# Effects of Targeted Intervention plus Comprehensive Nursing on the Quality of Life and Nursing Satisfaction in Multiple Traumas

Authors: Xihong Zhang
Journal: Evidence-Based Complementary and Alternative Medicine
 (2022)

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## Abstract

Objective. To explore the effect of targeted intervention plus comprehensive nursing on quality of life and nursing satisfaction of patients with multiple traumas. Methods. Totally 68 cases with multiple traumas admitted to Xishan People’s Hospital from September 2018 to September 2019 were recruited and randomized into a control group and a study group via the random number table method, with 34 cases in each group. The control group received conventional nursing, and the study group adopted targeted intervention plus comprehensive nursing. Results. The study group showed significantly lower life scores and Hospital Anxiety and Depression Scale (HADS) scores after the intervention, as compared to the control group. The average Newcastle Nursing Service Satisfaction Scale (NSNS) scores, various self-care ability scores, and comprehensive self-care ability scores were higher than those of the control group. Significantly lower Numerical Rating Scale (NRS) scores were observed in the study group at 7 d and 10 d of intervention than those of the control group. Conclusion. Targeted intervention plus comprehensive nursing enhances the quality of life of patients and nursing satisfaction, which merits clinical promotion.


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## Body

## 1. Introduction

Survey data show that sudden trauma results in over 10 million deaths and injuries worldwide and is considered a major public hazard [1]. Multiple traumas refer to the simultaneous or sequential damage of two or more anatomical parts of the body after a single injury [2, 3]. Therefore, the reduction of the disability and mortality of multiple traumas has become a clinical concern. The current trauma treatment includes prehospital first aid, in-hospital treatment, and rehabilitation care, among which clinical care is a key measure to improve the quality of life of patients and improve prognosis [4, 5]. Emergency care for multiple traumas begins with the maintenance of an unobstructed airway, as patients with severe multiple traumas are commonly associated with respiratory obstruction and even asphyxia. Thus, medical staff should quickly remove foreign bodies from the airway, provide oxygen therapy, and administer ventilator assistance, if necessary, at the beginning of rescue [6]. Nursing strategies are essential for multiple traumas. Traditional nursing interventions for multiple traumas are reduced to treatment and management of existing symptoms without prospective warning and advance control of possible risk problems, resulting in a failure or ineffectiveness of multiple traumas risk care [7].Comprehensive nursing intervention is a holistic and humanized nursing measure that achieves the best physical and mental state of patients and improves the prognosis by providing patients with well-rounded interventions [8]. In addition, traditional Chinese medicine (TCM) acupuncture, massage, food therapy, and other important parts of comprehensive nursing play a role in promoting the recovery of patients [9]. Targeted intervention is the main type of comprehensive nursing that satisfies the physiological and psychological needs of patients through targeted intervention programs after an accurate assessment of patients’ clinical condition to improve quality of life [10]. Accordingly, this study was undertaken to analyze the application value of targeted intervention plus comprehensive nursing on the quality of life and nursing satisfaction of patients with multiple traumas.


## 2. Materials and Methods

### 2.1. General Information

A total of 68 cases with multiple traumas admitted to Xishan People’s Hospital from September 2018 to September 2019 were recruited and randomized into the control group and study group by the random number table method, with 34 cases in each group. The protocol of this study was approved by the Ethical Committee of Xishan People’s Hospital (approved no. 2017/33-341).


### 2.2. Inclusion and Exclusion Criteria

#### 2.2.1. Inclusion Criteria

The inclusion criteria were as follows:(1)
Aged older than 18 years(2)
Met diagnostic criteria for multiple traumas [11](3)
Expected to be hospitalized for more than 1 week, conscious, and able to communicate(4)
Provided written informed consent


#### 2.2.2. Exclusion Criteria

The exclusion criteria were as follows:(1)
Died before the treatment(2)
With injuries at a single site(3)
With chronic diseases of the hematopoietic, immune, and renal systems(4)
Pregnancy or lactation women(5)
Patients with malignant tumor and pain, history of long-term analgesics, and history of chronic pain


