Effect of continuous nursing care based on the IKAP theory on the quality of life of patients with chronic obstructive pulmonary disease: A randomized controlled study

The effectiveness of a web-based information-knowledge-attitude-practice continuous intervention on the psychological status, medical compliance, and quality of life of patients after coronary artery bypass grafting surgery: a parallel randomized clinical trial

BACKGROUND

Coronary artery disease (CAD) patients who have undergone coronary artery bypass grafting (CABG) often experience a severe psychological burden for a long period of time, which can adversely affect their post-operative prognosis. Therefore, this study aimed to evaluate the effect of a web-based Information-Knowledge-Attitude-Practice (WIKAP) continuous intervention on the psychological status, medical compliance, and quality of life (QoL) in patients with CAD after CABG surgery.

METHODS

A parallel randomized clinical trial enrolled 174 CAD patients who underwent CABG at our hospital between January 2018 and December 2019. The participants were randomly divided into the Control and WIKAP group and received intervention for 12 months. The scores for anxiety, depression, medical compliance, and QoL were assessed on the first day (M0), 3rd month (M3), 6th month (M6), 9th month (M9) and 12th month (M12) after discharge. Furthermore, the occurrence of major adverse cardiac and cerebrovascular events (MACCE) was analyzed using the Kaplan-Meier curve and Cox proportional regression models for an additional 24-month follow-up period without any intervention.

RESULTS

After the 12-month intervention, the scores of anxiety and depression were significantly reduced in the WIKAP group at M9 and M12 compared to those in the Control group (all P < 0.05). Additionally, the scores of medical compliance in the WIKAP group were remarkably elevated at M6, M9, and M12 compared with those scores in the Control group (all P < 0.05). Furthermore, the QoL scores were lower in the WIKAP group at M6, M9, and M12 compared to the Control group (all P < 0.05). However, the MACCE-free survival showed no significant difference between the two groups (P > 0.05). Cox proportional regression analysis also showed that the nursing intervention (Control vs. WKIAP) was not associated with the incidence of MACCE.

CONCLUSION

WIKAP nursing intervention effectively improved the psychological health, medical compliance, and QoL in CAD patients who underwent CABG operation, but it did not prolong MACCE-free survival.

TRAIL REGISTRATION

The study is registered in isrctn.org: ISRCTN13653455.

Application of the Knowledge, Attitude, and Practice model combined with motivational interviewing for health education in female patients with systemic lupus erythematosus

To explore the application effect of the Knowledge, Attitude, and Practice (KAP) model combined with motivational interviewing for health education in the chronic disease management of female patients with systemic lupus erythematosus (SLE). In this study, 84 women with SLE who were admitted to a tertiary hospital in Tianjin from July 2021 to April 2022 were enrolled in this study and divided into observation (n = 42) and control groups (n = 42). The control group received routine health education and treatment for chronic diseases. Based on the control group, the KAP method and questionnaire survey were adopted. Health literacy and compliance in the 2 groups were compared in the first and third months after the intervention. The observation group had a higher total score of health literacy in the third month than the control group. From before the intervention to the first and third months, improvement in the observation group was compared with that in the control group (F = 36.543, P 6..001; F = 4.884, P = .03; F = 23.881, P 3..001). The observation group had a higher total compliance score in the third month than the control group (t = 5.101, P = .007). From before the intervention to the first and third months of the intervention, the improvement in the observation group demonstrated an interaction with the time group compared with that in the control group (F = 68.116, P 8..001; F = 4.884, P = .032; F = 24.789, P < .001). Motivational interviewing based on the KAP model is effective in the short-term overall health literacy of female patients with SLE, especially in terms of communication, health improvement, and information acquisition; after 3 months, it can influence and maintain high patient compliance.

O uso do core set da CIF para avaliação de pacientes com distúrbios cardiorrespiratórios

Introdução: A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) categoriza a saúde e deficiência do indivíduo considerando a funcionalidade e os fatores contextuais. No entanto, a CIF apresenta muitas categorias que dificultam o seu uso diário e, por isso, foram criados os core sets. Entre os diversos core sets propostos, existe um core set para condições cardiorrespiratórias pós-agudas. Objetivo: classificar os pacientes com alterações cardíacas, respiratórias e mistas, assistidos ambulatoriais por meio de um core sets para esta população, além de verificar se existem diferenças entre os grupos na aplicação deste core set. Métodos: Foram avaliados indivíduos com diagnóstico clínico de doenças cardiorrespiratórias em acompanhamento fisioterapêutico ambulatorial para reabilitação cardiopulmonar. A amostra foi dividida em três grupos: cardíacos, respiratórios e mistos. Os pacientes foram avaliados por meio da versão abreviada do core set para condições cardiorrespiratórios pós-agudas, funcionalidade, força de preensão palmar e dos músculos respiratórios. Resultados: A amostra foi composta por 67 indivíduos alocados de acordo com seu comprometimento. Verificou-se que apenas as funções de energia e impulso, cardíaca e de ingestão, estrutura do sistema respiratório e a atividade andar apresentaram respostas significativamente diferentes entres os grupos. Pacientes com distúrbios respiratórios, cardíacos e mistos apresentam perfis funcionais semelhantes, porém as categorias com diferença desse perfil foram as relacionadas ao sistema respiratório, atividades e funções relacionadas ao aumento da demanda metabólica como andar. Conclusão: Assim é possível afirmar que o core set auxilia a identificar as disfunções dos pacientes sem depender se sua disfunção é cardíaca, respiratória ou mista que pode ser uma ferramenta utilizada no meio clínico.

