# The Effect of High-Quality Nursing Management on Thyroid Tumor Patients after Bipolar Coagulation

Authors: Yanting Ji; Buyong Zhang; Xuan Zhang; Lingbo Xue; Qingfeng Shi; Jie Li
Journal: Journal of Oncology
 (2022)

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## Abstract

Objective. To evaluate the effect of high-quality nursing on thyroid tumor patients after bipolar coagulation and its impact on nursing satisfaction. Methods. From January 2019 to January 2020, 90 patients with thyroid tumors treated with bipolar coagulation in our hospital were identified as the study objects and randomized to the control group (n=45) and the experimental group (n=45) random number table method. Both groups received conventional nursing, and the experimental group additionally adopted high-quality nursing. The incidence of postoperative complications and nursing satisfaction between the two groups was compared. The Exercise of Self-Care Agency Scale (ESCA) was used to assess the self-care ability of patients after the intervention, and the Generic Quality of Life Inventory-74 (GQOLI-74) was used to evaluate the quality of life of the two groups of patients after the intervention. The Hospital Anxiety and Depression (HAD) scale was adopted to evaluate the emotional state of the patient before and after the intervention, and the Numerical Rating Scale (NRS) was employed to evaluate the pain intensity of the patient after the intervention. Counting data was analyzed by the X2 test, and the measurement data was analyzed by t-test. Results. After the intervention, the total incidence of postoperative complications in the experimental group was significantly lower than that in the control group (11.11% versus 33.33%, P<0.05). The experimental group obtained remarkably higher nursing satisfaction (93.33% versus 71.11%), ESCA scores, and GQOLI-74 scores than the control group (P<0.05). Lower HAD scores were observed in the experimental group than those of the control group (P<0.001). Lower HAD scores were observed in the experimental group than those of the control group (P<0.001). The NRS score of the experimental group was significantly lower than that of the control group 12 h and 24 h after the intervention (P<0.001). Conclusion. High-quality nursing for patients with thyroid tumors can effectively alleviate the negative emotions, improve the quality of life, and contribute to a harmonious nurse-patient relationship, which is worthy of promotion and application.


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## Body

## 1. Introduction

The thyroid is the most important endocrine organ and the largest endocrine gland of the human body [1, 2]. Thyroid tumors and thyroid functional disorders are the two main thyroid diseases with a morbidity of 10% [2, 3]. Thyroid tumors are common in endocrinology, manifested by cervical lymphadenopathy and palpitations. Delayed treatment may result in various complications such as nerve paralysis and tracheal collapse, which takes a toll on the patient’s quality of life [4–6]. Thyroid tumors, with elusive pathogenesis, are considered to be related to bad living habits and genetic factors. The current clinical treatment of thyroid diseases mainly relies on surgery. Bipolar coagulation is appreciated for a clear surgical field and small trauma. However, the difficulty of treatment due to the surgical site and the high psychological pressure of the patients may hinder the prognosis without proper nursing intervention [7, 8]. Nursing interventions can effectively reduce risk events, improve self-management efficacy, and alleviate adverse emotions of thyroid cancer patients, leading to fewer adverse reactions [9]. It has been clinically found that positive nursing measures effectively alleviate the patients’ negative emotions and improve the quality of life of the patients, based on which high-quality nursing has been widely used in clinical practice and has achieved significant nursing effects [10, 11]. Accordingly, to evaluate the effect of high-quality nursing on thyroid tumor patients after bipolar coagulation and its impact on nursing satisfaction, patients with thyroid tumors treated with bipolar coagulation in our hospital from January 2019 to January 2020 were identified as the research objects for analysis. The report is as follows.


## 2. Materials and Methods

### 2.1. General Information

Patients with thyroid tumors treated with bipolar coagulation in our hospital from January 2019 to January 2020 were identified as the research objects and randomized to the control group and the experimental group by random number table method.


### 2.2. Inclusion Criteria

(1) Patients received thyroid surgery for the first time; (2) patients with normal parathyroid function before surgery; (3) this study was approved by the hospital ethics committee, and the patients and their family members were informed of the purpose and process of the study and signed the informed consent form.


