100306
  28. Chon KK, Rhee MK. Preliminary development of Korean version of CES-D. Korean Journal of Clinical Psychology. 1992;11(1):65-76.
  29. Walker SN, Sechrist KR, Pender NJ. The health promoting lifestyle profile II [Internet]. Omaha: University of Nebraska Medical Center; c1995 [cited 2022 Apr 10]. Available from: https://www.unmc.edu/nursing/faculty/health-promoting-lifestyle-profile-II.html.
  30. Yun SN, Kim JH. Health-promoting behaviors of the women workers at the manufacturing industry-based on the Pender's Health Promotion Model. Korean Journal of Occupational Health Nursing. 1999;8(2):130-140.
  31. Rosenberg M. Society and the adolescent self-image. Princeton (NJ): Princeton University Press; 1965. p. 338.
  32. Bae HN, Choi SW, Yu JC, Lee JS, Choi KS. Reliability and validity of the Korean version of the Rosenberg Self-Esteem Scale(K-RSES) in adult. Journal of Korean Society for Depressive and Bipolar Disorders. 2014;12(1):43-49.
  33. Metcalfe J, Jacobs WJ. A "hot-system/cool-system" view of memory under stress. PTSD Research Quarterly. 1996;7(2):1-3.
  34. Schauer M, Neuner F, Elbert T. Narrative exposure therapy: A short-term treatment for traumatic stress disorders. 2nd rev. and expand. ed. Cambridge (MA): Hogrefe Publishing; 2011. p. 59-72.
  35. Demirci E. Non suicidal self-injury, emotional eating and insomnia after child sexual abuse: Are those symptoms related to emotion regulation? Journal of Forensic and Legal Medicine. 2018;53:17-21. https://doi.org/10.1016/j.jflm.2017.10.012
  36. Seppala EM, Nitschke JB, Tudorascu DL, Hayes A, Goldstein MR, Nguyen DT, et al. Breathing-based meditation decreases posttraumatic stress disorder symptoms in U.S. military veterans: A randomized controlled longitudinal study. Journal of Traumatic Stress. 2014;27(4):397-405. https://doi.org/10.1002/jts.21936
  37. Chouliara Z, Karatzias T, Gullone A. Recovering from childhood sexual abuse: A theoretical framework for practice and research. Journal of Psychiatric and Mental Health Nursing. 2014;21(1):69-78. https://doi.org/10.1111/jpm.12048
  38. Vogelsang J. The visual analog scale: An accurate and sensitive method for self-reporting preoperative anxiety. Journal of Post Anesthesia Nursing. 1988;3(4):235-239.
  39. Blake VK, Nehrkorn AM, Patrick JH. Differential effects of health-promoting behaviors on wellbeing among adults. International Journal of Wellbeing. 2017;7(2):28-42. https://doi.org/10.5502/ijw.v7i1.471
  40. Smith PN, Gamble SA, Cort NA, Ward EA, He H, Talbot NL. Attachment and alliance in the treatment of depressed, sexually abused women. Depression and Anxiety. 2012;29(2):123-130. https://doi.org/10.1002/da.20913
  41. Talbot NL, Chaudron LH, Ward EA, Duberstein PR, Conwell Y, O'Hara MW, et al. A randomized effectiveness trial of interpersonal psychotherapy for depressed women with sexual abuse histories. Psychiatric Services. 2011;62(4):374-380. https://doi.org/10.1176/ps.62.4.pss6204_0374
  42. Watkins LE, Sprang KR, Rothbaum BO. Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience. 2018;12:258. https://doi.org/10.3389/fnbeh.2018.00258
  43. Hawton K, Casanas I Comabella C, Haw C, Saunders K. Risk factors for suicide in individuals with depression: A systematic review. Journal of Affective Disorders. 2013;147(1-3):17-28. https://doi.org/10.1016/j.jad.2013.01.004
  44. Zen AL, Whooley MA, Zhao S, Cohen BE. Post-traumatic stress disorder is associated with poor health behaviors: Findings from the heart and soul study. Health Psychology. 2012;31(2):194-201. https://doi.org/10.1037/a0025989
  45. Bang KS, Lee IS, Kim SJ, Song MK, Park SE. The effects of urban forest-walking program on health promotion behavior, physical health, depression, and quality of life: A randomized controlled trial of office-workers. Journal of Korean Academy of Nursing. 2016;46(1):140-148. https://doi.org/10.4040/jkan.2016.46.1.140
  46. Jiang M, Li T, Huang L, Zhuang Y. Effect of a comprehensive nursing care on the treatment of ulcerative keratitis and patient's emotions. International Journal of Clinical and Experimental Medicine. 2018;11(11):12676-12681.
  47. Hertzog MA. Considerations in determining sample size for pilot studies. Research in Nursing and Health. 2008;31(2):180-191. https://doi.org/10.1002/nur.20247
  48. Marsden E, Torgerson CJ. Single group, pre- and post-test research designs: Some methodological concerns. Oxford Review of Education. 2012;38(5):583-616. https://doi.org/10.1080/03054985.2012.731208