Comparison of posttraumatic growth and posttraumatic stress of nurses with physicians and medical students after caring of COVID‑19 patients

Objectives:The present study compared the prevalence and psychosocial factors affecting posttraumatic growth(PTG),posttraumatic stress disorder(PTSD),and psychological distress in nurses,physicians,and medical students.Materials and Methods:In a cross‑sectional study,three groups of medical staff including nurses(n=57),physicians(n=40),and medical students(n=34)who were responsible for the care/treatment of COVID‑19 patients admitted to a general hospital for 4 months responded to Posttraumatic Growth Inventory,Brief Symptom Inventory‑18,Resilience Questionnaire,PTSD Screen,and Social Capital‑Integrated Questionnaire.Results:After the exposure of medical staff to at least 4 months of treatment/care of COVID‑19 patients,PTG prevalence was higher than PTSD(38.2%vs.14.6%),but they experienced some degrees of psychological distress(65.5%).The nurses had 8.33(confidence interval[CI]:2.5–26.7)times higher PTG rate than medical students(P<0.001).Physicists also experienced 5.00(CI:1.4–26.7)times higher PTG than medical students(P<0.001).PTG was aided by age,married status,strong resilience,and high social capital,but gender had no influence.Resilience played an important protective role to prevent the incidence of psychological distress in nurses,medical students,and physicians.Conclusion:Despite the fact that the PTSD and psychological distress were same in the three groups of medical staff,the nurses had a greater rate of PTG than physicians and medical students.

Psychological trauma,posttraumatic stress disorder and traumarelated depression:A mini-review

There are various types of traumatic stimuli,such as catastrophic events like wars,natural calamities like earthquakes,and personal trauma from physical and psychological neglect or abuse and sexual abuse.Traumatic events can be divided into type I and type II trauma,and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’self-evaluation of the traumatic events.Individual stress reactions to trauma include posttraumatic stress disorder(PTSD),complex PTSD and trauma-related depression.Trauma-related depression is a reactive depression with unclear pathology,and depression occurring due to trauma in the childhood has gained increasing attention,because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy,which is similar to the pattern observed for PTSD.Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse,it is necessary to explore its pathogenesis and therapeutic strategy.

Serial Multiple Mediation of the Relationshipbetween Positive Coping Style and PostTraumatic Growth among Chinese CollegeStudents in the Aftermath of COVID-19

Given the ongoing character of COVID-19, higher-education students encountered multifaceted pressures brought about by thepandemic and had to overcome many difficulties during this period. Accordingly, it is imperative to identify the factors that mayhave protective effects on the social functioning and mental status of college students in the aftermath of COVID-19. This crosssectional study sought to ascertain the internal mechanism of positive coping (PC) styles affecting post-traumatic growth (PTG)and considered the mediating roles of cognitive reappraisal (CR), psychological resilience (PR), and deliberate rumination (DR),which are essential for understanding how and to what extent these factors shaped PTG in the context of the present pandemic. 463Chinese college students recruited via a convenience sampling method completed a set of online self-report measures of PC, PTG,CR, PR and DR. The findings revealed that the abovementioned five variables were positively correlated with each other, and theindependent variable directly predicted the dependent variable. More importantly, two out of three mediators in parallel mediatedthe relationship between PC and PTG, illustrating that more PC adoption was associated with increased PTG through high levels ofPR and DR, respectively. The two significant serial mediating effects also indicated that PC could contribute to CR, which furtherfacilitates either PR or DR and subsequently promotes the development of PTG. Colleges should adopt routine protectivebehaviors in accordance with such evidence to strengthen students’ mental health education and establish scientific methods toboost their psychological well-being. Overall, our results may shed new light on the process of positive adaption and providetheoretical support for targeted crisis intervention during the late phase of the pandemic.

