Clinical Nursing Intervention Research Articles

Development and Evaluation of Motivational Interviewing Pulmonary Rehabilitation Program Based on Self-Determination Theory for Patients with Chronic Obstructive Pulmonary Disease

This study aimed to develop a motivational interviewing pulmonary rehabilitation program based on self-determination theory to maintain pulmonary rehabilitation-related health behaviors in patients with chronic obstructive pulmonary disease. The program was developed by reviewing the literature on pulmonary rehabilitation guidelines, drawing on the self-determinism theory to establish its contents, recruiting experts to test its validity, and conducting a preliminary survey. A quasi-experimental design was used to confirm the effect of the program. The participants were outpatients diagnosed with chronic obstructive pulmonary disease at three general hospitals in Busan. There were 33 subjects: 15 in the experimental group and 18 in the control group. The experimental group performed a motivational interviewing pulmonary rehabilitation program which comprised 11 sessions delivered over 10 weeks. The outcomes were measured using basic psychological needs, dyspnea, 6-minute walking distance, and functional status. Intervention effects were analyzed using repeated-measures ANOVA. The analysis revealed significant differences between the experimental and control groups in competence among the subdomains of basic psychological needs, dyspnea during exercise, and functional status. The developed program affects physical conditions and can be applied as an effective clinical nursing intervention to continuously improve the pulmonary rehabilitation behavior of patients with chronic obstructive pulmonary disease.

The effect of clinical hierarchical nursing intervention on patients with acute non-variceal upper gastrointestinal bleeding

Introduction: Acute non-variceal upper gastrointestinal bleeding has high risk of rebleeding, severely affecting patients’ life. While this risk of rebleeding can be effectively reduced via targeted clinical hierarchical nursing intervention. Object: To investigate the effect of clinical hierarchical nursing intervention on patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB). Design: Randomized controlled study. Methods: A total of 150 ANVUGIB patients treated in the Department of Gastroenterology in our hospital from January 2017 to October 2020 were selected and equally divided into two groups according to random number table method. The control group received routine care for ANVUGIB, including routine health education, health monitoring, medication care, etc. The nursing staff in the intervention group were divided into four different levels: senior, intermediate, junior and assistant nursing staff, and they were assigned with different responsibilities and nursing contents. The baseline conditions of the two groups of patients were compared, and the evaluation indexes include: incidence of bleeding-related complications during hospitalization, rebleeding situation within 1 month after discharge, quality of life, medical compliance, mastery rate of disease knowledge, comfort level, and nursing satisfaction. Results: There was no significant difference in the basic condition between the two groups (p > 0.05), showing comparability. The incidence of complications and rebleeding during hospitalization in the observation group were both 4.00%, which were significantly lower than those in the control group (χ2 = 6.996, 4.127, p < 0.05). After nursing intervention during hospitalization, the scores of physiological function, physiological functioning, body pain, general health, vitality, social function, mental health and emotional function of ANVUGIB patients in the observation group were significantly higher than those in the control group at discharge (p < 0.05). In addition, the mastery rate of disease knowledge, comfort level and nursing satisfaction of ANVUGIB patients in the observation group were significantly higher than those in the control group (p < 0.05). Although the compliance rate in the observation group was higher than that in the control group, no significant difference was found (p > 0.05). Conclusion: Clinical nursing intervention can significantly reduce the incidence of complications and rebleeding in patients with acute non-variceal upper gastrointestinal bleeding, and improve their quality of life, comfort level and nursing satisfaction.

Perioperative Nursing of Patients with Reoperation of Recurrent Parathyroid Carcinoma Invading the Upper Digestive or Respiratory Tract.

Objective The aim of this study was to summarize the perioperative nursing care of patients with recurrent parathyroid carcinoma. Methods A retrospective analysis of 10 patients with recurrent parathyroid carcinoma was performed. The clinical data, diagnosis, treatment process, and nursing process (including clinical nursing intervention of various complications) were analyzed. The nursing experience and methods were discussed, summarized, and analyzed. Results A total of 10 patients were reviewed (male : female 7 : 3; aged 48.6 ± 14.60 years). The mean interval between the initial operation and reoperation was 2.23 ± 1.65 years. The mean number of operations was 4.00 ± 1.41. Invasion of the trachea or esophagus was evident in 7 patients, larynx in 6 patients, recurrent laryngeal nerve in 1 patient, and cyclic cartilage in 2 patients. Serum calcium range was 3.20–4.68 mmol/L, and parathyroid hormone (PTH) range was 860–2830 pg/ml at admission. 6 patients underwent prophylactic tracheostomy, 2 patients underwent partial laryngectomy, and 2 patients underwent total laryngectomy. 1 patient experienced temporary water-electrolyte disorder and hypoproteinemia. The median serum calcium was 2.28 mmol/L (1.66–3.18 mmol/L) and median PTH level was 82.60 pg/ml (63.70–900.00 pg/ml) postoperatively. Serum PTH and calcium were still higher than the upper limit of normal in 2 patients after surgery. 2 of the other 8 patients relapsed within 8–11 months, and 6 patients remained normal for 11–40 months. Conclusion For patients with reoperation of recurrent parathyroid carcinoma, high-quality, reasonable, and careful perioperative nursing ensured a successful operation and optimized outcome.