### 2.3. Exclusion Criteria

(1) Combined with blood system diseases; (2) pregnant and lactating women; (3) patients with hypoparathyroidism; (4) patients with significant cardiac, hepatic, and renal dysfunction; (5) patients with other cancers.


### 2.4. Method

The control group received conventional nursing, including basic nursing, dietary intervention, health education, close monitoring of the patient’s physical signs, and postoperative analgesic nursing.Based on the control group, the experimental group adopted high-quality nursing: (1) A nursing team was established, and regular training and evaluation were conducted to improve the nursing skills, nursing awareness, and nursing quality of nursing staff. (2) Disease-knowledge education was provided to improve patients’ awareness of their diseases and enhance the confidence in treatment. (3) Clinical psychological evaluations of patients were conducted to formulate targeted psychological guidance programs according to the patient’s personality characteristics as patients are prone to negative emotions for surgery. Multiple psychological comfort and guidance were provided for patients with severe anxiety or depression to relieve the patients’ negative emotions; (4) preoperative nursing staff should comprehensively and systematically understand the patient’s drug allergy history and clinical data and guide the patient to relieve fear by adjusting breathing; (5) the patients’ vital signs and drainage conditions were closely observed during the operation to ensure tube patency and smooth breathing; (6) a clean and tidy treatment environment was provided for the patients after surgery, and the patients were given drugs regularly, with clinical reactions closely observed to avoid adverse events; (7) the patients were instructed by nursing staff to perform breathing and relaxation exercises, with relaxing music to divert their attention and reduce pain. Measures for severe pain were adopted if necessary. (8) Dietary instruction was provided according to the actual situation of the patients, including diets with nutritional balance, less raw and cold food, and food with more protein and vitamins; (9) reasonable rehabilitation training was provided, and patients were instructed to visit the hospital for review at regular intervals after discharge.The Hospital Anxiety and Depression (HAD) scale was adopted to evaluate the emotional state of the patient before and after the intervention, and the Numerical Rating Scale (NRS) was employed to evaluate the pain intensity of the patient after the intervention.


### 2.5. Observational Indicators

The incidence of postoperative complications including hematoma, incision infection, hypothyroidism, and hoarseness was compared between the two groups.The “Patient Clinical Satisfaction Questionnaire” prepared by the department was used to investigate the nursing satisfaction of the patients, with the total score of 100 points. The higher the score, the higher the nursing satisfaction.The “Exercise of SelfCare Agency Scale (ESCA)” [12] was used to assess the self-care ability of the patients, including self-concept, self-responsibility, and self-care skills health knowledge level, with a total score of 4 points for each item. The higher the score, the higher the self-care ability of the patients.The Generic Quality of Life Inventory-74 (GQOLI-74) [13] was used to evaluate the quality of life of the two groups of patients after the intervention, including mental function, physical function, social function, and material life state, with the total score of 100 points. The higher the score, the better the quality of life of the patient.The Hospital Anxiety and Depression (HAD) [14] was adopted to evaluate the emotional state of the patient before and after the intervention, with the total score of 42 scores. The higher the score, the more severe the anxiety and depression of the patients.The Numerical Rating Scale (NRS) [15] was employed to evaluate the pain intensity of the patients after the intervention, with the total score of 10 points. 0: no pain; 1-3: mild pain; 4-6: moderate pain; and 7-10: severe pain. 6 h after the intervention, 12 h after the intervention, and 24 h after intervention were set as T0, T1, and T2, respectively, and the pain levels of the two groups of patients at different time points were compared.


### 2.6. Observational Indicators

SPSS20.0 was used for data analysis, and GraphPad Prism 7 (GraphPad Software, San Diego, USA) was used to plot the graphics. The study included counting data and measurement data. Counting data was analyzed by theX2 test, and the measurement data was analyzed by t-test. P<0.05 indicates statistical significance.


## 2.1. General Information

Patients with thyroid tumors treated with bipolar coagulation in our hospital from January 2019 to January 2020 were identified as the research objects and randomized to the control group and the experimental group by random number table method.


## 2.2. Inclusion Criteria

(1) Patients received thyroid surgery for the first time; (2) patients with normal parathyroid function before surgery; (3) this study was approved by the hospital ethics committee, and the patients and their family members were informed of the purpose and process of the study and signed the informed consent form.