Sepsis one-hour bundle management combined with psychological intervention on negative emotion and sleep quality in patients with sepsis

BACKGROUND Sepsis is a serious infectious disease caused by various systemic inflammatory responses and is ultimately life-threatening.Patients usually experience depression and anxiety,which affect their sleep quality and post-traumatic growth levels.AIM To investigate the effects of sepsis,a one-hour bundle(H1B)management was combined with psychological intervention in patients with sepsis.METHODS This retrospective analysis included 300 patients with sepsis who were admitted to Henan Provincial People’s Hospital between June 2022 and June 2023.According to different intervention methods,the participants were divided into a simple group(SG,n=150)and combined group(CG,n=150).H1B management was used in the SG and H1B management combined with psychological intervention was used in the CG.The changes of negative emotion,sleep quality and post-traumatic growth and prognosis were compared between the two groups before(T0)and after(T1)intervention.RESULTS After intervention(T1),the scores of the Hamilton Anxiety scale and Hamilton Depression scale in the CG were significantly lower than those in the SG(P<0.001).Sleep time,sleep quality,sleep efficiency,daytime dysfunction,sleep disturbance dimension score,and the total score in the CG were significantly lower than those in the SG(P<0.001).The appreciation of life,mental changes,relationship with others,personal strength dimension score,and total score of the CG were significantly higher than those of the SG(P<0.001).The scores for mental health,general health status,physiological function,emotional function,physical pain,social function,energy,and physiological function in the CG were significantly higher than those in the SG(P<0.001).The mechanical ventilation time,intensive care unit stay time,and 28-d mortality of the CG were significantly lower than those of the SG(P<0.05).CONCLUSION H1B management combined with psychological intervention can effectively alleviate the negative emotions of patients with sepsis and increase their quality of sleep and life.

A conceptual model of posttraumatic growth of nursing students with a disabled parent

Objectives: To examine a conceptual model of posttraumatic growth (PTG) with the inclusion of family resilience as a mediator,and social support,individual resilience,maternal care,and family members' intimacy after trauma as protective factors.Methods: A cross-sectional questionnaire survey was carried out in a sample of 134 college nursing students who had a parent with a non-congenital disability.The Socio-demographic Information Questionnaire,the Chinese version of Perceived Social Support Scale (PSSS),10-item Connor-Davidson Resilience Scale (CD-RISC10),Parental Bonding Instrument (PBI),Family Resilience Assessment Scale (FRAS) and the Posttraumatic Growth Inventory (PTGI) were used to collect data.Results: Results showed that social support,individual resilience,maternal care,and family members' intimacy after trauma positively predicted family resilience (β=0.41,0.20,0.20,0.22,all P<0.01),respectively,and indirectly predicted PTG through family resilience.Family resilience positively predicted PTG (β =0.25,P < 0.01).Moreover,individual resilience directly positively predicted PTG (β =0.25,P < 0.001).Conclusions: Family resilience could facilitate PTG in nursing students in the face of parental disability.Interventions to promote PTG among college nursing students who have experienced parental disability should consider individual or family resilience-based intervention.

A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence,relatedness, and growth theory

Objective:This study aimed to explore the psychological needs of nurses caring for patients with coronavirus disease 2019(COVID-19)and to propose corresponding interventions.Methods:In-depth interviews were conducted with 10 nurses who cared for patients with COVID-19.Interview data were analyzed by category analysis from the perspective of the existence,relatedness,and growth theory(ERG).Results:The existence needs were mainly reflected in health and security needs,whereas the relatedness needs consisting mainly of interpersonal needs,humanistic concern needs,and family needs;further,the growth needs were mainly reflected as a strong need for knowledge.Existence needs were the main needs during the epidemic,with health and security needs influencing each other.Humanistic concern needs were the most important of the relatedness needs;interpersonal and family needs were also growing.Conclusion:It is found that the existence,relatedness,and growth needs coexist in clinical nurses.It is helpful to take effective interventions to meet their needs if the needs of nurses caring for COVID-19 patients could be perceived well.