### 2.3. Methods

The control group received clinical routine care, and the specific steps were as follows. The green channel is opened, ECG monitoring is performed, vital signs are monitored, and rescue is prepared. Unblocked airway and adequate oxygen intake are maintained. Venous channels are established to replenish blood volume quickly. The doctor’s advice for relevant examinationsis followed. Relevant departments are contacted for consultation if necessary. The changes of the condition are closely observed, if there is any abnormality, timely report to the doctor, and cooperate with the corresponding emergency measures.Additionally, the study group adopted targeted intervention plus comprehensive nursing. The specific implementation steps were as follows. (1) A rescue plan was formulated after the patients’ conditions were briefly assessed. After entering the rescue room, an oxygen supply was performed immediately, with the patient’s blood pressure and electrocardiogram being closely monitored. Cardiopulmonary resuscitation was performed if necessary, and appropriate analgesia and sedative drugs were given to the patients for pain relief. During the rescues, the nursing staff cooperated closely with the attending physician. (2) For patients with shock, special personnel were arranged for nursing intervention to raise the lower limbs of the patients by 15–30° and raise the body and head by 20–30° to avoid the internal organs from moving. (3) During the shock period, the patients were administered alkaline drugs for acidosis correction, followed by the supplementation of the blood and vasoactive substances. (4) Medical staff helped the patient adjust the sitting posture and clear the secretions in the respiratory tract daily. Oxygen therapy or mechanical ventilation was performed according to the patient’s condition, with the oxygen flow and concentration being strictly and accurately controlled. (5) The wounds of the patients were cleaned and bandaged, fracture sites were fixed, and analgesics were given if necessary. The patient’s airway was maintained unobstructed. In the event of coma, the patient’s head was tilted to one side, with the tongue out, and a nasopharyngeal tube was placed or tracheal intubation was performed to ensure smooth breathing according to the patient’s condition. (6) Before the rescue, the family members were informed of the rescue procedures and risks in advance to eliminate their fear and avoid inappropriate behaviors. (7) Active communication with the patients was performed after their conditions were stable to improve the patients’ understanding of the disease and eliminate anxiety and depression. Patients were instructed to develop good living habits and carry out early functional exercises according to their conditions, and positive social and family support was encouraged to boost recovery. (8) TCM nursing: during the convalescence of fracture patients, acupoint massage was carried out, and the ear acupoint was pressed. Through the stimulation of relevant acupoints, promote the regression of fracture symptoms and promote fracture healing. TCM fumigations is applicated to promote blood circulation at the fracture site to speed healing.


### 2.4. Observational Indicators

#### 2.4.1. Quality of Life

The quality of life of all groups after intervention was evaluated with reference to the self-made quality of life score sheet for inpatients with multiple traumas in our department. The scale includes emotional score, symptom score, and social restriction score, with 12 points for each item. The lower the score, the higher the quality of life of the patient.


#### 2.4.2. Emotion Statue

The Hospital Anxiety and Depression Scale (HADS) was used to evaluate the emotional state of patients after intervention [12]. The scale has a total of 14 scoring items, with each item of 3 points and a total score of 42 points: 0–7, asymptomatic; 8–10, potential anxiety and depression; 11–21, anxiety and depression. ≥8 points were regarded as positive.


#### 2.4.3. Nursing Satisfaction

The “Newcastle Nursing Service Satisfaction Scale” (NSNS) was used to judge the clinical nursing satisfaction of all patients [13]. The scale has all 19 scoring items, and each item is divided into unsatisfied (1 point), moderately satisfied (3 points), and satisfied (5 points), with a total score of 95 points. The higher the score, the higher the satisfaction.


#### 2.4.4. Self-Care Ability

The self-care ability scale developed by our department was used to assess the self-care ability of the patients. The scale includes medication compliance and self-care ability with a score of 100 points. The higher the score, the better the patient’s self-care ability.


#### 2.4.5. Pain Evaluation

The Numerical Rating Scale-10 (NRS-10) was used to evaluate the severity of pain in the limbs of patients at different time points [14]. The scale has a score between 0 and 10 points. The higher the score, the more severe the pain.


