Effects of clinical nursing pathway on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta-analysis

This study aimed to explore the impact of clinical nursing pathway applied to acute appendicitis surgery on patients' postoperative wound infections and complications. A computerised search of PubMed, Cochrane Library, Web of Science, EMBASE, Wanfang, Chinese Biomedical Literature Database and China National Knowledge Infrastructure was conducted and supplemented by a manual search, from database inception to October 2023, to collect randomised controlled trials (RCTs) on the application of clinical nursing pathways to acute appendicitis surgery. Literature screening, data extraction and quality assessment of the included literature were carried out independently by two researchers. RevMan 5.4 software was applied for data analysis. Twenty-one RCTs with a total of 2408 patients were finally included. The analysis revealed the implementation of clinical nursing pathway could effectively reduce the incidence of wound infection (OR = 0.26, 95% CI: 0.15-0.46, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15-0.27, p < 0.001), as well as shorten the hospital length of stay (MD = -3.26, 95% CI: -3.74 to -2.79, p < 0.001) and accelerated the time to first ventilations (MD = -14.85, 95% CI: -21.56 to -8.13, p < 0.001), as well as significantly improved patient satisfaction (OR = 5.52, 95% CI: 3.52-8.65, p < 0.001) in patients undergoing surgery for acute appendicitis. The application of clinical nursing pathway in acute appendicitis surgery can significantly reduce postoperative wound infection and complications, and at the same time can shorten the hospital length of stay as well as improve the satisfaction of patients.

Multidisciplinary management based on clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage: A randomized controlled trial

OBJECTIVE

To explore the effectiveness of multidisciplinary management based on a clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage (HICH).

METHODS

A total of 124 patients with HICH admitted to our hospital between February 2021 and June 2023 were selected as research subjects in this randomized, controlled, unblinded study. They were divided into Control-group and Study-group using a random number table method, with 62 cases in each group. The Control-group received routine care and the Study-group adopted a multidisciplinary management approach based on the clinical nursing pathway model. A multidisciplinary intervention group including 1 attending physician, 1 psychotherapist, 1 nutritionist, 1 rehabilitation specialist, and 4 responsible nurses was constructed. From preoperative to postoperative day, patients were provided with psychological intervention, health education, respiratory tract management, and specific care for patients who were restless. One to 3 days after operation, the patients and their family members were guided in basic postoperative care and nutrition care. From the 4th day after surgery to the 1st day before discharge, patients were guided for rehabilitation exercises. Patients also received discharge advices upon discharge. Activities of daily living, neurological function, stress response indicators, incidence of complications, and nursing satisfaction before and after the intervention were compared between the 2 groups.

RESULTS

After the intervention, the activities of daily living and neurological function of the 2 groups were significantly improved compared to before the intervention, and the Study-group was significantly higher than the Control-group (P < .05). After intervention, the levels of stress response indicators in both groups significantly decreased compared to before the intervention, and the Study-group was significantly lower than the Control-group (P < .05). The incidence of complications in the Study-group (3.23%) was lower than that in the Control-group (15.00%) (P < .05). Nursing satisfaction in the Study-group (95.16%) was higher than that in the Control-group (83.33%) (P < .05).

CONCLUSIONS

Our findings indicate that adopting a multidisciplinary management approach based on clinical nursing pathways to intervene in patients with HICH can reduce stress response levels, reduce the risk of complications, and facilitate the recovery of neurological function and activities of daily living with high patient satisfaction.

CNP model intervention effect on acute urticaria patients' psychological status, compliance, and life quality

