Clinical,nursing,visual,health,education,pathway,for,patients,with,perianal,abscess†

Ye-Qi H Xu-Xi Ch En-Jie Zhu, He-Ye Jin, Li-Cho Bo*

aDepartment of Orthopedics, The First Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China

bDepartment of Neurology, The First Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China

cEICU (Emergency Intensive Care Unit), The First Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China

dDepartment of Internal Medicine, Anji County Second People’s Hospital, Huzhou, Zhejiang 313000, China

eDepartment of Anorectal Surgery, The First Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang 313000, China

Abstract: Objective: To investigate the effect of a clinical nursing pathway and visual health education on patients with perianal abscesses was the objective of this study. Methods: Eighty patients with perianal abscesses undergoing in-patient surgical treatment (blinded for review) between December 2019 and November 2020 were divided randomly and evenly into a control group and an experimental group. The control group received routine nursing care, and the experimental group received visual health education nursing care. Digital pain scores, patient satisfaction scores, nursing quality scores, and scores measuring knowledge of perianal abscess disease for the two groups before and after nursing care were compared and analyzed. Results: The experimental group had visual analog scale (VAS) scores significantly lower than those of the control group (P < 0.05). For total nursing satisfaction, the experimental group demonstrated a higher satisfaction rate (P < 0.05). Clinical nursing quality scores were significantly higher in the experimental group than those in the control group (P < 0.05). The perianal abscess disease-related knowledge scores after intervention were significantly higher in the experimental group than those in the control group (P < 0.01). Conclusions: Visual health education nursing can help patients better understand and deal with perianal abscess disease.

Keywords: clinical nursing • nursing quality • pain • perianal abscess • visual health-education

Perianal abscess, also known as perirectal abscess of the anal canal, is a common clinical disease. It refers primarily to acute purulent infectious disease, which is a relatively typical bacterial infectious disease and a precursor to anal fistula disease in a patient’s anus, rectum, and surrounding anal canal.1,2The clinical incidence of perianal abscess can reach 2%, and the proportion of patients with anorectal diseases can be as high as one in four.3,4The primary symptoms of this disease are mucus overflow, pain, and blood in the stool, all of which interfere significantly with the patient’s daily life and work.5,6

Clinical treatment for the disease should be a high priority; the patient should receive treatment as soon as possible after diagnosis. During treatment, the quality of care provided to patients directly impacts the treatment effect and the patient prognosis. According to relevant studies, health education and psychological care for patients can enhance the effect of treatment on patients.7–9When patients with perianal abscess undergo surgical treatment, good nursing measures are of significant importance in improving the prognosis.10Since conventional nursing methods may need improvement, exploring more effective methods is an urgent concern. A visual health education nursing pathway establishes responsibility system groups and provides for one-to-one administration, which can raise the responsibility consciousness of nursing staff and establish a harmonious nurse-patient relationship to improve the overall therapeutic effect.

2.1. General information

The study was approved by the Hospital Ethics Committee. Eighty patients with perianal abscesses undergoing surgical treatment in our hospital from December 2019 to November 2020 were selected as the study subjects and randomly divided into the control (n= 40) and experimental (n= 40) groups.

2.2. Inclusion/exclusion criteria

Inclusion criteria were as follows:

(1) Patients met the diagnostic criteria of perianal abscess and were aged over 18 years.

(2) Patients had clear consciousness and good communication and had been hospitalized for >3 d.

(3) The patients and their families were informed of the purpose and process of this study and signed the informed consent.

(4) Patients participated in the study voluntarily.

Exclusion criteria were as follows:

(1) Patients had other organic lesions in the brain, heart, kidney, or liver.

(2) Patients had cognitive or communication disorders, such as mental disorders.

(3) Patients refused to cooperate with the study.

2.3. Methods

A total of 80 patients were divided evenly into a control group and an experimental group, according to the random number table method. Patients in the control group received routine nursing care, which consisted of clean rooms with appropriate room temperature and humidity levels. Their vital signs were observed and recorded regularly. They were also required to stay in bed and not physically exercise excessively. As soon as possible, nursing staff members began to evaluate patients’ conditions using a digital scoring scale for pain.