Self-compassion and resilience mediate the relationship between childhood exposure to domestic violence and posttraumatic growth/stress disorder during COVID-19 pandemic

BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a common/different underlying mechanism.AIM To explore the common/different underlying mechanism of PTG and PTSD.METHODS Between February 12 and 17,2020,a nationwide cross-sectional online survey was conducted in China among 2038 university students,and a self-administered questionnaire was used for the data collection.The data included demographic characteristics,such as age,gender,and subjective social economic status,and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question,Self-compassion Scale,Connor–Davidson Resilience Scale,Posttraumatic Growth Inventory,and the Abbreviated PTSD Checklist-Civilian version.A structural equation model was used to test the hypotheses.RESULTS Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion(PTG:β=-0.023,95%CI:-0.44 to-0.007;PTSD:β=0.008,95%CI:0.002,0.014)and via a 2-step indirect path from self-compassion to resilience(PTG:β=-0.008,95%CI:-0.018 to-0.002;PTSD:β=0.013,95%CI:0.004-0.024).However,resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD.CONCLUSION PTG and PTSD are common results of childhood exposure to domestic violence,which may be influenced by self-compassion and resilience.

Posttraumatic stress symptom trajectories of Chinese university students during the first eight months of the COVID-19 pandemic and their association with cognitive reappraisal,expressive suppression,and posttraumatic growth

Objective: To identify the moderating effects of cognitive reappraisal(CR) and expressive suppression(ES) on the relationship between posttraumatic stress(PTS) symptoms and posttraumatic growth(PTG) in university students. Methods: The survey included 1 987 Chinese university students who completed questionnaires on PTS symptoms in February 2020, with three follow-up surveys at two-month intervals until August 2020. We assessed CR and ES at February 2020 and PTG at August 2020. Growth mixture modeling was used to classify the PTS symptom trajectories. Multinomial logistic regression was used to recognize the predictors of class membership. The relationships among PTS symptoms, CR, ES, and PTG were examined using multi-group path analysis.Results: Sex, SARS-Co V-2 infection of a family member or friend, number of siblings, CR, and ES were significantly associated with PTS symptoms. Three latent classes were identified: ‘Increasing PTS’(n=205, 10.0%) who had rapid deterioration of PTS symptoms, ‘Moderate PTS’(n=149, 8.0%) who had a high level of PTS symptoms at the beginning and slightly increasing, and ‘Persistent Minimal PTS’(n=1 633, 82.0%), who had slow resolution of PTS symptoms over time. Male, SARS-Co V-2 infection of a family member or friend, and having a lower CR and a higher ES, were more likely to have ‘Increasing PTS’. PTS at February 2020 predicted PTG only in ‘Increasing PTS’ class, and both CR and ES had moderating effects on the conversion between them.Conclusions: Most students recovered from posttraumatic stress of COVID-19 pandemic, but a small proportion expeienced increasing PTS symptoms, and those with this condition may benefit from emotional regulation intervention.

Application of Psychological Elastic Development Model in Postoperative Trauma Growth of Patients with Esophageal Cancer

Purpose: Use the psychological resilience development model to formulate effective nursing measures, and explore the impact of relevant nursing measures on the psychological resilience and post-traumatic growth of patients. Methods: Using a general data sheet, post-traumatic growth scale, and psychological resilience scale, 100 patients discharged from the hospital after esophageal cancer were investigated in groups, and statistical software spss26.0 was used for statistical analysis. Results: The psychological resilience and post-traumatic growth levels of the experimental group were significantly higher than those of the control group, the P-value. Conclusion: As a common gastrointestinal tumor, esophageal cancer is traumatized by surgery. Not only will there be more discomfort during hospitalization, but also a series of complications will still occur after discharge, such as pain, weakness, and other discomforts, which will cause the patient’s emotions. Subject to strong fluctuations, the patient suffers great psychological trauma. After being discharged from the hospital, caregivers need to master more related skills when caring for patients, which is time-consuming and labor-intensive, and often causes the patients to feel the emotion of dragging the family members. Under the condition of both physical and psychological pressure, patients often appear fearful and uneasy, and suffer great psychological trauma, which leads to low levels of psychological resilience and post-traumatic growth of patients, and related nursing interventions based on Rutter’s psychological development model It can significantly improve the patient’s psychological flexibility, improve the patient’s post-traumatic growth level, promote the patient’s physical and mental recovery, make the patient produce positive emotions, increase positive psychological changes, and thereby improve the patient’s quality of life after discharge.

