Abstract
Background:
To explore the perioperative effect of the evaluation system of nursing quality in otorhinolaryngology patients.
Methods:
A total of 100 patients hospitalized in the Department of Otorhinolaryngology of the Third Affiliated Hospital of Qiqihar Medical College, Qiqihar City, China in 2019 were selected as the control group, and routine nursing mode was adopted. The control group was data before the implementation of this study. A total of 100 patients (experimental group) hospitalized in the Department of Otolaryngology in 2020 were selected to adopt the nursing model constructed by nursing quality evaluation system. The adverse mood of patients in the two groups were evaluated at admission and discharge, and postoperative pain and satisfaction were compared between the two groups.
Results:
Anxiety, depression and quality of life scores were improved in both groups, but the degree of improvement in experimental group was significantly higher than that in control group (t=481.759, 353.502, P<0.05), and the postoperative pain score in experimental group was lower than that in control group (t=54.086, P<0.05). The satisfaction of experimental group was better than that of control group (χ2=30.327, P<0.05).
Conclusion:
The nursing model based on the evaluation system of the nursing quality of otorhinolaryngology can relieve patients’ adverse emotions, relieve postoperative pain of otorhinolaryngology patients, and improve patient satisfaction. Therefore, it is worth popularizing and applying in the future.
Keywords: Ear, Nose and throat diseases; Perioperative; Nursing quality evaluation system; Nursing
Introduction
China has a large number of ear, nose and throat (ENT) diseases patients, accounting for 80% of the total number of patients worldwide (1). ENT diseases have a long course and are mostly combined with auditory, olfactory and acoustic disorders. Patients are often accompanied by different degrees of psychological disorders, such as anxiety, depression, mania, etc. (2). Approximately half of patients with ENT disease need surgery. However, ENT surgery sites are mostly located in the nasal cavity, ear canal or respiratory tract where nerves and blood vessels are densely distributed, so the postoperative pain is more intense and lasts longer than other surgical procedures. What’s more, the bad mood of postoperative patients is more obvious, which affects the prognosis and recovery (3).
Therefore, it is crucial to find out how to effectively relieve postoperative patient pain and reduce the degree of perioperative dysphoria.
Clinical care is an important part of daily treatment, and the role of different care models in the occurrence of perioperative dysphoria also varies. At present, the studies on nursing models that effectively alleviate postoperative dysphoria in ENT patients are relatively rare. Most of the reported effective nursing models focus on patient psychological counseling and emphasize humanistic care, they are less holistic and specific, and lack quality standards for guiding and judgment (4). Nursing quality evaluation system or can make up for the above deficiencies. Previous study revealed that the nursing quality evaluation system is an effective tool, which can assess nursing quality and guide nursing work, with evaluation indicators as the basic elements (5). Specialized nursing evaluation indicators with high specificity according to the characteristics and problems of nursing in different disciplines was developed by the nursing quality evaluation system. Postpartum depression as an evaluation index was included in the obstetric specialty care quality evaluation system, which significantly reduced the incidence of adverse emotions such as postpartum depression (6).
However, there is no specialist nursing evaluation system for postoperative ENT patients. Therefore, we aimed to explore the perioperative effect of the evaluation system of nursing quality in otorhinolaryngology patients.
Materials and Methods
General data
The sample size calculation (7) between 2 groups was N= (Uα+Uβ)22P(1−P)/(P1−P2)2, Uα is the test level, and Uβ is the value corresponding to the probability of type II error (Uα=1.64, Uβ=1.28). P1 and P2 are estimates of the prevalence of anxiety and depression in ENT patients with preoperative and postoperative, respectively, and P is the cumulative rate. The prevalence of anxiety and depression in ENT patients is about 20%. We aimed to improve the patients’ adverse mood to reduce it to 5% through a trial, therefore, the sample size was calculated to be 100 according to formula.
A total of 100 patients hospitalized in the Department of Otorhinolaryngology of the Third Affiliated Hospital of Qiqihar Medical College, Qiqihar City, China in 2019 were selected as the control group, and routine nursing mode was adopted. The control group was data before the implementation of this study. A total of 100 patients (experimental group) hospitalized in the Department of Otolaryngology of our hospital from January 2020 to December 2020 were selected to adopt the nursing model constructed by nursing quality evaluation system.