The experimental group followed the clinical nursing visual health education pathway. For the intervention process, a clinical nursing visual health education pathway implementation team was first established. Five medical workers in the department were selected to form the research group: one associate chief physician, one associate chief nurse, and three nurses. Second, the team was trained to familiarize them with the implementation process of the clinical visual health education pathway. The implementation of the clinical nursing pathway included the following steps:

1. The production of the visual health education video. Under the guidance of the associate chief physicians and experts, information about perianal abscess disease, surgical methods, postoperative adjuvant treatment methods, and nursing precautions were compiled in a video.

2. After the patient was admitted to the hospital, and as soon as possible, the research team consulted the patient’s family members to jointly formulate a scientific clinical nursing pathway, according to the patient’s physical and mental health status. The nursing staff evaluated the patient’s condition using a digital scoring scale for pain.

3. The clinical visual health education nursing video was broadcast to patients twice a day, at 10:00 am and 4:00 pm. The nursing staff answered questions and offered patients additional accurate information in real time throughout each day while performing their clinical nursing duties.

2.4. Main outcome measures

1. The degree of pain, with and without intervention, was evaluated through a visual analog scale (VAS) score that ranged from 0 up to a total score of 10 points, with higher scores indicating a higher degree of pain.

2. The Patient Clinical Satisfaction Questionnaire prepared by the hospital was also used. Patients were encouraged to complete the questionnaire truthfully in terms of clinical (nursing) satisfaction level. The questionnaire response options were as follows: very satisfied, satisfied, needing improvement, and unsatisfied.

3. A Patient Disease-Related Knowledge Scale prepared by the surgery department was adopted to evaluate the perianal abscess disease knowledge mastery across the two groups. A total score of 50 points was possible, and higher scores indicated higher knowledge mastery.

4. The Clinical Nursing Quality Scores Questionnaire was used to assess clinical nursing quality. Patients were encouraged to complete the questionnaire truthfully. The questionnaire item categories were nursing responsibility, nursing skills, and nursing ability.

2.5. Statistical methods

All analyses were carried out using SPSS, version 26, and figure illustration was conducted using GraphPad Prism, version 6. Measurement data were expressed as (± SD) and tested byt-test. Counting data were expressed as (n, %) and tested by chi-squared test. AP-value of <0.05 indicated a significant difference.

3.1. Comparison of general information between the two groups

Patients in the experimental group were aged 25–59 years, with an average age of 41.8 ± 7.5 years. Patients in the control group were aged 24–57 years, with an average age of 40.2 ± 8.2 years. There were 24 male and 16 female patients in the experimental group and 21 males and 19 female patients in the control group. After analysis, theP-values of the basic data (age, gender, and height) of patients in the two groups were all >0.05, with no statistical significance, as shown in Table 1.

Table 1. Comparison of general information between the two groups (n = 40).

3.2. Comparison of VAS scores between the two groups, before and after intervention

Comparison of VAS scores between the two groups before and after intervention (x ± s). The VAS scores in the experimental group before and after intervention were 6.97 ± 1.15 points and 4.08 ± 0.71 points, while the VAS scores in the control group before and after intervention were 6.96 ± 0.99 points and 5.38 ± 0.53 points, respectively. In both groups, VAS scores after intervention were significantly lower than scores before intervention (P< 0.05). The VAS scores after intervention were significantly lower in the experimental group than those in the control group (P< 0.05), as shown in Figure 1.

3.3. Comparison of clinical nursing quality between the two groups

Comparison of clinical nursing quality between the two groups (x ± s). The nursing responsibility, nursing skills, and nursing ability scores in the experimental group were 39.19 ± 3.51, 37.80 ± 2.30, and 42.31 ± 2.18, respectively. However, in the control group, they were 35.06 ± 2.21, 34.41 ± 2.86, and 38.10 ± 1.85, respectively. Nursing ability, nursing skills, and nursing responsibility scores were significantly higher in the experimental group than in the control group (P< 0.05), as shown in Figure 2.

Figure 1. Between group comparison of VAS scores before and after intervention.

Figure 2. Between group comparison of clinical nursing quality.

3.4. Comparison of clinical nursing satisfaction between the two groups

Results showed that patient satisfaction in the experimental group was higher than that in the control group (P< 0.05), as shown in Table 2.