Is There Growth in Grief: Measuring Posttraumatic Growth in the Grief Response

Introduction: Grief is considered to be negative manifestations of affect, cognition, and behavior. However, persons who experience grief have also reported enduring positive outcomes in such domains as interpersonal relationships, personal strengths, and life perspectives. This review evaluated current measures of grief to determine if such positive outcomes can be adequately assessed. Methods: The Texas Revised Inventory of Grief, Grief Experience Inventory, Bereavement Phenomenology Questionnaire, Core Bereavement Items, Continuing Bonds Scale, and Hogan Grief Reaction Checklist (currently the most common measures of grief) are reviewed. Results: Only one of the reviewed measures assessed posttraumatic growth as a component of grief (i.e., Hogan Grief Reaction Checklist). Conclusion: Since posttraumatic growth and negative psychological adjustment after traumatic events can coexist, it is important that measures of grief used in both clinical and research domains allow an assessment of positive response.

Reliability and Validity of a French Version of the Posttraumatic Growth Inventory

In the context of traumatic stress, the dominant discourse has mainly focused on distress, thus undermining the role that eustress has in traumatic experiences. One of the few exceptions to this has been the research on posttraumatic growth, which has generated much interest since its beginning. There is an increasing interest in posttraumatic growth in various cultures and hence an expansion of the measure, the Post Traumatic Growth Inventory (PTGI), into various languages. This article is the first to perform a rigorous investigation of the psychometric properties of the PTGI, including the scale and subscale reliability, inter-item and subscale correlations, and using a CFA approach. The properties are established with a French translation using two populations of caregivers: those bereaved by HIV/AIDS and parents who are caring for a child with a life-limiting illness. These properties were determined for both the original 21 item scale as well as the shortened version.

Review of possible psychological impacts of COVID-19 on frontline medical staff and reduction strategies

Like soldiers,frontline medical staff provide a first line of defense and have played a critical role in responses to the outbreak of coronavirus disease-2019 in December 2019.It is important to acknowledge the considerable pressure placed on frontline medical staff in the face of a new type of coronavirus that is highly infectious and for which no specific treatment is available.Here,we review the various kinds of psychological problems afflicting frontline medical staff who are combatting the severe acute respiratory syndrome epidemic.These include anxiety,insomnia,depression,interpersonal difficulties,and post-traumatic stress disorder syndrome.We further present a summary of countermeasures for alleviating these problems based on our findings.These countermeasures include ensuring the provision of adequate protective gear for frontline medical staff,developing timely and clear guidelines,strengthening social support,and providing clear criteria and additional training,focusing on the choice of frontline medical staff.An understanding of the psychological impacts of an epidemic situation and of relevant countermeasures will contribute to reducing the psychological pressures on frontline medical staff.Consequently,they will be able to cope better with outbreaks of infectious diseases in the future,to reduce the psychological pressure of the front-line medical staff,and to improve the treatment level.

Infective endocarditis and thoracic aortic disease: A review on forgotten psychological aspects

AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.

