Abstract
To explore the effect of individualized comfortable nursing on prognosis of vacuum sealing drainage (VSD) in patients with orthopedic trauma. 110 patients with orthopedic trauma VSD were randomly divided into the control group and the observation group, with 55 patients in each group receiving routine care and comfortable care. The wound healing time, visual analog scale, quality of life score, the level of inflammatory factors, the incidence of complications, and patient satisfaction were compared between the 2 groups. The average time of wound healing in the observation group was significantly lower than that in the control group (P < .01). The satisfaction rate in the observation group was significantly higher than that in the control group (P = .029). Meanwhile, the results showed that visual analog scale and quality of life scores in the observation group was significantly improved than that of the control group after receiving intervention (P < .05). After receiving intervention, the levels of TNF-α and IL-6 of patients in both groups were decreased, and the levels of TNF-α and IL-6 in the observation group were significantly decreased than those in the control group. Moreover, the incidence rate of adverse reaction in the observation group was significantly lower than that in the control group (P < .01). Comfortable nursing can reduce the wound healing time, the postoperative pain level, the incidence of complications, and improve patient satisfaction, which is of great significance for the prognosis of VSD in patients with orthopedic trauma.
Keywords: comfort care, efficacy, orthopedic trauma, vacuum sealing drainage
1. Introduction
With the development of economy and the convenience of transportation, the incidence of orthopedic trauma is increasing. Orthopedic trauma is a common trauma disease in clinic, including skin and soft tissue, bone, muscle, blood vessels, nerves and other injuries.[1] The condition is usually complex and critical, or may be accompanied by bleeding, infection, and pain.[2,3] Posttraumatic infection is a common complication after internal fixation of fractures, which complicates the clinical process of patients and leads to long-term intensive care and hospitalization. With the wide use of internal fixation devices, the infection rate after fracture is increasing.[4] Therefore, it is necessary to explore the treatment plan for prevention and treatment of orthopedic trauma infection.[5]
Open drainage is usually used to treat infection in orthopedic trauma. During this period, pus, necrotic tissue and exudate can be drained to improve clinical symptoms. However, the treatment process is usually very long and the results are often poor.[6] Therefore, vacuum sealing drainage (VSD) technology is applicable to the treatment of wound surface treatment and deep drainage after a variety of acute and chronic soft tissue injuries, and has been widely used in the treatment of orthopedic trauma patients, with significant effect.[7–9] However, after VSD, conventional nursing methods can no longer meet the needs of patients’ prognosis, and more comprehensive, effective and targeted nursing is needed.[10] Comfortable nursing is a new nursing method derived from the current social requirements. It is accepted by patients with its effective nursing mode, in-depth nursing research, scientific nursing methods, and progressive nursing philosophy. The way is to take targeted nursing measures to make patients reach the most pleasant state physically and psychologically, or shorten and reduce the unpleasant degree.[11] At the same time, nurses can reduce the incidence of adverse events during drainage and promote wound healing through nursing intervention on patients.[12] However, few clinical studies have investigated the role of nursing intervention in the treatment of orthopedic trauma infection with VSD. Therefore, the purpose of this study is to analyze the impact of individualized comfort care on the prognosis of VSD in patients with orthopedic trauma.
2. Data and methods
2.1. General information
From May 2021 to May 2022, 110 patients with orthopedic trauma using VSD were randomly divided into the control group (55 cases) and the observation group (55 cases). Inclusion criteria: Patients who meet the diagnosis of “orthopedic trauma” confirmed by CT or X-ray; Patients with complete clinical data and signed informed consent; No other clinical studies were conducted during the study period, and follow-up can be conducted after treatment; The patient cognitive function was normal. Exclusion criteria: Patients < 18 years old; Patients with secondary severe infection; Patients with severe other system diseases; Pregnant or lactating women; Patients with a history of mental disorders or cognitive impairment; Patients undergoing other medical research; Coagulation dysfunction. This study was approved by the ethics committee of the first people hospital of Jiangxia district.
2.2. Methods
The control group was given routine nursing care, including routine vital sign monitoring, hygienic treatment, medication guidance, health education, postoperative functional recovery: Monitor the heart rate, respiratory rate and blood pressure dynamically, and recheck the blood routine test and urine routine test regularly; Routine wound cleaning and replacement of equipment to keep the affected area clean and sanitary; Instruct patients to take medicine, inform them of the correct dosage, method of taking medicine and adverse reactions; Health education on diseases shall be carried out for patients, and knowledge about relevant diseases and their complications shall be popularized.