This study aimed to evaluate the impact of the clinical nursing pathway (CNP) on the psychological state, treatment adherence, and quality of life in patients with acute urticaria. A total of 240 patients diagnosed with acute urticaria at a tertiary hospital in Shandong Province were retrospectively assigned to either a control group, receiving standard care, or an intervention group, receiving care according to the CNP model. The primary outcomes assessed were levels of anxiety, depression, quality of life, and patient compliance. Statistical analyses were employed to evaluate the outcomes. Following the intervention, significant differences were observed in the anxiety and depression scores (P < .001), with the intervention group demonstrating lower levels of both. The control group's psychological state exhibited significant variance pre- and post-intervention (P < .001), alongside notably reduced overall compliance (P < .01). Post-intervention, patients in the intervention group showed enhanced treatment compliance, with a rapid increase within the first hour and a stable ascent over the following 10 hours, albeit with a marginally greater increase in the CNP group. Beyond 10 hours, the CNP group's compliance gradually declined, with a slight uptick in noncompliance rates. By 14 hours, the control group's overall compliance began to wane, with a sharp decline in full compliance and a rapid rise in noncompliance rates observed after 19 hours. At the 20-hour mark, the control group's noncompliance rate surpassed both the partial and full compliance rates. Conversely, post-20 hours, the CNP group maintained higher rates of full and partial compliance, with a lower noncompliance rate. No significant changes were noted in the control group's physiological or mental state, except in the domains of self-care and social ability, where notable differences were absent pre- and post-intervention. In contrast, the CNP group showed significant improvements in physiological and mental states, self-care, and social abilities post-intervention (P < .001), with noticeable differences in these domains evident 6 hours into the treatment (P < .01), leading to an enhanced quality of life. The CNP-based clinical nursing model intervention significantly benefits patients with acute urticaria by alleviating anxiety and depression, enhancing treatment adherence, and improving overall quality of life.

Effects of clinical nursing pathway on the surgical site wound infection in patients undergoing knee or hip replacement surgery: A meta-analysis

To explore the effect of clinical nursing pathway on wound infection in patients undergoing knee or hip replacement surgery. Computerised searches of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database, China National Knowledge Infrastructure databases were conducted, from database inception to September 2023, on the randomised controlled trials (RCTs) of application of clinical nursing pathway to patients undergoing knee and hip arthroplasty. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 5.4 software was employed for data analysis. Overall, 48 RCTs involving 4139 surgical patients were included, including 2072 and 2067 in the clinical nursing pathway and routine nursing groups, respectively. The results revealed, compared with routine nursing, the use of clinical nursing pathways was effective in reducing the rate of complications (OR = 0.17, 95%CI: 0.14-0.21, p < 0.001) and wound infections (OR = 0.29, 95%CI: 0.16-0.51, p < 0.001), shortens the hospital length of stay (MD = -4.11, 95%CI: -5.40 to -2.83, p < 0.001) and improves wound pain (MD = -1.34, 95%CI: -1.98 to -0.70, p < 0.001); it also improve patient satisfaction (OR = 7.13, 95%CI: 4.69-10.85, p < 0.001). The implementation of clinical nursing pathways in clinical care after knee or hip arthroplasty can effectively reduce the incidence of complications and wound infections, and also improve the wound pain, while also improving treatment satisfaction so that patients can be discharged from the hospital as soon as possible.

Effects of application of the clinical nursing pathway on surgical site wound infection and postoperative complication rates in patients with total knee arthroplasty: A meta-analysis

This study aimed to systematically evaluate the effects of clinical nursing on surgical site wound infections and postoperative complications in patients after undergoing total knee arthroplasty (TKA). Computerised searches of Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, VIP and Wanfang databases were conducted from inception to August 2023 to collect randomised controlled trials (RCTs) on patients with TKA who received clinical nursing pathway interventions. Literature screening, data extraction and quality assessment of the included studies were performed independently by two researchers. The meta-analysis was performed using Stata 17.0. A total of 14 RCTs with 1174 patients were included, including 587 patients each in the intervention and control groups. The meta-analysis results showed that the application of clinical nursing pathways to patients undergoing TKA significantly reduced surgical site wound infections (risk ratio [RR] = 0.28, 95% confidence interval [CI]: 0.15-0.54, p < 0.001) and postoperative complications (RR = 0.25, 95% CI: 0.17-0.37, p < 0.001). Therefore, clinical nursing pathway interventions in patients undergoing TKA should be promoted in clinical practice as they can effectively reduce the incidence of wound infection and postoperative complications.

Effect assessment of evidence-based nursing in combination with clinical nursing pathway on nephrotic syndrome care in children: A protocol for systematic review and meta-analysis

BACKGROUND

Childhood nephrotic syndrome is widespread in pediatric nephrology. In most cases, it needs hospitalization for patient management. An increasing number of studies report that proper nursing care could promote the rate of treatment and improve post-treatment prognosis. Clinical nursing pathways refer to innovative nursing modes with high-quality, excellent efficacy, and low costing treatment. There are reports on how nursing methods that utilize data combine with clinical nursing pathway to enhance nephrotic syndrome care in kids. However, the results remain controversial. Therefore, it is necessary to conduct this study to systematically explore how evidence-based nursing combined with clinical nursing pathway plays a role in nephrotic syndrome care among children.