## 2.3. Exclusion Criteria

(1) Combined with blood system diseases; (2) pregnant and lactating women; (3) patients with hypoparathyroidism; (4) patients with significant cardiac, hepatic, and renal dysfunction; (5) patients with other cancers.


## 2.4. Method

The control group received conventional nursing, including basic nursing, dietary intervention, health education, close monitoring of the patient’s physical signs, and postoperative analgesic nursing.Based on the control group, the experimental group adopted high-quality nursing: (1) A nursing team was established, and regular training and evaluation were conducted to improve the nursing skills, nursing awareness, and nursing quality of nursing staff. (2) Disease-knowledge education was provided to improve patients’ awareness of their diseases and enhance the confidence in treatment. (3) Clinical psychological evaluations of patients were conducted to formulate targeted psychological guidance programs according to the patient’s personality characteristics as patients are prone to negative emotions for surgery. Multiple psychological comfort and guidance were provided for patients with severe anxiety or depression to relieve the patients’ negative emotions; (4) preoperative nursing staff should comprehensively and systematically understand the patient’s drug allergy history and clinical data and guide the patient to relieve fear by adjusting breathing; (5) the patients’ vital signs and drainage conditions were closely observed during the operation to ensure tube patency and smooth breathing; (6) a clean and tidy treatment environment was provided for the patients after surgery, and the patients were given drugs regularly, with clinical reactions closely observed to avoid adverse events; (7) the patients were instructed by nursing staff to perform breathing and relaxation exercises, with relaxing music to divert their attention and reduce pain. Measures for severe pain were adopted if necessary. (8) Dietary instruction was provided according to the actual situation of the patients, including diets with nutritional balance, less raw and cold food, and food with more protein and vitamins; (9) reasonable rehabilitation training was provided, and patients were instructed to visit the hospital for review at regular intervals after discharge.The Hospital Anxiety and Depression (HAD) scale was adopted to evaluate the emotional state of the patient before and after the intervention, and the Numerical Rating Scale (NRS) was employed to evaluate the pain intensity of the patient after the intervention.


## 2.5. Observational Indicators

The incidence of postoperative complications including hematoma, incision infection, hypothyroidism, and hoarseness was compared between the two groups.The “Patient Clinical Satisfaction Questionnaire” prepared by the department was used to investigate the nursing satisfaction of the patients, with the total score of 100 points. The higher the score, the higher the nursing satisfaction.The “Exercise of SelfCare Agency Scale (ESCA)” [12] was used to assess the self-care ability of the patients, including self-concept, self-responsibility, and self-care skills health knowledge level, with a total score of 4 points for each item. The higher the score, the higher the self-care ability of the patients.The Generic Quality of Life Inventory-74 (GQOLI-74) [13] was used to evaluate the quality of life of the two groups of patients after the intervention, including mental function, physical function, social function, and material life state, with the total score of 100 points. The higher the score, the better the quality of life of the patient.The Hospital Anxiety and Depression (HAD) [14] was adopted to evaluate the emotional state of the patient before and after the intervention, with the total score of 42 scores. The higher the score, the more severe the anxiety and depression of the patients.The Numerical Rating Scale (NRS) [15] was employed to evaluate the pain intensity of the patients after the intervention, with the total score of 10 points. 0: no pain; 1-3: mild pain; 4-6: moderate pain; and 7-10: severe pain. 6 h after the intervention, 12 h after the intervention, and 24 h after intervention were set as T0, T1, and T2, respectively, and the pain levels of the two groups of patients at different time points were compared.


## 2.6. Observational Indicators

SPSS20.0 was used for data analysis, and GraphPad Prism 7 (GraphPad Software, San Diego, USA) was used to plot the graphics. The study included counting data and measurement data. Counting data was analyzed by theX2 test, and the measurement data was analyzed by t-test. P<0.05 indicates statistical significance.