### 2.5. Statistical Methods

All data management and analysis were conducted by SPSS 21.0, and GraphPad Prism 8.0 (GraphPad Software, San Diego, USA) was used to plot the graphics. Counting data are expressed as (n, %) and analyzed by the chi-square test. Measurement data are expressed as (x¯±s) and analyzed using the t-test. The level of significance for all outcomes was 0.05.


## 2.1. General Information

A total of 68 cases with multiple traumas admitted to Xishan People’s Hospital from September 2018 to September 2019 were recruited and randomized into the control group and study group by the random number table method, with 34 cases in each group. The protocol of this study was approved by the Ethical Committee of Xishan People’s Hospital (approved no. 2017/33-341).


## 2.2. Inclusion and Exclusion Criteria

### 2.2.1. Inclusion Criteria

The inclusion criteria were as follows:(1)
Aged older than 18 years(2)
Met diagnostic criteria for multiple traumas [11](3)
Expected to be hospitalized for more than 1 week, conscious, and able to communicate(4)
Provided written informed consent


### 2.2.2. Exclusion Criteria

The exclusion criteria were as follows:(1)
Died before the treatment(2)
With injuries at a single site(3)
With chronic diseases of the hematopoietic, immune, and renal systems(4)
Pregnancy or lactation women(5)
Patients with malignant tumor and pain, history of long-term analgesics, and history of chronic pain


## 2.2.1. Inclusion Criteria

The inclusion criteria were as follows:(1)
Aged older than 18 years(2)
Met diagnostic criteria for multiple traumas [11](3)
Expected to be hospitalized for more than 1 week, conscious, and able to communicate(4)
Provided written informed consent


## 2.2.2. Exclusion Criteria

The exclusion criteria were as follows:(1)
Died before the treatment(2)
With injuries at a single site(3)
With chronic diseases of the hematopoietic, immune, and renal systems(4)
Pregnancy or lactation women(5)
Patients with malignant tumor and pain, history of long-term analgesics, and history of chronic pain


## 2.3. Methods

The control group received clinical routine care, and the specific steps were as follows. The green channel is opened, ECG monitoring is performed, vital signs are monitored, and rescue is prepared. Unblocked airway and adequate oxygen intake are maintained. Venous channels are established to replenish blood volume quickly. The doctor’s advice for relevant examinationsis followed. Relevant departments are contacted for consultation if necessary. The changes of the condition are closely observed, if there is any abnormality, timely report to the doctor, and cooperate with the corresponding emergency measures.Additionally, the study group adopted targeted intervention plus comprehensive nursing. The specific implementation steps were as follows. (1) A rescue plan was formulated after the patients’ conditions were briefly assessed. After entering the rescue room, an oxygen supply was performed immediately, with the patient’s blood pressure and electrocardiogram being closely monitored. Cardiopulmonary resuscitation was performed if necessary, and appropriate analgesia and sedative drugs were given to the patients for pain relief. During the rescues, the nursing staff cooperated closely with the attending physician. (2) For patients with shock, special personnel were arranged for nursing intervention to raise the lower limbs of the patients by 15–30° and raise the body and head by 20–30° to avoid the internal organs from moving. (3) During the shock period, the patients were administered alkaline drugs for acidosis correction, followed by the supplementation of the blood and vasoactive substances. (4) Medical staff helped the patient adjust the sitting posture and clear the secretions in the respiratory tract daily. Oxygen therapy or mechanical ventilation was performed according to the patient’s condition, with the oxygen flow and concentration being strictly and accurately controlled. (5) The wounds of the patients were cleaned and bandaged, fracture sites were fixed, and analgesics were given if necessary. The patient’s airway was maintained unobstructed. In the event of coma, the patient’s head was tilted to one side, with the tongue out, and a nasopharyngeal tube was placed or tracheal intubation was performed to ensure smooth breathing according to the patient’s condition. (6) Before the rescue, the family members were informed of the rescue procedures and risks in advance to eliminate their fear and avoid inappropriate behaviors. (7) Active communication with the patients was performed after their conditions were stable to improve the patients’ understanding of the disease and eliminate anxiety and depression. Patients were instructed to develop good living habits and carry out early functional exercises according to their conditions, and positive social and family support was encouraged to boost recovery. (8) TCM nursing: during the convalescence of fracture patients, acupoint massage was carried out, and the ear acupoint was pressed. Through the stimulation of relevant acupoints, promote the regression of fracture symptoms and promote fracture healing. TCM fumigations is applicated to promote blood circulation at the fracture site to speed healing.