Coping and rumination as predictors of posttraumatic growth and depreciation

Purpose: The present study examined the joint impact of coping and rumination after trauma on posttraumatic growth (PTG) and posttraumatic depreciation (PTD) based on the PTG model. Methods: A cross-sectional study was conducted between October 2017 and May 2018. A sample of 253 individuals who had experienced a traumatic event in the last two years, was included. Participants completed an online self-reported survey, including demographic variables, trauma characteristics, the German Posttraumatic Growth and Depreciation Inventory — Expanded, the Brief COPE Inventory, and the Event Related Rumination Inventory. An analysis of correlation, a principal component analysis and hierarchical regression analyses were conducted. Statistical analyses were undertaken on SPSS (version 25.0;IBM, New York, USA). Results: After controlling for the effects of personal and trauma characteristics, self-sufficient coping and socially supported coping were found to favor the emergence of PTG. Event-related and recent deliberate rumination were positively related to PTG. Avoidant-focused coping and recent intrusive rumination were positively associated with PTD. Overall, the final models accounted for 46% and 58% of the variance in PTG and PTD. Conclusion: Our findings confirm the PTG model and support the central role of deliberate rumination, self-sufficient coping and socially supported coping in the development of PTG. Our results indicate that a similar model of PTD with comparable influencing factors can be assumed: if the individual is stuck in ongoing intrusive rumination and uses more avoidance-focused coping, it might lead to more reports of PTD.

Effectiveness of Post-Traumatic Growth Intervention to Promote Positive Post-Traumatic Traits in Chinese Breast Cancer Patients:A Randomized Controlled Trial

Objective:The purpose of this study was to evaluate the effectiveness of post-traumatic growth(PTG)model-based intervention to improve positive psychological traits in Chinese breast cancer patients.Design:A randomized control trial of a psychological group intervention based on PTG model.Methods:The Clinical Trial was registered on 17 August 2019 at Chinese Clinical Trials.gov with Registration number ChiCTR1900025264.A total of 92 patients with breast cancer were recruited.The participants were randomly assigned to the experimental group(n=46)and the control group(n=46).A six-session psychological group intervention based on PTG model was implemented in the experimental group,and a six-session health education was implemented in the control group.The outcomes weremeasured at baseline(pre-intervention),3 weeks,6 weeks after the intervention.The primary outcome was posttraumatic growth assessed by the Chinese version of the Post-Traumatic Growth Inventory(PTGI);Secondary outcomes included psychological resilience,family resilience,rumination,and self-disclosure.Results:A total of 87 patients with breast cancer completed this study,including 44 patients in the experimental group and 43 patients in the control group.There was no significant difference in baseline data of breast cancer patients between the two groups except for the treatment regimen(p>0.05).The two groups were compared after the intervention;the interaction effects between the total scores of posttraumatic growth,family resilience,and self-disclosure and the time term were statistically significant(p<0.05),indicating that the trend of change in total scores of post-traumatic growth,family resilience,and self-disclosure differed between the experimental and control groups over time,and the scores improved in the experimental group were significantly higher than those in the control group.The comparison of psychological resilience and total score of rumination at each time point was statistically significant(p<0.05),indicating that group intervention based on the PTG model could improve the psychological recovery ability and rumination level of the experimental group.Conclusion:The psychological group intervention based on the PTG model significantly improved post-traumatic growth,family resilience,and self-disclosure in patients with breast cancer.However,the impact on psychological resilience and rumination was relatively small.Long-term intervention is needed to further test the effect of the PTG model on psychological resilience and rumination.

正念疗法对肺腺癌患者创伤后成长及生命质量的影响

目的探讨正念训练对肺腺癌患者的创伤后成长水平及生命质量的影响。方法采取整群随机法将呼吸内科2个病区按抛币法分为对照组和观察组,各纳入肺腺癌患者40例。对照组给予肿瘤呼吸内科常规护理,观察组在此基础上行连续8次的正念疗法。干预前后采用简体中文版创伤后成长评定量表、中文版癌症患者生命质量测定量表C30进行测评。结果对照组38例、观察组33例完成全程研究。干预后观察组患者的创伤后成长水平总分、人生感悟、个人力量、新的可能、自我转变维度得分显著高于对照组(均P<0.05);总体生命质量、情绪功能、认知功能、社会功能维度得分显著高于对照组(均P<0.05)。结论正念疗法可以提升肺腺癌患者的创伤后成长水平,并影响其生命质量。