The observation group: comfortable nursing was adopted on the basis of routine nursing: Environmental care: create a good postoperative environment for patients, including improving the overall service attitude, keeping the room clean and warm, bright and soft indoor light, fresh and odorless air, to increase patients comfort; Psychological nursing: patiently communicate with patients, provide targeted psychological counseling for patients, explain adverse reactions and complications, relieve patients psychological pressure, comfort and encourage patients, enhance self-confidence, and maintain a positive attitude to promote postoperative recovery; Diet care: recommend a healthy diet plan for patients. Eat a light diet, increase the intake of protein and other nutrients, and promote wound healing; Posture nursing: after orthopedic trauma VSD, patients need to maintain a certain position to promote wound treatment. Long term maintenance will affect patients discomfort, even lead to pressure sores, venous thrombosis and other complications. Nurses need to appropriately change their positions according to patients demands, massage and relax the parts of patients who have been oppressed for a long time to alleviate patients discomfort; Functional nursing: during the hospitalization, the nursing staff should carry out active or passive functional training for the patients, encourage them to exercise moderately, promote blood circulation, and maintain a good state of the body; Medication nursing: guide patients to use drugs, and inform them in detail about the frequency, dosage and effect of drugs, so that patients can effectively maintain scientific medication compliance; VSD wound nursing: regularly check the patient incision exudation, redness, swelling, heat and pain, observe the color of drainage fluid, measure the drainage volume, timely report the patient VSD drainage and wound healing, and record it in the record, and ask the competent doctor for further drainage nursing plan.
2.3. Outcome indicators
The wound healing time of the 2 groups of patients was compared: 1 point for “0 to 6 days,” 2 points for “7 to 14 days,” and 3 points for “more than 14 days.” The lower the score, the better the postoperative care; Satisfaction of the 2 groups of patients: Self-made satisfaction questionnaire was used to evaluate the satisfaction of patients: < 60 points: dissatisfied; 60 to 80: satisfied; > 80 points: very satisfied. The higher the satisfaction, the better the nursing effect;[13] Visual analog scale (VAS) scoring: VAS was used to assess the pain level.[14] A 10 cm vernier scale was used. “10” and “0” were marked on both ends of the 10 scales. 10 meant severe pain and 0 meant no pain. The patient carries out a rating scale according to the degree of pain. The lower the score, the less pain; Quality of life (QOL) score: SF-36 scale was used to evaluate patients’ emotional, social, role and cognitive functions, with a total score of 100 points.[15] The higher the score, the better the quality of life; Tumor necrosis factor-α (TNF-α), Interleukin-6 (IL-6) level: Take 3 mL of fasting venous blood and centrifugate (3500 rpm, 10 minutes). The supernatant was separated to obtain serum. Detection of TNF-α and IL-6 by ELISA. The kit is provided by Shanghai Bangjing Industry Co., Ltd. (Project No. 48T/96T) and operated according to the kit instructions. The more the value tends to the normal value, the more ideal the intervention effect will be; The adverse reaction symptoms of patients were compared according to the number of cases counted by symptom self-made scale.
2.4. Statistical analysis
SPSS 26.0 statistical software was used to analyze and process the data, t test was used to compare the measurement data, and Wilcoxon rank sum test was used to compare the grade data. Comparison of adverse reaction rate and satisfaction rate were performed by χ2 test. P < .05 indicates that the difference is statistically significant.
3. Results
3.1. General clinical data
In the control group, there were 31 males and 24 females, with an average age of (35.66 ± 5.44) years. There were 35 males and 20 females in the observation group, with an average age of (37.42 ± 4.77) years. The comparison of baseline data of orthopedic trauma between the 2 groups is shown in Table 1. There was no statistically significant difference.
Table 1.
Comparison of general clinical data between the 2 groups.
| Variables | Control group | Observation group | t/χ2 | P |
|---|---|---|---|---|
| Gender | 0.016 | .901 | ||
| Male | 31 | 35 | ||
| Female | 24 | 20 | ||
| Average age (yr) | 35.66 ± 5.44 | 37.42 ± 4.77 | 0.071 | .847 |
| Average weight (kg) | 69.11 ± 2.21 | 68.98 ± 2.32 | 0.301 | .796 |
| Infection sites | 0.334 | .545 | ||
| Femur | 13 | 12 | ||
| Tibia | 4 | 3 | ||
| Food and ankle | 12 | 14 | ||
| Perone | 5 | 6 | ||
| Upper forearm | 21 | 20 |
3.2. Distribution of wound healing time and comparison of healing time
There was a significant difference between the 2 groups in the time of wound healing by segments (P < .01). The time of wound healing in the observation group was mostly distributed in “7 to 14 days,” while that in the control group was mostly distributed in “>14 days.” The average time of wound healing in the observation group was significantly lower than that in the control group (P < .01), as shown in Table 2.