## 2.4. Observational Indicators

### 2.4.1. Quality of Life

The quality of life of all groups after intervention was evaluated with reference to the self-made quality of life score sheet for inpatients with multiple traumas in our department. The scale includes emotional score, symptom score, and social restriction score, with 12 points for each item. The lower the score, the higher the quality of life of the patient.


### 2.4.2. Emotion Statue

The Hospital Anxiety and Depression Scale (HADS) was used to evaluate the emotional state of patients after intervention [12]. The scale has a total of 14 scoring items, with each item of 3 points and a total score of 42 points: 0–7, asymptomatic; 8–10, potential anxiety and depression; 11–21, anxiety and depression. ≥8 points were regarded as positive.


### 2.4.3. Nursing Satisfaction

The “Newcastle Nursing Service Satisfaction Scale” (NSNS) was used to judge the clinical nursing satisfaction of all patients [13]. The scale has all 19 scoring items, and each item is divided into unsatisfied (1 point), moderately satisfied (3 points), and satisfied (5 points), with a total score of 95 points. The higher the score, the higher the satisfaction.


### 2.4.4. Self-Care Ability

The self-care ability scale developed by our department was used to assess the self-care ability of the patients. The scale includes medication compliance and self-care ability with a score of 100 points. The higher the score, the better the patient’s self-care ability.


### 2.4.5. Pain Evaluation

The Numerical Rating Scale-10 (NRS-10) was used to evaluate the severity of pain in the limbs of patients at different time points [14]. The scale has a score between 0 and 10 points. The higher the score, the more severe the pain.


## 2.4.1. Quality of Life

The quality of life of all groups after intervention was evaluated with reference to the self-made quality of life score sheet for inpatients with multiple traumas in our department. The scale includes emotional score, symptom score, and social restriction score, with 12 points for each item. The lower the score, the higher the quality of life of the patient.


## 2.4.2. Emotion Statue

The Hospital Anxiety and Depression Scale (HADS) was used to evaluate the emotional state of patients after intervention [12]. The scale has a total of 14 scoring items, with each item of 3 points and a total score of 42 points: 0–7, asymptomatic; 8–10, potential anxiety and depression; 11–21, anxiety and depression. ≥8 points were regarded as positive.


## 2.4.3. Nursing Satisfaction

The “Newcastle Nursing Service Satisfaction Scale” (NSNS) was used to judge the clinical nursing satisfaction of all patients [13]. The scale has all 19 scoring items, and each item is divided into unsatisfied (1 point), moderately satisfied (3 points), and satisfied (5 points), with a total score of 95 points. The higher the score, the higher the satisfaction.


## 2.4.4. Self-Care Ability

The self-care ability scale developed by our department was used to assess the self-care ability of the patients. The scale includes medication compliance and self-care ability with a score of 100 points. The higher the score, the better the patient’s self-care ability.


## 2.4.5. Pain Evaluation

The Numerical Rating Scale-10 (NRS-10) was used to evaluate the severity of pain in the limbs of patients at different time points [14]. The scale has a score between 0 and 10 points. The higher the score, the more severe the pain.


## 2.5. Statistical Methods

All data management and analysis were conducted by SPSS 21.0, and GraphPad Prism 8.0 (GraphPad Software, San Diego, USA) was used to plot the graphics. Counting data are expressed as (n, %) and analyzed by the chi-square test. Measurement data are expressed as (x¯±s) and analyzed using the t-test. The level of significance for all outcomes was 0.05.