## 3. Results

### 3.1. General Information Comparison

The two groups showed comparable general information such as age, gender, BMI, average course of disease, type of disease, smoking, drinking, and place of residence (P>0.05), as shown in Table 1.Table 1
Comparison of general information of the two groups of patients.
Experimental group (n=45)Control group (n=45)χ2/tPAge (year)45.75±3.3245.69±3.290.1000.920Gender (male/female)23/2221/240.1780.673BMI (kg/m2)26.27±1.5925.89±1.631.1190.266Disease course (year)1.51±0.211.49±0.250.4110.682Disease type (malignancy/benign)28/1727/180.0470.829Smoking (yes/no)20/2521/240.0450.832Drinking (yes/no)22/2324/210.1780.673Hypertension (yes/no)29/1622/232.2170.068Diabetes (yes/no)24/2119/261.1130.146CAD ((yes/no))11/3415/300.8650.176Place of residence (urban/rural)31/1430/150.0500.822


### 3.2. Comparison of Postoperative Complications

The total incidence of postoperative complications after the intervention in the experimental group was significantly lower than that in the control group (P<0.05), as shown in Table 2.Table 2
Comparison of postoperative complications between the two groups (n%).
GroupsnHematomaIncision infectionHypothyroidismHoarse voiceTotal incidenceExperimental group452.22% (1/45)0.00% (0/45)4.44% (2/45)2.22% (1/45)11.11% (5/45)Control group456.67% (3/45)6.67% (3/45)8.89% (4/45)11.11% (5/45)33.33% (15/45)x26.429P<0.05


### 3.3. Comparison of Nursing Satisfaction

Patients in the experimental group were more satisfied with the nursing when compared with those in the control group (P<0.05), see Table 3.Table 3
Comparison of nursing satisfaction between the two groups (n%).
GroupsnSatisfiedModerately satisfiedDissatisfiedTotal satisfactionExperimental group4568.89% (31/45)24.44% (11/45)8.89% (3/45)93.33% (42/45)Control group4548.89% (22/45)22.22% (10/45)28.89% (13/45)71.11% (32/45)x27.601P<0.05


### 3.4. Comparison of ESCA Scores

After the intervention, higher ESCA scores were observed in the experimental group than the control group (P<0.05), as shown in Table 4.Table 4
Comparison of ESCA scores between the two groups (−x±s, points).
GroupsnSelf-conceptSelf-responsibilitySelf-care skillsHealth knowledge levelExperimental group452.71±0.822.32±0.612.73±0.453.13±0.31Control group451.33±0.521.15±0.321.21±0.121.52±0.63t9.53411.39421.89415.382P<0.001<0.001<0.001<0.001


### 3.5. Comparison of GQOLI-74 Scores

After the intervention, the experimental group yielded significantly higher GQOLI-74 scores, as compared to the control group (P<0.05), see Table 5.Table 5
Comparison of GQOLI-74 scores between the two groups (−x±s, points).
GroupsnMental functionPhysical functionSocial functionMaterial life stateExperimental group4582.35±5.883.27±5.983.56±6.884.52±7.9Control group4563.32±4.762.12±4.965.32±5.765.23±5.8t17.90818.49913.78913.203P<0.001<0.001<0.001<0.001


### 3.6. Comparison of HAD Scores

After the nursing, lower HAD scores were observed in the experimental group than those of the control group (P<0.05), as shown in Figure 1.Figure 1
Comparison of HAD scores between the two groups (−x±s, points). Note: the abscissa represents before and after nursing, and the ordinate represents the HAD score, points; the HAD scores of the experimental group before and after the intervention were (35.12±2.11) points and (4.65±1.02) points, respectively; the HAD scores of the control group before and after the intervention were (35.15±2.08) points and (14.62±1.96) points, respectively; ∗ indicates that there was a significant difference in HAD scores before and after the nursing intervention in the experimental group (t=87.216, P<0.001); ∗∗ indicates that there was a significant difference in the HAD scores before and after the nursing intervention in the control group (t=48.187, P<0.001); ∗∗∗ indicates that there was a significant difference in the HAD scores of the two groups of patients after the nursing intervention (t=30.269, P<0.001).