Patient inclusion Criteria were: 1. ENT patients requiring surgical treatment. 2. Patients with no previous mental illness who can cooperate with the experimental study. 3. Voluntary participation and signed informed consent form.
Exclusion criteria were: 1. Those who perform surgical procedures other than ENT surgery. 2. Pre-existing serious underlying medical conditions, or inability to participate in the entire study. There was no significant difference in general data between the two groups.
Nursing method in the control group
Patients in the control group were treated with the usual perioperative care methods. The nursing contents includes: admission safety preaching, preoperative water fasting notification, postoperative implementation of medical advice, regular observation of patients’ vital signs and wound bleeding and drainage, etc.
The evaluation criteria of nursing quality, such as execution rate of medical orders, incidence of adverse events, qualified rate of ward management, qualified rate of technical operation, patient complaint rate, etc. are evaluated by nursing department (once every 6 months), department (once a quarter) and head nurse (once a month).
Construction of nursing quality evaluation system
First of all, we set up a nursing evaluation system group. A total of 15 nurses were selected to set up a nursing management evaluation team. There was 1 chief superintendent nurse, 2 co-chief superintendent nurses, 5 nurses-in-charge and 7 nurses in this team, which head-nurse was the leader. All team members were required to have a bachelor degree or higher and at least 5 years of first-line clinical nursing experience. Participants were required to pass a psychological intervention course instructed by a professional psychological rehabilitation practitioner before they were allowed to participate in the experiment. There were 3 data collectors and statisticians in the team, and the experimental data were collected and kept by these 3 members. What’s more, we constructed an evaluation system. By reviewing the previous research and related books (8), initial evaluation metrics were established, and then screened according to the statistics method. After that, we interviewed ENT specialists to supplement the evaluation metrics within the evaluation system. At last, ENT nursing quality evaluation system was established based on the Delphi method (Table 1).
Table 1:
ENT nursing quality evaluation system
| Level 1 Indicators | Level 2 Indicators | Level 3 Indicators |
|---|---|---|
| Elements Index | Personnel allocation | Bed-nurse ratio |
| Nurse-patient ratio | ||
| Nurse competence | Training hours for nurses’ knowledge related to otorhinolaryngology and psychotherapy | |
| Passing rate of professional knowledge assessment for nurses in otorhinolaryngology | ||
| Accuracy of mental health assessment | ||
| Accuracy of the pain assessment | ||
| Accuracy of the sleep quality assessment | ||
| Length of psychological counseling | ||
| Procedure Index | Disease observation | Accuracy rate of vital signs detection |
| Timely rate of respiratory function detection | ||
| Timeliness of neurological function testing | ||
| Complication intervention | Timeliness of pain interventions | |
| Accuracy of determining complications of ENT surgery | ||
| Nursing Records | Nursing Record Writing | |
| Accuracy of nursing records | ||
| Timeliness of medical advice execution | ||
| System implementation rate of responsible nurses | ||
| Final Index | Patient | Satisfaction with patients |
| Nursing complaint rate | ||
| Tube blockage rate in intubated patients | ||
| Nurse | Satisfaction with nursing care | |
| Incidence of accidental injury among nurses |
Implementation of ENT nursing quality evaluation system
The evaluation indexes included in the ENT nursing quality evaluation system are used as evaluation contents. The bed-nurse ratio, nurse-patient ratio and training hours of ENT-related knowledge are evaluated according to the indexes in the system. and the problems found are rectified according to the quality control results (Table 2).