3.5. Comparison of perianal abscess diseaserelated knowledge scores between the two groups

The health knowledge mastery rate was 95% in the experimental group, which was significantly higher than the rate in the control group (70%). The difference was statistically significant (P< 0.05), proving that visual health education nursing can improve patients’ health knowledge mastery rate significantly (Table 3).

Table 2. Between group comparison of clinical nursing satisfaction, n (%) (n = 40).

Table 3. Between group comparison of perianal abscess related knowledge scores, n (%) (n = 40).

Perianal abscess is a typical anorectal disease. The disease is concentrated primarily in the patient’s anus and surrounding tissues of the rectum. Intestinal bacteria enter the patient’s anal sinus, affecting the patient’s anal glands.11,12The disease occurs most often in men aged 20–40 years. The primary clinical manifestations are pain, constipation, and poor urination.13Clinically, surgery is the primary option for treating the disease. At the same time, reasonable and effective nursing methods are necessary to improve a patient’s prognosis. Traditional nursing pathways tend to address the physical condition of patients but cannot significantly improve the pain and psychological conditions of patients, which is why the ideal nursing effect is not achieved.14,15

As a patient-centered nursing concept and a nursing standard, visual health education nursing requires nurses to focus on patients’ awareness and acknowledgment of their hospital care. This focus can enhance the clinical treatment effect and earn patients’ and patient families’ acceptance of hospital nursing work.16,17At the same time, this nursing method encourages patients to participate actively in the treatment of the disease and raises patients’ awareness of self-care,18,19in contrast with passive acceptance of treatment. In this way, patients better accept and comply with treatment measures. After the implementation of the visual health education nursing intervention for patients with perianal abscess, the VAS scores of the experimental group were significantly lower than those of the control group. Pain leads to adverse emotions that can be detrimental to the prognosis of patients.20,21As an effort to improve patients’ psychological and emotional stability and help patients accept the possible pain range, the visual health education nursing pathway explains the cause of the pain, corresponding nursing measures, and important precautions that the patient must know. The goals of the pathway are to help patients overcome negative emotions and enable the smooth completion of treatment.

A notable study result is that the experimental group demonstrated higher total satisfaction with nursing care. This finding indicates that visual health education nursing may not only improve the patient’s condition, but it is also recognized by the majority of patients. Data show that the strengths of visual health education nursing extend to the quality of nursing. In the experimental group, nursing quality is rated significantly higher than that in the control group. As they guide and correct the patient’s understanding of the treatment and the disease, primary nurses not only oversee patient care and treatment but also self-examine and self-correct promptly, effectively improving their own responsibility consciousness.22–24

In the course of our study, we found that we have some shortcomings, which need to be further improved in our subsequent study. For the experimental group to carry out clinical nursing measures based on visual health education, this concept may be a good starting point to promote the prognosis of patients. However, during the study, we found that it is necessary to play the role of visual health education from more perspectives. With the development of society, people are exposed to more and more information through scientific and technological products. At the same time, we should consider the differences in the educational information received by patients and better promote the development of measures to help patients recover. Meanwhile, we found that in the process of measuring patient satisfaction, the relevant indicators need to be further considered, which is one of the shortcomings of this study. We should use more objective measures. In addition, we should collect more data for analysis to support the results of this study. As this is insufficient, we will supplement the relevant data in subsequent experiments.

In this study, we promote the rehabilitation of patients by performing clinical care based on visual health education for patients with abscess. This study revealed that following the visual health education nursing pathway significantly lowered the VAS scores of the experimental group, as compared with the scores of the control group. Improvements in quality of nursing scores and patient satisfaction scores were also larger in the experimental group than those in the control group. To a certain extent, this study needs more evidence to support the study, and throughout the study design, although we found that clinical care based on visual health education is beneficial to promote the rehabilitation of patients, in some way, we should more refine and concretize the intervention, taking into account other influencing factors.

Relevance to clinical practice

The present study has shown that the visual health education nursing pathway is applicable in the care of patients with perianal abscess and is worthy of promotion in clinical nursing. However, it is important to note that this study was a retrospective study, and selection bias cannot be ruled out. Future prospective studies should expand the trial to obtain more reliable clinical data. At the same time, we are also considering whether our research can be applied to the rehabilitation of other diseases.

Ethics approval

This study was approved by the ethics committee of The First Affiliated Hospital of Huzhou Teachers College.

Conflicts of interest

All contributing authors declare no conflicts of interest.