### 3.7. Comparison of NRS Scores

The NRS scores of the experimental group were significantly lower than those of the control group 12 h and 24 h after the intervention (P<0.05), as shown in Figure 2.Figure 2
Comparison of NRS scores between the two groups (−x±s, points). Note: the abscissa represents the T0, T1, and T2, and the ordinate represents the NRS score, points; the NRS scores of patients in the experimental group at T0, T1, and T2 were (8.74±1.12, 4.33±0.51, 1.05±0.21) points, respectively; the NRS scores of patients in the control group at T0, T1, and T2 were (8.87±1.05, 6.49±0.83, 4.23±0.52) points, respectively; ∗ indicates that there was a significant difference in the NRS score at T1 between the two groups (t=14.874, P<0.001); ∗∗ indicates that there was a significant difference in the NRS score at T2 between the two groups (t=38.038, P<0.001).


## 3.1. General Information Comparison

The two groups showed comparable general information such as age, gender, BMI, average course of disease, type of disease, smoking, drinking, and place of residence (P>0.05), as shown in Table 1.Table 1
Comparison of general information of the two groups of patients.
Experimental group (n=45)Control group (n=45)χ2/tPAge (year)45.75±3.3245.69±3.290.1000.920Gender (male/female)23/2221/240.1780.673BMI (kg/m2)26.27±1.5925.89±1.631.1190.266Disease course (year)1.51±0.211.49±0.250.4110.682Disease type (malignancy/benign)28/1727/180.0470.829Smoking (yes/no)20/2521/240.0450.832Drinking (yes/no)22/2324/210.1780.673Hypertension (yes/no)29/1622/232.2170.068Diabetes (yes/no)24/2119/261.1130.146CAD ((yes/no))11/3415/300.8650.176Place of residence (urban/rural)31/1430/150.0500.822


## 3.2. Comparison of Postoperative Complications

The total incidence of postoperative complications after the intervention in the experimental group was significantly lower than that in the control group (P<0.05), as shown in Table 2.Table 2
Comparison of postoperative complications between the two groups (n%).
GroupsnHematomaIncision infectionHypothyroidismHoarse voiceTotal incidenceExperimental group452.22% (1/45)0.00% (0/45)4.44% (2/45)2.22% (1/45)11.11% (5/45)Control group456.67% (3/45)6.67% (3/45)8.89% (4/45)11.11% (5/45)33.33% (15/45)x26.429P<0.05


## 3.3. Comparison of Nursing Satisfaction

Patients in the experimental group were more satisfied with the nursing when compared with those in the control group (P<0.05), see Table 3.Table 3
Comparison of nursing satisfaction between the two groups (n%).
GroupsnSatisfiedModerately satisfiedDissatisfiedTotal satisfactionExperimental group4568.89% (31/45)24.44% (11/45)8.89% (3/45)93.33% (42/45)Control group4548.89% (22/45)22.22% (10/45)28.89% (13/45)71.11% (32/45)x27.601P<0.05


## 3.4. Comparison of ESCA Scores

After the intervention, higher ESCA scores were observed in the experimental group than the control group (P<0.05), as shown in Table 4.Table 4
Comparison of ESCA scores between the two groups (−x±s, points).
GroupsnSelf-conceptSelf-responsibilitySelf-care skillsHealth knowledge levelExperimental group452.71±0.822.32±0.612.73±0.453.13±0.31Control group451.33±0.521.15±0.321.21±0.121.52±0.63t9.53411.39421.89415.382P<0.001<0.001<0.001<0.001


## 3.5. Comparison of GQOLI-74 Scores

After the intervention, the experimental group yielded significantly higher GQOLI-74 scores, as compared to the control group (P<0.05), see Table 5.Table 5
Comparison of GQOLI-74 scores between the two groups (−x±s, points).
GroupsnMental functionPhysical functionSocial functionMaterial life stateExperimental group4582.35±5.883.27±5.983.56±6.884.52±7.9Control group4563.32±4.762.12±4.965.32±5.765.23±5.8t17.90818.49913.78913.203P<0.001<0.001<0.001<0.001


## 3.6. Comparison of HAD Scores

After the nursing, lower HAD scores were observed in the experimental group than those of the control group (P<0.05), as shown in Figure 1.Figure 1
Comparison of HAD scores between the two groups (−x±s, points). Note: the abscissa represents before and after nursing, and the ordinate represents the HAD score, points; the HAD scores of the experimental group before and after the intervention were (35.12±2.11) points and (4.65±1.02) points, respectively; the HAD scores of the control group before and after the intervention were (35.15±2.08) points and (14.62±1.96) points, respectively; ∗ indicates that there was a significant difference in HAD scores before and after the nursing intervention in the experimental group (t=87.216, P<0.001); ∗∗ indicates that there was a significant difference in the HAD scores before and after the nursing intervention in the control group (t=48.187, P<0.001); ∗∗∗ indicates that there was a significant difference in the HAD scores of the two groups of patients after the nursing intervention (t=30.269, P<0.001).