Table 2.
Distribution of wound healing time and comparison of healing time between the 2 groups.
| Group | n | Distribution of wound healing time | Average wound healing time (d) | ||
|---|---|---|---|---|---|
| 0–6d | 7–14d | >14d | |||
| Control group | 55 | 0 | 8 | 47 | 17.83 ± 3.38 |
| Observation group | 55 | 7 | 39 | 9 | 11.00 ± 3.74 |
| t/χ2 | −21.021 | −5.473 | |||
| P | <.01 | <.01 | |||
3.3. Patient satisfaction evaluation
Among the patients in the observation group, there were 46 cases of “Very satisfied” and 9 cases of “Satisfied,” the satisfaction rate was 100.0%. Among the patients in the control group, there were 19 cases of “Very satisfied,” 29 cases of “Satisfied,” and 7 cases of “Dissatisfied,” the satisfaction rate was 87.3%. The satisfaction rate in the observation group was significantly higher than that in the control group (P = .029), as shown in Table 3.
Table 3.
Comparison of patient satisfaction.
| Group | n | Very satisfied | Satisfied | Dissatisfied | Satisfaction rate |
|---|---|---|---|---|---|
| Observation group | 55 | 46 (83.64) | 9 (16.36) | 0 (0.0) | 100.00% |
| Control group | 55 | 19 (34.55) | 29 (52.73) | 7 (12.73) | 87.30% |
| χ2 | 14.91 | ||||
| P | .029 | ||||
3.4. VAS evaluation
The pain degree of the 2 groups was compared by VAS score. The results showed that the pain degree of the patients in the observation group was significantly lower than that of the control group (P < .05), as shown in Figure 1.
Figure 1.
Comparison of VAS scores between the 2 groups. VAS = visual analog scale.
3.5. QOL score
Before receiving nursing intervention, there was no significant difference in the scores of emotional functions, social function, role function, and cognition function between the control group and the observation group (all P > .05). After receiving intervention, the QOL scores of patients in both groups were significantly improved, and the observation group was significantly higher than the control group (all P < .05), as shown in Figure 2.
Figure 2.
Comparison of QOL scores between the 2 groups. QOL = quality of life.
3.6. Comparison of inflammatory factor levels
Before receiving intervention, there was no significant difference in the levels of TNF-α and IL-6 between the observation group and the control group (all P > .05). After receiving intervention, the levels of TNF-α and IL-6 of patients in both groups were decreased, and the levels of TNF-α and IL-6 in the observation group were significantly decreased than those in the control group, as shown in Figure 3.
Figure 3.
Comparison of inflammatory factor levels between the 2 groups.
3.7. Adverse reactions evaluation
Among the patients in the observation group, there were 3 cases of “Fever,” 5 cases of “Numbness of limbs,” 2 cases of “Hemorrhage,” and 1 case of “Infected,” the incidence rate of adverse reaction was 20.0%. Among the patients in the control group, there were 8 cases of “Fever,” 13 cases of “Numbness of limbs,” 5 cases of “Hemorrhage,” and 6 cases of “Infected,” the incidence rate of adverse reaction was 58.18%. The incidence rate of adverse reaction in the observation group was significantly lower than that in the control group (P < .01), as shown in Table 4.
Table 4.
Comparison of adverse reactions between the 2 groups.
