ABSTRACT
Objective:To investigate the effect of the explain-simulate-practice-communication-support (ESPCS) nursing model on perioperative stress and postoperative rehabilitation in patients undergoing laparoscopic radical gastrectomy for gastric cancer. Provide a basis for the application of ESPCS nursing model in patients undergoing radical gastrectomy for gastric cancer.Methods:This was a quasi-experimental study. A total of 212 patients who underwent laparoscopic radical gastrectomy for gastric cancer in the First Affiliated Hospital of China Medical University from May 2019 to May 2023 were selected by convenience sampling and divided into the observation group and the control group by random digital table method, with 106 patients in each group. The control group received routine nursing intervention, while the observation group received ESPCS nursing intervention for 3 months. The perioperative stress hormones (serum cortisol and epinephrine), Self-rating Depression Scale (SDS) score, Self-rating Anxiety Scale (SAS) score, gastrointestinal function indicators, and the 36-item Short Form Health Survey Questionnaire (SF-36) score were compared between the two groups.Results:Two groups of patients were lost to follow-up, with a total of 104 patients in each group. The control group consisted of 65 males and 39 females, aged (61.59 ± 3.42) years old, while the observation group consisted of 61 males and 43 females, aged (60.78 ± 3.63) years old. Six days after operation, serum cortisol and epinephrine levels in the observation group were (221.46 ± 24.15) nmol/L and (28.11 ± 3.47) pmol/L, respectively, which were lower than those in the control group (261.84 ± 27.91) nmol/L and (31.49 ± 3.86) pmol/L, respectively, and the differences were statistically significant ( t=11.16, 6.64, both P<0.05). After 1 week of operation, the SDS and SAS scores in the observation group were (41.39 ± 2.21), (39.62 ± 2.31) points, respectively, which were lower than those in the control group (45.27 ± 2.34), (44.35 ± 2.37) points, and the differences were statistically significant ( t=12.29, 14.58, both P<0.05). The time of first exhaust, first defecation, intestinal ringing and first solid eating in the observation group were (55.38 ± 6.23), (68.84 ± 7.92), (38.73 ± 4.31), (62.31 ± 7.67) h, respectively, which were lower than those in the control group (67.51 ± 8.39), (84.17 ± 9.25), (48.43 ± 5.79), (75.65 ± 8.52) h, the differences were statistically significant ( t values were 11.84-13.71, all P<0.05). After intervention, the scores of physiological function, role physical, general health, mental health, social function and the total score of SF-36 in the observation group were (82.17 ± 4.12), (83.21 ± 3.67), (75.27 ± 3.64), (80.63 ± 4.31), (77.58 ± 4.13), (73.89 ± 4.86) points, respectively, which were higher than those in the control group (75.61 ± 4.39), (74.24 ± 3.88), (69.45 ± 4.38), (71.28 ± 4.05), (72.35 ± 3.84), (68.81 ± 5.14) points, the differences were statistically significant ( t values were 7.32-17.13, all P<0.05). Conclusions:The ESPCS nursing model can effectively alleviate the perioperative stress reaction of gastric cancer patients undergoing laparoscopic radical gastrectomy, promote the recovery of gastrointestinal function and improve the quality of life.
ABSTRACT
Objective:To study the credibility and effectiveness of nursing outcome classification for risk assessment of perioperative position injury.Methods:A total of 94 patients who underwent surgery at the First Affiliated Hospital of China Medical University from August 2017 to August 2018 were evaluated as "risk of perioperative positional injury" . Demographic variables, clinical variables, and intraoperative data were recorded for each patient. Eight clinical outcomes of 8 outcomes in the Nursing Outcome Classification (NOC) were evaluated at different time points and compared, and the reliability and validity of each indicator were also made.Results:Pressure ulcer condition score, blood loss severity score, circulation condition score, tissue perfusion (center) score, tissue perfusion (peripheral) score, temperature regulation score, peripheral nerve state score, skin tissue mucosal integrity score at each time point showed statistical differences ( F value was 8.45-12.67, P < 0.05). The factor load of the 8 results in NOC all passed the validity test. Among them, the pressure ulcers increased at T3-T5, the systolic pressure increased during the circulation, and the diastolic pressure increased. Tissue perfusion (central) pain at T3-T4 time point, paleness in tissue perfusion (periphery) at all time points, hypothermia at T2-T4 time point, muscle tension and limb paresthesia in peripheral nerve state At all time points, skin tissue and mucosal integrity, skin temperature, tissue perfusion at all time points, skin damage, and erythema at T2-T5 time point factors passed the reliability and validity of the perioperative position risk. Conclusion:A total of 8 outcomes and 13 clinical indicators in the classification of nursing outcomes can be used to assess the risk of perioperative postural injury through Likert scores.