Table 2:
Content of ENT nursing quality evaluation system
| Subject | Content | |
|---|---|---|
| Evaluation time | At the time of patient admission | |
| Evaluation frequency | Elements Index: once a week, Procedure Index: once a week, Final Index: once a month | |
| Valuator | Head-nurse | |
| Evaluation content | Elements index evaluation | Bed-nurse ratio and nurse-patient ratio were evaluated once a week to ensure that the bed-nurse ratio ≥1:0.4 and the nurse-patient ratio ≤1:8 |
| The professional knowledge assessment pass rate should be required to reach 100%. | ||
| The bedside nurse should assess the psychological health, pain, and sleep of the three sampled patients with 90% accuracy. The total duration of psychological counseling for the five sampled patients should be at least 14 hours. | ||
| Procedure Index evaluation | Every Sunday, the head-nurse will evaluated in the ward. The evaluation of the included indexes should be no less than five times, and no less than six patients per day, then the accuracy rate should be calculated. | |
| Final index evaluation | The nursing department counted the number of patient complaints in that month. | |
| Monthly satisfaction of discharged patients was collected by questionnaire. According to the questionnaire, the head nurse counted the nursing satisfaction rate of nursing team members and the pipe blockage of intubated patients. | ||
Quality Assurance
1) Personnel allocation. For those whose nurse-patient ratio and bed-nurse ratio do not meet the standard, on the one hand, increase the number of nursing staff while optimizing the scheduling system, and on the other hand, pay attention to the hierarchical allocation of nursing teams. 2) In order to ensure the homogeneity of the evaluation, before the implementation of the evaluation system, the nursing staff of the department was uniformly trained and the three-level ward rounds system was implemented. The head nurse paid attention to the bedside nurses’ assessment methods, ability and accuracy of patients’ conditions, sleep, complications, respiratory function and neurological function during the daily ward rounds. 3) Focus on the failing indexes after evaluation, strengthen the training work of nurses, especially for patients with nasolaryngology surgery, and have senior nurses take over after surgery, and establish a database of evaluation and correction contents. 4) The whole experiment was executed under the supervision of the head-nurse, the collected data was kept by the group, data entry and statistical analysis was performed by 3 members, 1 entry clerk, 1 statistician and 1 verifier. If the verifier found data discrepancies, timely corrections were made.
Evaluating indexes
Symptom Checklist 90 (SCL-90), Self-Rating Anxiety Scale (SAS), Self-rating depression scale (SDS), and Visual Analogue Scale(VAS) were used to assess the psychological health and pain levels in the two groups of patients at admission and discharge. SCL-90 was proposed to assess psychological health in 1975 (4). There are 90 entries and 9 dimensions, namely somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, and psychoticism in SCL-90. It used a Likert 5-point scale with a total score of 90 to 450, with higher scores indicating progressively worse symptoms, Cronbach’s α= 0.984. SAS was proposed to assess the patient’s subjective feelings of anxiety and its change during treatment in 1971 by W.K.Zung (9). SAS consists of 20 items and uses the Likert 4-point scale to assess the frequency of symptoms, Cronbach’s α= 0.80 (10). SDS was proposed to assess the patient depression levels in 1965 by W.K.Zung (11). Depression index less than 0.50 is no depression, 0.50 to 0.59 is mild depression, 0.60 to 0.69 is moderate to severe depression, and 0.70 or more is severe depression. Cronbach’s α= 0.80. VAS was proposed to assess the pain in clinical in 1975 by Ohnhaus (12). A score of 0 indicates no pain and a score of 10 represents the most intense pain that is unbearable. The patient satisfaction rating questionnaire was self-designed with reference to previous study (13), with a score of 100, and three evaluation criteria were set: particularly satisfied is more than 90, generally satisfied is more than 50 and less than 89, and unsatisfied is less than 50. Total satisfaction (%) = particularly satisfied + generally satisfied/total number.
Statistical analysis
The data of this study were analyzed by SPSS 22.0 statistical software (IBM Corp., Armonk, NY, USA). The measurement data were expressed by χ2±S, independent samples t-test was used for comparison between groups. The statistical data were expressed as percentages, and the rank sum test was used for comparison between groups. The differences were statistically significant, P<0.05.
Results
Comparison of Patient General Data
The general data were comparable between the two groups with no significant difference (P <0.05) (Table 3).
