| Objective: This study is based on Orem self-care theory to guide the development of comprehensive clinical nutrition management intervention program,which is expected to reduce the nutritional risk of tetanus patients,improve the nutritional level of patients,reduce the severity of disease,and thus improve the outcome of patients’ prognosis,and provide practical reference for the treatment and nursing of clinical tetanus patients.Methods: A total of 72 tetanus patients in the Department of surgery and intensive Care in a Grade-III hospital from January 2021 to November 2022 were enrolled by convenience sampling method,including 36 cases in the control group and 36 cases in the intervention group.During the study,1 patient in the control group and 1 patient in the intervention group withdrew from the study,resulting in a total of 70 patients,35 patients in each group.Basic information of patients was collected.Guided by PG-SGA scale,NRS2002 score,APACHE Ⅱ score,nutritional and biochemical indexes,incidence of nutrition-related complications,length of ICU stay and nursing satisfaction scores collected during the trial were compared and analyzed.Under the premise of no intervention in conventional treatment and nursing,the control group was given conventional nutrition nursing intervention program,and the intervention group was given PG-SGA nutrition assessment,and the corresponding nursing intervention was carried out according to the evaluation results and Orem self-care theory.Finally,NRS2002 score,APACHEⅡ score,nutritional biochemical index value(ALB、TP、PA 、RBP),the number of nutrition-related complications,length of ICU stay and nursing satisfaction score of the two groups were statistically analyzed.Results:1.The gender,age,marital status,ethnic group,monthly family income,BMI range,medical payment method,recent history of non-clean trauma and admission APACHEⅡscore of the two groups were statistically analyzed,and there were no significant statistical differences and were comparable(P>0.05).2.Comparison of nutritional risk score and disease severity score between the two groups:(1)Statistical results of NRS2002 score between the two groups were as follows: 1)Intra-group comparison showed that NRS2002 scores of patients in the intervention group at each time point were statistically different from those at the beginning of admission to ICU on the day of admission and before discharge(P<0.05).Compared with the day of admission to ICU,the score on the 14 th day of admission to ICU and before discharge were statistically different(P<0.05).The score of NRS2002 on the 14 th day of admission and before discharge was statistically different from that on the 7th day of admission(P<0.05).The score of NRS2002 before discharge was statistically different from that on the14 th day of admission(P<0.05).2)The comparison between groups showed that there was a statistically significant difference between the control group and the intervention group at ICU7 days(Z=-3.61,P<0.001);There was a statistically significant difference between the control group and the intervention group on ICU14 days(Z=-5.32,P<0.001).(2)The statistical results of APACHEⅡ scores of patients in the two groups were as follows: 1)Intra-group comparison showed that the APACHEⅡ scores of patients in the intervention group were statistically different from those at the beginning of admission on the day of ICU admission,on the day of ICU7 admission and before discharge(P<0.05);Compared with the day of ICU admission,the scores on the 7th day of admission,the 14 th day of admission and before discharge were statistically different(P<0.05).Compared with the score on the 7th day of admission,the score on the 14 th day of admission and before discharge was statistically different(P<0.05).Compared with 14 days after admission to ICU,the score before discharge was statistically different(P<0.05).2)The comparison between groups showed that there was a significant difference in APACHE Ⅱ scores between the control group and the intervention group on ICU7 days(F=3.51,P<0.001);There was a significant difference in APACHEⅡscores between the control group and the intervention group on ICU14 days(F=3.55,P=0.007).3.Comparison of nutritional indexes between the two groups(1)Comparison of albumin levels between the two groups: 1)Intra-group comparison found that there were statistical differences between the intervention group except that there was no statistical difference at the beginning of admission and the day of ICU admission(P<0.05).2)Intergroup comparison showed that there was an interaction effect between group and time(F=6.80,P<0.001),and the albumin level in both control group and intervention group had a time effect(P<0.001).There was a significant difference in albumin level between the control group and the intervention group at ICU7 days(F=3.05,P<0.001).There was a significant difference in albumin level between the control group and the intervention group on ICU14 days(F=1.30,P<0.001).The albumin level of the control group before discharge was significantly different from that of the intervention group(F=0.09,P=0.02<0.05).(2)Comparison of total protein levels between the two groups: 1)Intra-group comparison showed that there were statistical differences between the intervention group except at the beginning of admission and the day of ICU admission(P<0.05).2)The comparison between groups showed that there was an interaction effect between time and group(F=11.30,P<0.001),and the total protein level in both control group and intervention group had a time effect(P<0.001).The total protein level of the control group on ICU7 days was significantly different from that of the intervention group(F=0.09,P<0.001).The total protein level of the control group on ICU14 days was significantly different from that of the intervention group(F=0.18,P<0.001).The total protein level of the control group before discharge was significantly different from that of the intervention group(F=3.18,P=0.04<0.05).(3)Comparison of pre-protein levels between the two groups: 1)Intra-group comparison showed that there were statistical differences between the intervention group except at the beginning of admission and the day of ICU admission(P<0.05).2)The comparison between groups showed that there was a time effect on pre-protein levels in both control and intervention groups(P<0.001 for both groups).The protein level before ICU7 in the control group was significantly different from that in the intervention group(F=0.61,P=0.001<0.05).There was a statistical difference between the protein level before ICU14 day in the control group and that in the intervention group(F=1.13,P=0.002<0.05).There was no statistical difference between the control group and the intervention group in the level of preprotein before discharge(F=2.32,P=0.06>0.05).(4)Comparison of retinol-binding protein levels between the two groups: 1)Intra-group comparison found:(4)Comparison of retinol-binding protein levels between the two groups:1)Intra-group comparison showed that there were statistical differences between the intervention group except that there was no statistical difference at the beginning of admission and the day of ICU admission(P<0.05).2)The comparison between groups showed that there was an interaction effect between time and group(F=5.27,P=0.003<0.001),and the retinol binding protein level in both control group and intervention group had a time effect(P<0.001).The results showed that the level of retinol-binding protein in the control group was significantly different from that in the intervention group on ICU7 days(F=2.30,P<0.001).The level of retinol-binding protein in the control group was significantly different from that in the intervention group on ICU14 days(F=0.25,P<0.001).4.After the intervention,the length of ICU stay in the two groups was compared,the control group(17.97±2.18)and the intervention group(16.89±1.76),the difference was statistically significant(P<0.05).The incidence of nutrition-related complications in the control group(8.37 ±2.38)was statistically different from that in the intervention group(6.77±1.77)(P<0.05).The nursing satisfaction scores of patients in control group(8.06±0.68)and intervention group(8.91±0.74)were statistically different(P<0.05).Conclusion:1.The nursing mode intervention program guided by Orem self-care theory can improve the levels of albumin,total protein,proprotein and retinol-binding protein in adult tetanus patients,and reduce the NRS2002 nutritional risk score and APACHEⅡ disease severity score.The number of nutrition-related complications of nausea,vomiting,diarrhea,abdominal distension and abdominal pain was reduced.2.The intervention program provides precise nursing care according to the law of disease development of patients,thus reducing the severity of the disease,reducing the nutritional risk,shortening the length of ICU stay,improving the prognosis and quality of life of patients,and enhancing nursing satisfaction.This model can help clinical medical staff accurately judge patients’ conditions,guide the direction of nutritional nursing,and provide patients with comprehensive care and support,which has certain clinical reference significance. |
PDF Full Text Request