METHODS

This study protocol will conduct a comprehensive search on MEDLINE, Cochrane Library, CINAHL, EMBASE, Scopus, Chinese National Knowledge Infrastructure, WanFang, and Web of Science electronic databases to identify relevant research articles from inception to April 25, 2021. Studies in both English and Chinese languages are used for this study. This study protocol will analyze randomized controlled trials that investigated the role of evidence-based nursing combined with clinical nursing pathway to care for nephrotic syndrome in children. Two authors will independently screen the search results, select suitable studies for inclusion, extract the characteristics and outcome data of the selected studies, and evaluate the risk of bias based on standard Cochrane methodology. Any discrepancies will be resolved by consensus.

RESULTS

The present study will summarize high-quality evidence to systematically explore how a nursing model based on evidence combined with clinical nursing pathway influences the caring of children with nephrotic syndrome.

CONCLUSION

The present study will summarize the direct and indirect evidence to judge whether evidence-based nursing combined with clinical nursing pathway can improve the treatment and post-treatment prognosis in children with nephrotic syndrome.

ETHICS AND DISSEMINATION

This study does not require an ethical approval.

REGISTRATION NUMBER

April 25, 2021.osf.io/bcrdk/ (https://osf.io/bcrdk/).

Analysis of the change of clinical nursing pathway in health education among patients with ovarian carcinoma

OBJECTIVE

To investigate the effect of health education via clinical nursing pathway (CNP) on self-care agency, quality of life, negative emotions and nursing satisfaction among patients with ovarian carcinoma.

METHODS

The clinical data of 61 patients with ovarian carcinoma admitted to the Oncology Department of our hospital from January 2019 to January 2020 were analyzed retrospectively. According to the different nursing methods, the patients were divided into a control group (n=31) and an observation group (n=30). The postoperative complications, the scores of self-care agency and quality of life before and after intervention, sleep quality and negative emotions were compared and analyzed between the two groups.

RESULTS

Patients in the observation group had higher mastery of health knowledge and lower incidence of postoperative complications than those in the control group. The scores of SDS, SAS and PSQI were significantly decreased in both groups after intervention compared with those before intervention (P<0.05), and the scores in the observation group were significantly lower than those in the control group (P<0.05). After intervention, both groups showed higher scores of self-care agency and quality of life than before intervention (P<0.05), and patients in the observation group showed higher scores than those in the control group (P<0.05). The overall nursing satisfaction of patient was relatively high.

CONCLUSION

Health education via CNP can help patients better understand the diseases, reduce their psychological burden and improve sleep quality. Informing patients of the methods of postoperative restorative exercise through health education is able to reduce complications incidence and improve self-care agency and quality of life of patients.

Application of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients undergoing total hip arthroplasty

Objective

Methods

Results

Conclusion

Clinical nursing pathway improves the nursing satisfaction in patients with acute cerebral hemorrhage: A randomized controlled trial protocol

BACKGROUND

Cerebral hemorrhage (CH) is a very common cerebrovascular disorder in clinical practice. More and more studies reported that proper nursing care could promote the rate of treatment, and improve the prognosis after treatment. Clinical nursing pathway (CNP) refers to original nursing mode with good quality, outstanding efficiency, and low treatment spending. Few articles have reported the effect of CNP in patients with acute CH. The program is in urgent need of convinced evidence to prove the reliability. Thus, we perform this randomized controlled trial protocol and hypothesize that CNP is associated with improved outcomes and nursing satisfaction, reduced adverse reactions in patients with acute CH.

METHOD

It is a single-center randomized controlled study to be conducted from October 2020 to October 2021. It was admitted via the Ethics Committee of the West China Hospital of Sichuan University (0038842/121). Eighty patients meet diagnostic standards for CH are included. The study group receives the clinical nursing path model. In the control group, patients receive the routine care before and after taking to the hospital. The main outcome contains the Barthel index score, the patient's degree of satisfaction about care, the length of hospital stay, and the risk of complications such as infection, bedsores and gastrointestinal function between the 2 groups. Six months after admission, the functional independence measure and Fugl Meyer score are recorded. All data are analyzed by the IBM SPSS Statistics, version 20 (IBM Corp., Armonk, NY edition).