## 3.7. Comparison of NRS Scores

The NRS scores of the experimental group were significantly lower than those of the control group 12 h and 24 h after the intervention (P<0.05), as shown in Figure 2.Figure 2
Comparison of NRS scores between the two groups (−x±s, points). Note: the abscissa represents the T0, T1, and T2, and the ordinate represents the NRS score, points; the NRS scores of patients in the experimental group at T0, T1, and T2 were (8.74±1.12, 4.33±0.51, 1.05±0.21) points, respectively; the NRS scores of patients in the control group at T0, T1, and T2 were (8.87±1.05, 6.49±0.83, 4.23±0.52) points, respectively; ∗ indicates that there was a significant difference in the NRS score at T1 between the two groups (t=14.874, P<0.001); ∗∗ indicates that there was a significant difference in the NRS score at T2 between the two groups (t=38.038, P<0.001).


## 4. Discussion

Surgery is the current mainstay for the clinical treatment of thyroid diseases. Bipolar coagulation has been widely employed in clinical treatment due to its clear surgical field and low intraoperative blood loss and has achieved significant clinical effects [16–18]. However, the propensity for various complications such as hematoma, incision infection, hypothyroidism, and hoarseness after thyroid surgery, combined with the negative emotions and pain, poses a great psychological pressure on the patients, which results in a somber prognosis [19, 20]. It has been clinically discovered that proper nursing measures for thyroid patients after treatment can effectively alleviate the patients’ negative emotions, improve the patient’s quality of life and self-care ability, which is conducive to creating a harmonious nurse-patient relationship and promoting a quick recovery. In this study, the total incidence of postoperative complications after the intervention in the experimental group was significantly lower than that in the control group (P<0.05), indicating a better efficacy of high-quality nursing intervention than conventional nursing. In addition, the improvement of living standards results in patients’ stringent requirements for clinical nursing. Conventional nursing is a passive nursing mode that involves less communication and insufficient psychological assistance. As a consequence, negative emotions such as irritability and anxiety may impede the nursing satisfaction and the nurse-patient relationship, or even damage the hospital’s reputation and competitiveness [21, 22]. High-quality nursing, as an emerging nursing model conducts health education with relevant knowledge and precautions for patients, alleviates patients’ negative emotions, and establishes patients’ confidence toward the disease, with an appropriate nursing environment to reduce complications and postoperative analgesia to relieve the patients’ pain. In this study, the experimental group obtained significantly higher GQOLI-74 scores and lower HAD scores than the control group (P<0.05), indicating that high-quality nursing improves the quality of life and eliminates patients’ negative emotions. In addition, the NRS score of the experimental group was significantly lower than that of the control group 12 h and 24 h after intervention (P<0.05), indicating that high-quality nursing substantially relieves the pain of patients to ensure a better prognosis. Compared with conventional nursing, high-quality nursing is more standardized, targeted, and comprehensive, in which health education contributes to a better psychological status of the patients in treatment and the amelioration of prognosis [23, 24]. The results of this experiment demonstrated a higher nursing satisfaction in the experimental group than that of the control group after the intervention (P<0.05), which was consistent with the research results of Sun et al. [25] who confirmed that “the nursing satisfaction rate of the study group was 95.23%, which was significantly higher than the rate of 80.95% in the control group (P<0.05),” suggesting that high-quality nursing ensures a harmonious nurse-patient relationship by fulfilling the patients’ needs and reducing medical disputes.In conclusion, high-quality nursing for patients with thyroid tumors can effectively alleviate the negative emotions, improve the quality of life, and contribute to a harmonious nurse-patient relationship, which is worthy of promotion and application.



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