Table 3:
Comparison of Patient General Data
| Character | Control group | Experimental group | χ2/t | P | |
|---|---|---|---|---|---|
| Gender | Male | 65 | 63 | 0.086 | 0.768 |
| Female | 35 | 37 | |||
| Age (years) | 33.17±2.23 | 33.67±2.34 | 1.546 | 0.123 | |
| Education | Primary school | 22 | 20 | 0.277 | 0.870 |
| Junior school | 27 | 24 | |||
| Senior school | 31 | 33 | |||
| College degree or above | 20 | 23 | |||
| Occupation | Manual workers | 59 | 56 | 0.184 | 0.667 |
| Nonmanual workers | 41 | 44 | |||
| Underlying disease | Diabetes | 29 | 30 | 0.016 | 0.991 |
| Hypertension | 33 | 35 | |||
| Coronary disease | 37 | 40 | |||
| Disease site | Aural region | 32 | 30 | 0.213 | 0.898 |
| Epipharynx | 61 | 64 | |||
| Laryngeal part of pharynx | 7 | 6 | |||
| Nature of disease | Optimum | 97 | 95 | 0.130 | 0.718 |
| Malignant | 3 | 5 | |||
| Correction of deviated | 25 | 27 | |||
| Surgical category | septum | 0.638 | 0.887 | ||
| Nasal polypectomy | 21 | 23 | |||
| Otitis media surgery | 22 | 18 | |||
| Vocal Cord Polyps | 7 | 6 | |||
| Removal mastoidotympanectomy | 10 | 12 | |||
| Nasal trauma surgery | 15 | 14 | |||
| Day of hospitalization (days) | 8.77±1.12 | 6.57±0.63 | 17.120 | 0.000 | |
| Fee type | City Health Insurance | 37 | 35 | 0.381 | 0.827 |
| Rural cooperative health insurance | 28 | 32 | |||
| Self-financed | 35 | 33 | |||
| Hospitalization cost (ten thousand yuan) | 3.61±0.81 | 2.41±0.62 | 11.764 | 0.000 | |
| Surgical approaches | Lumpectomy | 46 | 45 | 0.020 | 0.887 |
| Open surgery | 54 | 55 | |||
| Mean duration of surgery | Ear | 121.47±3.31 | 121.75±4.65 | 0.490 | 0.624 |
| Nose | 105.66±3.08 | 106.01±2.97 | 0.818 | 0.414 | |
| Laryngeal part of pharynx | 143.84±2.64 | 143.96±2.43 | 0.334 | 0.738 |
Comparison of pain and negative emotions in the two groups
The differences in pain and negative emotions between the two groups were not statistically significant at admission (P > 0.05), but the differences were statistically significant at discharge compared to admission in both groups (P<0.05). Experimental group scores were significantly lower at discharge than at admission, and the difference was statistically significant (P < 0.05).
The scores on the symptom self-rating scale at admission were comparable between the two groups, and the differences were not statistically significant (P > 0.05). At discharge, all the scores of each dimension were lower than those at admission, but the degree of reduction in the experimental group was significantly greater than that in the control group, and the difference was statistically significant (P < 0.05) (Table 4, 5).
Table 4:
Comparison of the patient’s pain and negative emotions
| Score | Experimental group | Control group | t | P | |
|---|---|---|---|---|---|
| Pain score | At admission | 3.28±0.22 | 3.31±0.31 | 0.789 | 0.430 |
| At discharge | 1.15±0.18* | 4.28±0.55 | 54.086 | 0.000 | |
| Self-rating anxiety scale | At admission | 67.38±0.55 | 67.65±1.39 | 1.806 | 0.072 |
| At discharge | 18.44±0.57* | 54.34±0.48 | 481.759 | 0.000 | |
| Self-rating depressive scale | At admission | 71.82±0.65 | 71.71±0.29 | 1.546 | 0.124 |
| At discharge | 33.04±0.19* | 69.37±1.01 | 353.502 | 0.000 |
Note: * means P <0.05 compared with hospital admission.
Table 5:
Comparison of the patient symptom self-rating scale scores
| Dimension | Control group | Experimental group | ||
|---|---|---|---|---|
|
| ||||
| At admission | At discharge | At admission | At discharge | |
| Somatization | 26.18±1.35 | 10.12±1.18* | 27.03±1.22 | 20.16±1.47*# |
| Forced symptoms | 28.15±1.09 | 10.25±1.43* | 28.23±1.10 | 19.57±1.62*# |
| Sensitive to interpersonal relationship | 27.06±1.47 | 9.15±1.26* | 26.15±1.06 | 20.11±1.21*# |
| Depressed | 25.13±1.66 | 8.51±0.79* | 24.97±1.13 | 19.11±1.64*# |
| Anxiety | 23.34±0.98 | 9.11±1.67* | 23.15±0.84 | 18.38±0.81*# |
| Hostility | 18.17±1.15 | 8.79±1.05* | 17.68±1.03 | 14.43±0.93*# |
| Phobias | 18.96±0.77 | 9.37±1.68* | 18.13±0.65 | 14.48±0.62*# |
| Paranoia | 19.17±0.39 | 8.95±0.28* | 18.91±0.26 | 16.16±0.17*# |
| Psychiatric tendency | 16.22±0.68 | 9.13±0.92* | 15.93±0.55 | 11.31±0.57*# |
Note: * means P <0.05 compared to admission;
# means P <0.05 compared to the control group
Comparison of patient satisfaction after intervention
The satisfaction of patients in the two groups was comparable, and the experimental group was better than the control group, with statistically significant differences (P < 0.05) (Table 6).