RESULTS

Table 1 shows the clinical outcomes between groups.

CONCLUSION

CNP may improve the clinical outcomes for patients with acute CH and have a significant value in actual applications.

TRIAL REGISTRATION NUMBER

researchregistry6061.

Implementation of a clinical nursing pathway for percutaneous coronary intervention: A randomized controlled trial protocol

BACKGROUND

Acute myocardial infarction is a very common disease in the emergency room. Emergency percutaneous coronary intervention (PCI) is the first choice to open infarct-related artery in time to regain the active blood flow of myocardial tissue. Clinical nursing pathway (CNP), namely clinical project, is an original nursing mode with good quality, outstanding efficiency, and low treatment spending, so it has attracted more and more attention. However, few studies have reported the implementation of a CNP in PCIs. The purpose of the protocol is to assess the impact of CNP on the clinical efficacy of transradial emergency PCI.

METHODS

This is a randomized controlled, single center trial which will be implemented from January 2021 to June 2021. Hundred samples diagnosed with acute myocardial infarction will be included in this study. It was authorized via the Ethics Committee of Changshan County People's Hospital (CCPH002348). Patients are assigned to the following groups: control group, given normal routine care; CNP group, treated with CNP plan. The time from door to balloon, hospitalization expenses, length of stay, postoperative complications, patients' satisfaction with treatment are compared and analyzed. All data are collected and analyzed by Social Sciences software version 21.0 (SPSS, Inc., Chicago, IL) program.

RESULTS

Differences of clinical outcomes between groups ().

CONCLUSION

This original evidence-based nursing model can be used as the foundation for further research.

TRIAL REGISTRATION NUMBER

researchregistry6030.

Application values of clinical nursing pathway in patients with acute cerebral hemorrhage

Acute cerebral hemorrhage accounts for approximately 25% of strokes for elderly patients. Consequently, treatments to improve prognosis should be identified. The aim of the present study was to examine the clinical values of the application of clinical nursing pathway for patients with acute cerebral hemorrhage. Between January 2013 and January 2015, 92 patients diagnosed with acute intracerebral hemorrhage were enrolled in the study based on the guidelines recommended for providing appropriate surgical or conservative treatment and the sequence of admission. The 92 patients were randomly divided into the control and observation groups. Patients in the control group underwent routine nursing mode prior to and after admission, and underwent clinical nursing path model (hierarchical partitioning prior to admission to hospital plus general professional program of nursing in hospital) was applied to the observation group. Barthel index scores for the observation group were significantly higher than that of the control group. The length of hospital stay for patients in the observation group was significantly lower while the average score for patients' satisfaction on nursing care while in hospital was significantly higher than that of the control group, with statistically significant differences (P<0.05). The incidence of complications such as fever, infection, bedsore, gastrointestinal function, electrolyte disturbances, and malnutrition, in the observation group was significantly lower, with statistically significant differences (P<0.05). The functional independence measure (FIM) and Fugl-Meyer scores after 6 months for the observation group were significantly higher, with statistically significant differences (P<0.05). In conclusion, application of the clinical nursing pathway for patients with acute cerebral hemorrhage significantly improved the clinical effects and nursing satisfaction, reduced adverse reactions, and had a greater clinical application value.

Effect of clinical nursing pathway for endoscopic thyroidectomy in Chinese patients: A meta-analysis

The aim of this study was to assess the effect of the use of a clinical nursing pathway for patients undergoing endoscopic thyroidectomy by conducting a meta-analysis. Electronic databases were searched for relevant controlled trials published prior to August 2013. Only papers that compared the use of a clinical nursing pathway to usual care for patients undergoing endoscopic thyroidectomy were selected. The outcome measures were mean difference and 95% confidence interval for length of hospital stay and hospital charges and risk ratio for patient satisfaction. Six controlled trials were identified. The use of a clinical nursing pathway reduced the length of hospital stay and hospital charges. Furthermore, it improved patient satisfaction. This meta-analysis indicates that application of a clinical nursing pathway appears to reduce length of hospital stay and hospital charges and improve patient satisfaction for patients undergoing endoscopic thyroidectomy.