Impact of professional nursing interventions on clinical outcomes in patients with acute gastric bleeding: a retrospective analysis

Patient selection study design and participants

This study employed a retrospective cohort study design to evaluate the effectiveness of nurse-led interventions in improving outcomes in patients with acute gastric bleeding (AGB). The study participants consist of adult patients (18 years and above) who presented to the emergency department and were diagnosed with AGB, requiring hospitalization for intervention, during a specific time period (e.g., February 2022 to February 2023). The decision for patients to undergo professional nursing interventions is a joint decision between family members and the healthcare team. Both family members and patients have a high degree of autonomy in the decision-making process. AGB is defined as sudden bleeding in the stomach, with causes including gastric ulcers, gastric cancer, and other related conditions. The diagnosis of AGB was determined by collaboration between gastrointestinal surgeons, emergency medicine specialists, and radiologists based on clinical symptoms, X-ray examinations, and gastroscopy reports.

Strict inclusion and exclusion criteria were applied to ensure the integrity of the cases. Inclusion criteria were as follows: (1) age 18 years or above at the time of diagnosis, (2) confirmed diagnosis of AGB through imaging studies and physical examination, (3) absence of significant comorbidities (Including severe cardiovascular diseases, etc.), and (4) first-time occurrence of AGB. Exclusion criteria were: (1) incomplete clinical data, (2) death within 24 h of hospital admission, and (3) history of previous surgeries. This research was performed in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Affiliated Kunshan Hospital of Jiangsu University [Approve number TH-20211127].

Assessment of severity in acute gastric bleeding

The severity of gastric bleeding is determined based on factors such as the volume of bleeding, rate of bleeding, clinical symptoms, and the presence of complications.

Volume of bleeding

Gastric bleeding refers to damage to the gastric mucosa, leading to localized vascular rupture and bleeding. If the patient experiences a relatively small volume of bleeding, the condition is generally not considered particularly severe. However, if the bleeding volume is substantial, it may lead to shock, indicating a more serious situation.

Rate of bleeding

If the bleeding occurs at a slow rate and the volume is relatively small, the condition is generally not considered particularly severe. Conversely, a faster rate of bleeding, coupled with a larger volume, is indicative of a more severe condition.

Clinical symptoms

The absence of significant discomfort symptoms in the patient generally suggests a less severe condition. On the other hand, the presence of symptoms such as vomiting, melena, fever, etc., usually indicates a more severe situation.

Presence of complications

A smaller volume of bleeding without evident complications is typically not considered particularly severe. However, if the bleeding volume is larger and complications are present, the condition is likely to be more serious.

Sample size and power calculation

Firstly, we utilized experiential judgment for multivariate analysis based on previous BMJ literature10. According to the literature, we calculated the number of endpoint events by taking five times the number of independent variables. With 19 independent variables, this equates to 95. In other words, there should be 95 patients with endpoint events. The number of patients recruited in our study who subsequently reached endpoint events exceeds 95, thus confirming this experiential judgment.

Secondly, we employed PASS (version: 11.0) for calculation. Within PASS, we utilized the “Regression” section under “Logistics Regression,” setting a two-sided Alpha of 0.05 and Beta of 0.1. The corresponding results were incorporated into the PASS software, yielding a one-sided Sample Size (N) of 33. The sample size we included is greater than 66.

Professional nursing interventions

The non-professional nursing intervention group, serving as the control group, received standard nursing care. This care included the provision of explanations regarding the current treatment methods and their purposes to facilitate patient understanding of the treatment measures. We assisted patients in identifying potential problems that may arise during the treatment process and provided guidance on precautions to be taken. Standard nursing care also involved the continuous monitoring of relevant indicators throughout the treatment period, with prompt communication to the attending physician in case of any abnormalities. The control group received patient education on proper nutrition and medication use, covering information about potential adverse drug reactions and preventive measures.

It is important to note that electrolyte monitoring was a part of the standard nursing care provided to the control group, ensuring the comprehensive evaluation of patients’ health status during the treatment period. This approach aims to capture a realistic representation of routine nursing practices in a standard care setting.

The group receiving professional nursing interventions is provided with high-quality professional nursing services delivered by general nurses., including the following aspects:

Psychological care: Many patients with gastric bleeding have misunderstandings about their disease and may experience negative emotions that can aggravate their condition. Therefore, nursing staff should closely monitor patients’ psychological changes, provide education on gastric bleeding and its treatment, and offer emotional support to help patients stabilize their emotions and voluntarily cooperate with healthcare personnel. Family members can also be given appropriate nursing guidance to provide effective support for the patient. Fluid intervention: After admission, intravenous access is quickly established, electrolyte changes are tested, and vital signs are closely monitored, including body temperature, pulse, respiration, blood pressure, and other indicators. The amount of vomiting blood, black stool, and 24-h in and out volume are recorded, and hemostatic drugs are administered if necessary. In cases of shock, sodium bicarbonate or saline is used to expand volume, and blood transfusion is administered as needed. For patients with cirrhotic portal hypertension, caution must be taken to avoid rehemorrhage due to increased portal vein pressure from further blood transfusion. The amount of fluid input should be reduced appropriately to avoid excessive input, resulting in acute edema and rehemorrhage. Life care: Patients with acute gastric hemorrhage require strict bed rest, with no food or drink allowed. Electrolyte imbalances must be corrected, and attention should be paid to maintaining an appropriate temperature. Oxygen therapy should be administered to patients with severe bleeding. Diet care: Patients with gastric bleeding should be given a light diet, with regular and moderate intake, and small meals. Patients with nausea and vomiting should be instructed to fast until symptoms disappear and bleeding stops before resuming a proper diet. Exercise care: After the patient’s condition stabilizes, exercise should be encouraged to improve body resistance. However, the amount of exercise should follow the principle of gradual progress to avoid sudden increases. Health education: Patients with gastric bleeding should receive detailed information about their disease and preventive measures. For patients with recurring gastric bleeding, education should focus on avoiding causative factors and preventing complications to ensure better control of the condition and self-care.