| Group | n | Fever | Numbness of limbs | Hemorrhage | Infected | Incidence rate |
|---|---|---|---|---|---|---|
| Control group | 55 | 8 | 13 | 5 | 6 | 58.18% |
| Observation group | 55 | 3 | 5 | 2 | 1 | 20.00% |
| χ2 | 29.9 | |||||
| P | <.01 | |||||
4. Discussion
Orthopedic trauma is a common type of trauma in clinic, which includes not only bone trauma, but also skin, muscle and other soft tissue trauma injuries, such as no good treatment and nursing after trauma, or can cause a series of complications such as fever, infection, venous thrombosis, and even death.[16,17] VSD plays an important role in the treatment of orthopedic trauma infection, with the following advantages:[18] It can reduce the work intensity, thus preventing cross infection; Under negative pressure, it can suck out bacteria, accumulate blood and necrotic tissue, and avoid wound infection; It is beneficial to the growth of healthy granulation; Negative pressure is not conducive to the viability of bacteria. The application of VSD technology has expanded to a variety of wounds caused by trauma. Its mechanism includes the use of negative pressure suction devices to connect with wound dressings to generate negative pressure at the wound surface to keep the wound clean, remove necrotic tissue, promote the growth of granulation tissue, and promote wound healing.[19,20]
VSD is a commonly used wound treatment technology after orthopedic trauma at present. During the recovery period after surgery, comfortable nursing can improve the treatment effect to a greater extent.[21] Comfort nursing is a new nursing mode proposed in recent years.[22,23] It focuses on patients and respects the dominant position of patients. Through continuous research by nursing researchers, it expands the scientific content of this nursing plan and gradually deepens the connotation of nursing. Put forward comfortable nursing, make preparations, advance possible nursing defects, mistakes and accidents in the nursing process, combine individualized clinical nursing path, provide high-quality and accurate nursing for patients, and provide clinical decisions to reduce postoperative complications and improve the quality of life of patients in hospital.[24–26] In this study, the patients in the observation group took comfort care, including environmental comfort care, psychological comfort care, diet comfort care, posture comfort care, and postoperative functional comfort care, which played a certain role in assisting the recovery of patients diseases, effectively improving the cure rate of patients, reducing the occurrence of adverse reactions and complications, and reducing the wound healing time. It alleviates the pain level of patients during treatment and improves patient satisfaction, which is of great significance for the recovery and prognosis of patients after orthopedic trauma VSD.
The present study had several limitations. Firstly, the small sample size of the study was a major limitation. Secondly, another limitation of the study was the single-center study. The thirdly limitation is that our study was conducted among the Chinese population.
To sum up, comfort care has played an important role in orthopedic trauma using VSD, and it is necessary to promote the application of comfort care in the recovery and prognosis of various diseases.
Author contributions
Conceptualization: Huifang Xie, Na Luo.
Data curation: Zhaodi Guo, Qin Cao, Yuan Ye, Li Chen, Na Luo.
Formal analysis: Huifang Xie, Qin Cao, Na Luo.
Funding acquisition: Zhaodi Guo, Li Chen.
Investigation: Huifang Xie, Qin Cao, Yuan Ye, Na Luo.
Methodology: Huifang Xie, Zhaodi Guo.
Project administration: Zhaodi Guo, Qin Cao, Li Chen, Na Luo.
Resources: Huifang Xie, Qin Cao, Yuan Ye.
Supervision: Huifang Xie, Qin Cao, Yuan Ye.
Software: Zhaodi Guo, Li Chen, Na Luo.
Validation: Zhaodi Guo, Li Chen, Na Luo.
Visualization: Yuan Ye, Li Chen.
Writing – original draft: Huifang Xie.
Writing – review & editing: Na Luo.
Abbreviations:
- QOL
- quality of life
- VAS
- visual analog scale
- VSD
- vacuum sealing drainage
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
HX and ZG contributed equally to this work.
The authors have no funding and conflicts of interest to disclose.
How to cite this article: Xie H, Guo Z, Cao Q, Ye Y, Chen L, Luo N. Effect of individualized comfortable nursing on prognosis of vacuum sealing drainage in patients with orthopedic trauma. Medicine 2023;102:7(e32903).
Contributor Information
Huifang Xie, Email: 547205506@qq.com.
Zhaodi Guo, Email: 353863698@qq.com.
Qin Cao, Email: 17741348@qq.com.
Yuan Ye, Email: 1570335858@qq.com.
Li Chen, Email: 21698770@qq.com.