积极心理干预对中学生创伤后成长的影响

对经历过重大校园危机事件的中学生开展积极心理干预团体辅导干预的实验研究,结果表明,实施积极心理干预能够提高中学生创伤后成长水平,传统心理干预中蕴含着积极趋向与积极价值,可以在一定程度上提高中学生创伤后成长水平。为提高中学生的心理健康水平,学校要重视学生心理健康教育,坚持积极心理干预与传统心理干预相结合,并推广以班级为单位的积极心理干预团体辅导活动。

急诊科护士第二受害者经验与支持现状及影响因素研究

目的基于积极心理学视角对急诊科护士第二受害者经验与支持现状进行调查,并探讨其影响因素。方法采用一般资料问卷、第二受害者经验及支持量表、心理脱离量表和创伤后成长自评量表,对浙江省10所综合性医院的355名急诊科护士进行问卷调查,分析第二受害者经验与支持发生情况,并采用多元线性回归进行影响因素分析。结果样本人群中急诊科护士第二受害者经验及支持量表、创伤后成长量表、心理脱离量表总分分别为(89.63±10.83)分、(66.80±16.33)分、(13.23±3.63)分。第二受害者支持、心理脱离、创伤后成长得分呈正相关(r=0.275、0.434、0.212,均P<0.001)。单因素分析显示,急诊科护士性别、学历、职称、职务、平均月收入、是否为带教老师、对个人影响时间、是否听说过第二受害者概念是第二受害者经验与支持的影响因素(P<0.05);多因素分析中,急诊科护士性别、学历、对个人影响时间、是否听说过第二受害者概念、心理脱离、创伤后成长是急诊科护士第二受害者经验与支持的主要影响因素(P<0.05)。结论急诊科护士第二受害者经验与支持得分较高,心理困扰情况严重,但创伤后成长水平较高。建议医院完善相关支持,帮助护士培养积极情绪,提升急诊科护士职业获益感。

正性信息注意偏向在急性白血病患者 不同健康心理控制源类型与创伤后成长间的中介效应

目的 了解急性白血病(acute leukemia, AL)患者创伤后成长(post-traumatic growth, PTG)现状,探讨正性信息注意偏向在不同健康心理控制源(health locus of control, HLC)与PTG间的中介效应,为提高患者PTG水平提供依据。方法 2022年6月至2023年3月,采用便利抽样法选取河北省某三级甲等医院血液内科的AL患者201例为研究对象,采用多维度健康心理控制源量表、正性信息注意偏向量表、创伤后成长量表等对其进行调查。结果 AL患者PTG总分为[62(49.5,70.00)]分,与健康权威人士控制(powerful others HLC,P-HLC)、正性信息注意偏向均呈正相关(均P<0.01),与健康机遇控制(chance HLC,C-HLC)呈负相关(P<0.05);正性信息注意偏向在P-HLC与PTG间起部分中介作用,在I-HLC与PTG间起完全中介作用。结论 正性信息注意偏向在不同HLC与PTG间发挥的作用机制不同,护理人员可根据患者HLC类型,进行针对性的施护,从而提升PTG。

急诊科护士替代性创伤潜在剖面分析及各类别创伤后成长差异研究

目的探索急诊科护士替代性创伤的潜在类别及影响因素,并比较各类别间替代性创伤后成长水平的差异。方法采用方便抽样法,于2022年3月一5月选取安徽省20所公立综合医院的498名急诊科护士为研究对象,采用一般资料调查表、救助者替代性创伤问卷、创伤后成长评定量表进行问卷调查。结果急诊科护士替代性创伤可分为低创伤组(15.5%)、中等创伤组(53.0%)、高创伤-生活信念受损组(31.5%)3个类别。不同类别护士的替代性创伤后成长得分,差异具有统计学意义(F=3.736,P=0.025)。Logistic回归结果显示,性格偏向、是否参加过突发公共事件应急培训、护患关系是替代性创伤潜在类别的影响因素(P<0.05)。结论急诊科护士替代性创伤可划分为3个类别,替代性创伤程度越高,其替代性创伤后成长水平越高。护理管理者应关注性格内向、未参加过突发公共事件应急培训、护患关系差的急诊科护士,并采取针对性的干预措施,以减少替代性创伤的发生。