## 3. Results

### 3.1. Baseline Patient Profile

All groups presented similar baseline data such as gender, average age, body mass index, type of injury, and clinical symptoms (allP>0.05), as given in Table 1.Table 1
Comparison of baseline data.
Study group (n = 34)Control group (n = 34)χ2/tPGender (male/female)16/1817/170.0150.901Age (years)43.58 ± 6.7843.61 ± 6.830.0180.986BMI (kg/m2)21.26 ± 2.1721.32 ± 2.230.1120.911Type of injury1.8810.597Car accident1113Heavy objects86Crush injury129Falling from height36Clinical symptoms1.1050.576Multiple fractures1216Chest/abdomen closed injury1614Respiratory failure64


### 3.2. Quality of Life Scores

After intervention, patients in the study group had lower quality of life scores including emotional score, symptom score, and social restriction score, as compared to those of the control group (allP<0.001) (Table 2).Table 2
Comparison of quality of life scores (x¯±s, points).
GroupsnEmotional scoreSymptom scoreSocial restriction scoreStudy group347.14 ± 1.757.03 ± 1.466.17 ± 1.78Control group349.25 ± 1.688.82 ± 1.548.09 ± 1.83t5.0724.9184.385P<0.001<0.001<0.001


### 3.3. HADS and NSNS Scores

The study group had lower HADS scores than the control group (P<0.001). The study group garnered a significantly higher average NSNS score than the control group (all P<0.001), as shown in Figure 1.Figure 1
Comparison of HADS scores and NSNS scores. (a) HADS scores of the two groups. (b) NSNS scores of the two group.∗∗∗P<0.001.
(a)(b)


### 3.4. Comprehensive Self-Care Ability

After intervention, self-care ability scores and comprehensive self-care ability scores including medication compliance, understanding of the disease, and self-care ability of the study group were remarkably higher versus those of the control group (P<0.001) (Table 3).Table 3
Comparison of comprehensive self-care ability (x¯±s, points).
GroupsnMedication complianceUnderstanding of diseaseSelf-care abilityComprehensive self-care abilityStudy group3423.17 ± 2.0821.26 ± 3.4623.02 ± 3.2767.45 ± 8.81Control group3421.25 ± 1.9715.28 ± 2.1620.24 ± 3.3156.77 ± 7.44t3.9088.5493.4845.401P<0.001<0.001<0.001<0.001


### 3.5. NRS-10 Scores at Different Time Points

The differences in the NRS-10 scores before intervention and at 3 d of intervention between the two groups did not come up to statistical standard (allP>0.05). Significantly lower NRS-10 scores of the study group at 7 d and 10 d of intervention than the control group were observed (P<0.001) (Table 4).Table 4
NRS-10 scores at different time points (x¯±s, points).
GroupsnBefore intervention3 d of intervention7 d of intervention10 d of interventionStudy group348.05 ± 0.736.25 ± 0.644.32 ± 0.361.34 ± 0.26Control group348.03 ± 0.696.43 ± 0.575.15 ± 0.412.56 ± 0.32t0.1161.2258.87017.253P0.9080.225<0.001<0.001


## 3.1. Baseline Patient Profile

All groups presented similar baseline data such as gender, average age, body mass index, type of injury, and clinical symptoms (allP>0.05), as given in Table 1.Table 1
Comparison of baseline data.
Study group (n = 34)Control group (n = 34)χ2/tPGender (male/female)16/1817/170.0150.901Age (years)43.58 ± 6.7843.61 ± 6.830.0180.986BMI (kg/m2)21.26 ± 2.1721.32 ± 2.230.1120.911Type of injury1.8810.597Car accident1113Heavy objects86Crush injury129Falling from height36Clinical symptoms1.1050.576Multiple fractures1216Chest/abdomen closed injury1614Respiratory failure64


## 3.2. Quality of Life Scores

After intervention, patients in the study group had lower quality of life scores including emotional score, symptom score, and social restriction score, as compared to those of the control group (allP<0.001) (Table 2).Table 2
Comparison of quality of life scores (x¯±s, points).
GroupsnEmotional scoreSymptom scoreSocial restriction scoreStudy group347.14 ± 1.757.03 ± 1.466.17 ± 1.78Control group349.25 ± 1.688.82 ± 1.548.09 ± 1.83t5.0724.9184.385P<0.001<0.001<0.001