Nurses’ propaganda and education details in professional nursing interventions

Assess patient’s understanding and emotional state: Before beginning the mission, nursing staff should talk with patients to find out how much they know about gastric bleeding as well as any misconceptions and anxiety they may have.

Provide education on gastric bleeding and its treatment: Nursing staff should provide patients and their families with basic knowledge about gastric bleeding, including information about causes, symptoms, diagnostic methods, treatment options, and prognosis.

Emphasize the importance of treatment and cooperation: Nursing staff should clearly inform patients of the importance of their treatment and encourage them to actively cooperate with their healthcare provider’s treatment plan.

Offer emotional support and reassurance: Since gastric hemorrhage may lead to negative emotions, nursing staff should listen patiently to patients’ emotional expressions and understand and respect their feelings.

Instruct family members on effective support methods: Nursing staff can provide guidance to families on how to effectively support the patient, including emotional support, dietary care, and daily living care.

Highlight dietary and lifestyle recommendations: Nursing staff should introduce patients to appropriate diets and lifestyles to help them better manage and prevent stomach bleeding. This includes advice on dietary precautions, meal plans, and regular routines.

Guide rehabilitation exercises gradually: After the patient’s condition is stabilized, nursing staff can recommend appropriate rehabilitation exercises to help improve their body’s resistance and ability to recover.

Educate on prevention and self-management: For patients with recurrent gastric bleeding, nursing staff should focus on teaching how to avoid triggers and prevent complications to ensure better control and self-care.

Ensure patient’s comprehension and application of education: Nursing staff should double-check that patients understand the information provided during the education process and encourage them to apply the knowledge and skills they have learned in real-life situations.

Follow up regularly and address new concerns: Nursing staff should regularly follow up on patients’ conditions and treatment progress, answer any new questions they may have in a timely manner, and make any necessary adjustments and additional teachings. In summary, it is important to note that professional nursing interventions are designed to assist and support the treatment plans of the medical team. Nursing interventions are not intended to replace medical treatments but rather to work collaboratively with the physician’s treatment, aiming to comprehensively enhance the quality of patient care and treatment outcomes. And both professional nursing interventions and non-professional nursing interventions are provided by general nurses.

Data collection and outcome measures

Data collection for this retrospective analysis involved reviewing medical records of 220 patients with acute gastric bleeding who were admitted to the hospital between February 2022 and February 2023. The following outcome measures were assessed to evaluate the impact of nursing interventions on clinical outcomes:

Length of Hospital Stay: The length of hospital stay was recorded for each patient and compared between the group that received nursing interventions and the group that did not.

Blood Transfusion Requirements: The number of patients requiring blood transfusions was documented for both groups. A comparison was made to determine if nursing interventions had an influence on blood transfusion requirements.

Occurrence of Rebleeding: The incidence of rebleeding, defined as a rebleeding episode that occurs after initial treatment and complete hemostasis, was recorded and compared between the groups that received the nursing intervention and the group that did not receive the nursing intervention.

Mortality Rates: Mortality rates were calculated for patients in both groups to assess the impact of nursing interventions on patient survival.

Data analysis

The data collected from medical records served as the foundation for analyzing and comparing outcome measures between the group that received nursing interventions and the group that did not. Descriptive statistics, including means and standard deviations, were calculated to summarize the data and identify any significant differences. Covariates entered into the multivariate logistic regression analysis were prespecified, and the association between nursing interventions and postoperative rebleeding was assessed while considering potential confounding factors.

All statistical analyses were performed using SPSS 25.0 (IBM, Armonk, New York, USA). A significance level of P < 0.05 (two-sided) was considered statistically significant. To visually present the results, graphs were created using R language (version 4.0.5) and GraphPad Prism (version: 8.0). Sample size estimation was conducted before the study using PASS (version: 11.0).

Multivariate analysis included the consideration of prespecified covariates to account for potential confounding effects. Specifically, factors such as age, severity of bleeding, and history of gastrointestinal disorders were entered into the logistic regression model to assess their impact on the association between nursing interventions and postoperative rebleeding.

Follow-up

Following discharge from the hospital, all patients were followed up by two trained professionals. They conducted phone interviews with the patients to inquire about their current health status and requested them to visit the hospital for a comprehensive review. During the follow-up period, the professionals collected information regarding any ongoing symptoms, recurrence of gastric bleeding, or other complications. They also assessed the need for additional interventions or treatments. The collected data from the follow-up interviews were analyzed to determine the long-term impact of nursing interventions on patient outcomes, including the recurrence of bleeding and the overall effectiveness of the care provided. The follow-up continued until six months after the patients were discharged.

Ethical approval and consent to participation

Informed consent was obtained from all subjects and/or their legal guardian(s). This research was performed in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Affiliated Kunshan Hospital of Jiangsu University [Approve number TH-20211127].

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