Clinical evaluation and nursing intervention measures to bad symptoms in postoperative recovery phase of general anesthesia for internally fixed patients of lumbar vertebra

Objective To explore the bad symptoms in recovery phase and effective nursing intervention method through the relevant research of clinical evaluation and nursing intervention measures to bad symptoms in postoperative recovery phase of general anesthesia for internally fixed patients of lumbar vertebra so as to provide reference for the method of curing internally fixed patients of lumbar vertebra. Methods A total of 120 internally fixed patients of lumbar vertebra in recovery phase hospitalized since 2014 were selected from this hospital, which were divided into experimental group and control group where there were 60 patients each.Postoperative conventional therapy with the addition of clinical nursing intervention measures were used in experimental group, including functional practice to each organ and psychological guidance to patients.Conventional therapeutic method was conducted only to control group.First, the bad symptoms of experimental group and control group were observed, and then data statistics and analytical comparison were conducted to the treatment and recovery effect of experimental group and control group so as to explore the advantages and disadvantages of different therapeutic methods. Results With clinical response detection to the patients, internally fixed patients of lumbar vertebra appeared lumbar leg soreness at different degrees in the postoperative recovery phase of general anesthesia.The arms and legs had the symptoms of muscle weakness, difficulty in moving and being slow in movement.The comparison results of experimental group and control group were shown as below: ①The visual analogue score of control group was higher compared with experimental group.The experimental group had greater improvement compared with the patients before curing, and the improvement of control group was smaller.The data analysis of the two groups had statistical significance(P<0.05). ②Prior to and after treatment, the recovery state of internally fixed lumbar vertebra of control group and experimental group, the recovery of experimental group was more significant(P<0.05). ③For the appearance recovery comparison of patients in control group and experimental group, the results of experimental group were close to normal people, and the results of control group had difference from the movement of normal people. Conclusion The internally fixed patients of lumbar vertebra in postoperative recovery phase of general anesthesia had the symptoms of muscle weakness, difficulty in moving and being slow in movement.With the treatment of nursing intervention measures, it can better promote the recovery for patients. Key words: Lumbar fixation; Postoperative; Clinical evaluation; Nursing intervention

Qualitative research on perioperative psychological experience of patients undergoing Da Vinci robotic surgery

Objective To explore the authentic perioperative psychological experience of patients undergoing Da Vinci robotic surgery and provide the evidence for effective clinical nursing intervention plans. Methods A total of 12 patients undergoing Da Vinci Robotic surgery were selected and analyzed for the authentic psychological experience by using Colaizzi phenomenological approaches of qualitative research. Results After reorganization, analysis, distilling, five themes were acquired about real psychological experience of Da Vinci robotic surgery, including majority patients gradually psychologically accepting Da Vinci robotic surgeries, the close attention paid by hospital and the professional surgeon alleviateing patients′ anxiety, majority patients requiring robotic surgery-associated knowledge and guidance of postoperative rehabilitation, the patients′ satisfaction of curative effects about Da Vinci robotic surgery, majority patients with the potential concerns or worries about the expense of medical insurance. Conclusions The patients have potential concerns about new technology, Da Vinci robotic surgery. Thus, during the perioperative period, doctors and nurses should inform patients of the detailed procedures and the advantages of Robotic surgeries, patiently reply to the inquiries from patients, catch the psychological changes of the patients timely with providing the appropriate health guidance, and eventually reinforce their confidence on the new technology. Key words: Da Vinci Robot; Surgery; Perioperative period; Psychological experience; Qualitative research

Clinical nursing intervention of old diabetes patients with Alzheimer disease

Objective To study the clinical significance of nursing intervention in the treatment of diabetes patients with Alzheimer disease. Methods We screened 138 patients, who were randomly divided into intervention group and control group. Therapeutic counseling, diet control, psychological counseling and basic lifestyle guidance and other nursing interventions were applied in treatment of intervention group patients. Results After half and one month of intervention, the two hours postprandial blood glucose and fasting blood glucose in the intervention group were significantly decreased, compared with the control group (t=-2.890, -2.971, -2.822, -2.819, respectively; P<0.05). Meanwhile, the nursing satisfaction in the intervention group was significantly higher than that in the control group (69.57% vs 46.38%; Z=-2.966, P<0.05). Conclusions Nursing intervention for diabetes patients with Alzheimer disease can promote patients’ condition and increase their compliance. Key words: Diabetes; Alzheimer disease; Nursing

Chronic illness self-management: taking action to create order.

This paper presents research that was framed by our early understandings about the ways that people incorporate the consequences of illness into their lives. The word 'transition' has been used to describe this process. We believed self-management to be central to the transition process but this assertion required further research, hence this paper. The research aimed at understanding the way in which people who lived with chronic illness constructed the notion of self-management. While the participants of this study were living with arthritis, the focus was on understanding the meaning of self-management rather than the experience of living with the symptoms of arthritis. Data were generated when nine people living with arthritis were invited to write an autobiography about their life and experiences of living with illness. Two telephone interviews were recorded with each participant and then the research group (researchers and participants) convened for a discussion meeting. In contrast to health professionals who identify self-management as structured education, participants identified self-management as a process initiated to bring about order in their lives. Creating a sense of order, or self-management, had four key themes (i) Recognizing and monitoring the boundaries, (ii) Mobilizing the resources, (iii) Managing the shift in self-identity, (iv) Balancing, pacing, planning and prioritizing People learned about their responses to illness through daily life experiences and as a result of trial and error. They reconfigured their daily lives and reconstructed their self-identity by exploring their personal limitations or boundaries. Self-management of chronic illness has been considered as both structure and process, however it is the process of self-management that we contend is central to the experience of transition. Clinical nursing intervention for people with a long term illness may be enhanced when self-management is approached from a broad, contextual perspective and self-management processes are integrated into clinical practice. The challenge is for nurses to embrace processes in nursing practice that will facilitate interactions with clients without obstructing the diversity of perspectives, create an environment conducive to learning and engage individuals in identifying self-management strategies that have meaning in their lives.