References
- [1].Haesler E, Swanson T, Ousey K, et al. Clinical indicators of wound infection and biofilm: reaching international consensus. J Wound Care. 2019;28:s4–s12. [DOI] [PubMed] [Google Scholar]
- [2].Challa S, Wu HH, Cunningham BP, et al. Orthopaedic trauma in the developing world: where are the gaps in research and what can be done? J Orthop Trauma. 2018;32(Suppl 7):S43–6. [DOI] [PubMed] [Google Scholar]
- [3].Agarwal-Harding KJ, von Keudell A, Zirkle LG, et al. Understanding and addressing the global need for orthopaedic trauma care. J Bone Joint Surg Am. 2016;98:1844–53. [DOI] [PubMed] [Google Scholar]
- [4].Li S. Nursing of a child with wound infection and bowel evisceration following ileostomy: a case report. Ann Palliat Med. 2020;9:2367–74. [DOI] [PubMed] [Google Scholar]
- [5].Sanger PC, Simianu VV, Gaskill CE, et al. Diagnosing surgical site infection using wound photography: a scenario-based study. J Am Coll Surg. 2017;224:8–15e1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [6].Timmins BA, Thomas Riché C, Saint-Jean MW, et al. Nursing wound care practices in Haiti: facilitators and barriers to quality care. Int Nurs Rev. 2018;65:542–9. [DOI] [PubMed] [Google Scholar]
- [7].Yang L, Tai BC, Khin LW, et al. A systematic review on the efficacy and safety of transcatheter device closure of ventricular septal defects (VSD). J Interv Cardiol. 2014;27:260–72. [DOI] [PubMed] [Google Scholar]
- [8].Lumbers M. TIMERS: undertaking wound assessment in the community. Br J Community Nurs. 2019;24:S22–s5. [DOI] [PubMed] [Google Scholar]
- [9].Wiseman O, Rafferty AM, Stockley J, et al. Infection and wound breakdown in spontaneous second-degree perineal tears: an exploratory mixed methods study. Birth. 2019;46:80–9. [DOI] [PubMed] [Google Scholar]
- [10].Ousey K, Roberts D, Gefen A. Early identification of wound infection: understanding wound odour. J Wound Care. 2017;26:577–82. [DOI] [PubMed] [Google Scholar]
- [11].Lin ZW, Huang ST, Xu N, et al. Parents’ knowledge and attitudes regarding transthoracic device closure of VSD in children: a cross-sectional study. J Cardiothorac Surg. 2020;15:75. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [12].Snelgrove H, Baileff A. A review of interventions to reduce pain in chronic wounds. Br J Community Nurs. 2019;24:S12–7. [DOI] [PubMed] [Google Scholar]
- [13].Jiang S, Li C, Hu S, et al. To analyze the application value of perioperative nursing care in patients with resected brain tumor accompanied with epileptic symptoms under cortical electrocorticography monitoring. J Healthc Eng. 2022;2022:4012304. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Zhang P, Bian S, Wang X, et al. A real-world retrospective study of safety, efficacy, compliance and cost of combination treatment with rush immunotherapy plus one dose of pretreatment anti-IgE in Chinese children with respiratory allergies. Front Immunol. 2022;13:1024319. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [15].Ouyang S, Yin W, Zeng Q, et al. Lymphoplasma exchange improves myasthenia gravis exacerbations: a retrospective study in a chinese center. Front Immunol. 2022;13:757841. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16].Zhang D, He L. A systemic review and a meta-analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings. Int Wound J. 2023;20:46–54. [DOI] [PMC free article] [PubMed] [Google Scholar] [Retracted]
- [17].Markatos K, Tsoucalas G, Sgantzos M. Hallmarks in the history of orthopaedic implants for trauma and joint replacement. Acta Med Hist Adriat. 2016;14:161–76. [PubMed] [Google Scholar]
- [18].Kent DJ, Scardillo JN, Dale B, et al. Does the use of clean or sterile dressing technique affect the incidence of wound infection? J Wound Ostomy Continence Nurs. 2018;45:265–9. [DOI] [PubMed] [Google Scholar]
- [19].Cefalu JE, Barrier KM, Davis AH. Wound infections in critical care. Crit Care Nurs Clin North Am. 2017;29:81–96. [DOI] [PubMed] [Google Scholar]
- [20].Beeson T, Davis C. Urinary management with an external female collection device. J Wound Ostomy Continence Nurs. 2018;45:187–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [21].Lassalle S, Chéchin C, de la Forge D. [A new cleansing technique for complex wounds]. Soins. 2017;62:12–5. [DOI] [PubMed] [Google Scholar]
- [22].McCaughan D, Sheard L, Cullum N, et al. Patients’ perceptions and experiences of living with a surgical wound healing by secondary intention: a qualitative study. Int J Nurs Stud. 2018;77:29–38. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [23].Conlan TK, Beebe MJ, Weinlein JC. New imaging, diagnostic, and assessment techniques in orthopedic trauma. Orthop Clin North Am. 2019;50:47–56. [DOI] [PubMed] [Google Scholar]
- [24].Nímia HH, Carvalho VF, Isaac C, et al. Comparative study of silver sulfadiazine with other materials for healing and infection prevention in burns: a systematic review and meta-analysis. Burns. 2019;45:282–92. [DOI] [PubMed] [Google Scholar]
- [25].Lin F, Gillespie BM, Chaboyer W, et al. Preventing surgical site infections: facilitators and barriers to nurses’ adherence to clinical practice guidelines-a qualitative study. J Clin Nurs. 2019;28:1643–52. [DOI] [PubMed] [Google Scholar]
- [26].Shi D, Yao Y, Yu W. Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysis. J Clin Nurs. 2017;26:2907–14. [DOI] [PubMed] [Google Scholar]