Table 6:
Comparison of patient satisfaction
| Group | Very satisfied | Satisfied | Unsatisfied | degree of satisfaction (%) |
|---|---|---|---|---|
| Control group | 53 | 35 | 2 | 98 |
| Experimental group | 23 | 59 | 18 | 82 |
| χ2 | 30.327 | |||
| P | 0.000 |
Discussion
The nursing model based on the ENT quality evaluation system can reduce patient dysphoria
Reviewing the previous research, studies on the construction of a quality evaluation system for ENT are rare, and there is a lack of research reports on the effects of its clinical application, especially on patients’ adverse emotions (14,15). This study compared the self-rating scores and anxiety and depression scores between the two groups. The results showed that the postoperative scores of both groups were lower than the preoperative scores. The reduction in scores in the experimental group was significantly greater than that in the control group, which proved that the ENT nursing quality evaluation system could better improve the mental health of patients and alleviate the adverse emotions.
There are some advantages of ENT nursing quality evaluation system. First of all, it has more specific quantitative evaluation criteria, detailed requirements for nurses to judge the accuracy of adverse emotions and pain, and good prediction power for the psychological condition and pain level of patients, which helps to provide targeted treatment for patients. What’s more, traditional nursing evaluation system is mostly empirical summaries with a low level of evidence and lack of evidence-based support, and the indicators included are mostly end-of-life indicators while ignoring element and link indicators. In addition, ENT nursing quality evaluation system emphasizes the regular training and appraisal of bedside nurses in the areas of otolaryngology and psychological counseling to to make nurses more specialized in daily psychological interventions. It also sets requirements for the length of psychological interventions for patients to ensure that patients can receive psychological interventions on a sustainable basis.
The nursing model based on the ENT quality evaluation system can relieve postoperative pain and increase satisfaction
Pain, a common post-surgical complication, is an important factor affecting the patient’s postoperative recovery (16). The reduction of postoperative pain can significantly shorten the postoperative rehabilitation time, increase the degree of patient compliance, and is conducive to their functional recovery (17). In this investigation, patients in the experimental group had significantly reduced postoperative pain. Analysis of the reasons for this may be related to the fact that the nursing model adopted by the experimental group can detect the patient’s pain more early, and report to the bedside physician for pain and symptomatic management in a more timely manner. Besides, the postoperative pain of patients is partly caused by psychology, and the nursing model adopted by the experimental group is more systematic and organized than the traditional model, so that the problems in nursing work can be solved in time and avoid unnecessary conflicts with patients. Patients are mentally sensitive and easy to depression, increasing the inpatient comfort of patients can also reduce the degree of depression and anxiety of patients. However, if the nursing staff do not detect psychological abnormalities and use the traditional nursing models, inadequate communication will lead to nurse-patient disputes. It also makes nursing staff doubtful and tired of their profession. The nursing model adopted in this study can improve the working ability of nursing staff, deepen their understanding of otorhinolaryngology, resulting in a greater focus on daily communication with patients.
Conclusion
The nursing model guided by the ENT quality evaluation system can alleviate patients’ adverse emotions, reduce postoperative pain in ENT patients, and improve patient satisfaction. Therefore, it is worth promoting its application in the future.
Journalism Ethics considerations
Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.
Acknowledgements
This work was supported by Science and Technology Plan Joint Guidance Project of Qiqihar City (LSFGG-2023020).
Footnotes
Conflict of Interest
The authors declare that there is no conflict of interest.
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