## 3.3. HADS and NSNS Scores

The study group had lower HADS scores than the control group (P<0.001). The study group garnered a significantly higher average NSNS score than the control group (all P<0.001), as shown in Figure 1.Figure 1
Comparison of HADS scores and NSNS scores. (a) HADS scores of the two groups. (b) NSNS scores of the two group.∗∗∗P<0.001.
(a)(b)


## 3.4. Comprehensive Self-Care Ability

After intervention, self-care ability scores and comprehensive self-care ability scores including medication compliance, understanding of the disease, and self-care ability of the study group were remarkably higher versus those of the control group (P<0.001) (Table 3).Table 3
Comparison of comprehensive self-care ability (x¯±s, points).
GroupsnMedication complianceUnderstanding of diseaseSelf-care abilityComprehensive self-care abilityStudy group3423.17 ± 2.0821.26 ± 3.4623.02 ± 3.2767.45 ± 8.81Control group3421.25 ± 1.9715.28 ± 2.1620.24 ± 3.3156.77 ± 7.44t3.9088.5493.4845.401P<0.001<0.001<0.001<0.001


## 3.5. NRS-10 Scores at Different Time Points

The differences in the NRS-10 scores before intervention and at 3 d of intervention between the two groups did not come up to statistical standard (allP>0.05). Significantly lower NRS-10 scores of the study group at 7 d and 10 d of intervention than the control group were observed (P<0.001) (Table 4).Table 4
NRS-10 scores at different time points (x¯±s, points).
GroupsnBefore intervention3 d of intervention7 d of intervention10 d of interventionStudy group348.05 ± 0.736.25 ± 0.644.32 ± 0.361.34 ± 0.26Control group348.03 ± 0.696.43 ± 0.575.15 ± 0.412.56 ± 0.32t0.1161.2258.87017.253P0.9080.225<0.001<0.001


## 4. Discussion

In this study, a self-made patient quality of life scoring scale was used to comprehensively evaluate the quality of life of cases. Results showed that the study group patients showed lower quality of life scores, indicating that targeted intervention plus comprehensive nursing ensures a better quality of life of patients with multiple traumas and satisfies the patients’ physical and psychological needs.The condition of patients with multiple traumas is often complex and critical. According to several data, severe multiple traumas are one of the main causes of human death today, accounting for up to 7% of the global total. Multiple traumas can be life-threatening with critical conditions and rapid changes, which underlines the significance of efficient rescue measures [15]. Multiple traumas progress rapidly and can lead to disability or even death if the patient cannot receive effective treatment within a short period of time. Moreover, patients may experience negative psychological impacts, which may compromise the treatment efficiency and rehabilitation [16, 17]. In targeted intervention plus comprehensive nursing, tailored nursing plans are formulated according to the patient’s condition to improve the nursing efficiency and fulfill the personalized diagnosis and treatment requirements of modern medicine [18]. In addition, psychological interventions effectively alleviate the pressure on patients and enhance their confidence in overcoming the disease. Results of LEARY demonstrated that targeted intervention plus comprehensive nursing enhances patients’ treatment compliance, establishes a good nurse-patient relationship, and helps the patients cultivate a healthy lifestyle, which shows great prognosis benefits [19]. Clinical research has found a strong association between nursing satisfaction and the allocation of medical staff, which highlights the rational use of human resources to ensure the quality of care and improve nursing satisfaction [20]. In targeted intervention plus comprehensive nursing, the close cooperation of attending physicians and nursing staff contributes to an effective and timely rescue [21]. In the present study, the NSNS score was used to evaluate clinical nursing satisfaction of all groups after the intervention. It was found that the average NSNS scores of the study group were, significantly higher than those of the control group after the intervention, indicating that targeted intervention plus comprehensive nursing for patients with multiple traumas improves clinical nursing satisfaction and promotes the treatment compliance. However, this study has several limitations. First, there are many types of injuries in patients included in this study, and the results of different injuries have great heterogeneity. Second, the number of patients included in this study was small, so subgroup analysis was not possible. Finally, the demand for individual nursing measures is high and the implementation is difficult.


## 5. Conclusion

Targeted intervention markedly ameliorates the quality of life of patients and nursing satisfaction, which merits clinical promotion.



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*Source: 8929418-2022-07-05.xml*