Nurse-Led Interventions in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.32 million deaths in 2019. COPD management has increasingly become a major component of general and hospital practice and has led to a different model of care. Nurse-led interventions have shown beneficial effects on COPD patient satisfaction and clinical outcomes. This systematic review was conducted to identify and assess nurse-led interventions in COPD patients in terms of mental, physical, and clinical status. The review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The relevance of each manuscript was assessed according to the inclusion criteria, and we retrieved full texts, as required, to reach our conclusions. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Forty-eight articles were included in the analysis, which focused on the management of COPD patients by hospital, respiratory and primary nursing care. Nursing management was shown to be highly effective in improving quality of life, emotional state, and pulmonary and physical capacity in COPD patients. In comparison, hospital and respiratory nurses carried out interventions with higher levels of effectiveness than community nurses.

Effects of the information–knowledge–attitude–practice nursing model combined with predictability intervention on patients with cerebrovascular disease

BACKGROUND

Cerebrovascular disease (CVD) poses a serious threat to human health and safety. Thus, developing a reasonable exercise program plays an important role in the long-term recovery and prognosis for patients with CVD. Studies have shown that predictive nursing can improve the quality of care and that the information –knowledge–attitude–practice (IKAP) nursing model has a positive impact on patients who suffered a stroke. Few studies have combined these two nursing models to treat CVD.

AIM

To explore the effect of the IKAP nursing model combined with predictive nursing on the Fugl–Meyer motor function (FMA) score, Barthel index score, and disease knowledge mastery rate in patients with CVD.

METHODS

A total of 140 patients with CVD treated at our hospital between December 2019 and September 2021 were randomly divided into two groups, with 70 patients in each. The control group received routine nursing, while the observation group received the IKAP nursing model combined with predictive nursing. Both groups were observed for self-care ability, motor function, and disease knowledge mastery rate after one month of nursing.

RESULTS

There was no clear difference between the Barthel index and FMA scores of the two groups before nursing (P > 0.05); however, their scores increased after nursing. This increase was more apparent in the observation group, and the difference was statistically significant (P < 0.05). The rates of disease knowledge mastery, timely medication, appropriate exercise, and reasonable diet were significantly higher in the observation group than in the control group (P < 0.05). The satisfaction rate in the observation group (97.14%) was significantly higher than that in the control group (81.43%; P < 0.05).

CONCLUSION

The IKAP nursing model, combined with predictive nursing, is more effective than routine nursing in the care of patients with CVD, and it can significantly improve the Barthel index and FMA scores with better knowledge acquisition, as well as produce high satisfaction in patients. Moreover, they can be widely used in the clinical setting.

Effects of continuous care on health outcomes in patients with stoma: A systematic review and meta-analysis

Objective

Continuing care, which is an extension of post-discharge care, is recognized as a crucial element of high-quality health services and is essential to patients. This systematic review aims to identify the effectiveness of continuing care for patients with stomas.

Methods

PubMed, EMBASE, Cochrane Trial Register and Web of Science databases were searched. Study selection and quality appraisal were performed independently by two reviewers. We calculated the mean differences (MD) or the relative risk (RR) with 95% confidence intervals and assessed heterogeneity.

Results

Nine studies (1134 participants) met the inclusion criteria. This meta-analysis revealed that, in the continuous care group, the stoma self-efficacy (MD ​= ​6.46; 95% CI ​= ​3.81–9.11; P ​< ​0.001; I² ​= ​0%), and the quality of life (MD ​= ​7.48; 95% CI ​= ​5.13–9.82; P ​< ​0.001; I² ​= ​0%) increased significantly 1 month after discharge; stoma adjustment and care satisfaction also showed a trend toward improvement while stoma complications (RR ​= ​0.71; 95% CI ​= ​0.58–0.87; P ​= ​0.001; I² ​= ​25%) decreased significantly. Continuing care did not decrease hospital readmission rates or medical costs.

Conclusions

Continuing care showed beneficial effects in improving health outcomes and care satisfaction for patients with stomas compared with routine care. We proposed an integrated continuing care program with different elements and recommendations for its implementation.

Effect of standardized enteral nutrition on AECOPD patients with respiratory failure

OBJECTIVE

To investigate the effects of standardized enteral nutrition (EN) on nutritional indicators and immunological functioning of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients with respiratory failure.

METHODS

We selected 92 cases of AECOPD patients with respiratory failure as the research objects, and classified them into two groups (control/observation group, n=46 respectively) according to random number table. Both groups were given conventional anti-infection and symptomatic treatment. In addition, the control group received diet support therapy, and the observation group was given standard EN treatment. Afterwards, the changes of nutritional indicators, immunological functioning, inflammatory indicators and cardiopulmonary function of the two groups before and after therapy were compared.

RESULTS

Hemoglobin (HB), serum albumin (ALB), and total protein (TP) of the two groups after treatment were critically higher than those before treatment, and the indicators in observation group in post-treatment were remarkably higher than those in control group (P<0.05); lymphocyte count (TLC), immunoglobulin A (IgA) and immunoglobulin G (IgG) of the two groups tremendously increased in post-treatment than before receiving treatment, and the post-treatment indicators of observation group were obviously higher than those of control group (P<0.05); high sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) in two groups sharply decreased after treatment comparing to which before treatment, and the observation group had notably lower post-treatment indexes than that of the control group (P<0.05); Ejection minutes (LVEF), NT proBNP, partial pressure of carbon dioxide (PaCO₂), partial pressure of blood oxygen (PaO₂) and pH of the two groups had remarkably improved after treatment, and the improvement effect in observation group was superior to that in control group (P<0.05).

CONCLUSION

The standard EN can substantially improve the nutritional status and immunological functioning of AECOPD patients with respiratory failure, reduce the inflammatory indicators, and promote their cardiopulmonary function.