Nursing Plan And Empirical Study Of Patients With Lumbar Disc Herniation After Minimally Invasive Surgery Based On Interaction Model Of Client Health Behavior

Objectives1.To construct a nursing plan for minimally invasive postoperative patients with lumbar disc herniation based on Interaction Model of Client Health Behavior.2.To verify clinical application effects of this program in patients with lumbar disc herniation after minimally invasive surgery and to explore the feasibility and scientificity of this program.MethodsPart one: Literature ReviewFirstly,the research team clarified the research question,devised a search strategy,conducted an analysis of guidelines,systematic reviews,evidence summaries,RCTs,and quasi-experimental studies relevant to the research question published in major domestic and international guideline repositories,association websites,and databases over the last decade.They performed a thorough literature screening and evaluation based on predefined inclusion criteria,including high-quality publications.They subsequently developed an initial nursing intervention plan.Part two: Delphi MethodAfter discussion,the research team members finally formulated the first draft of a nursing plan for patients after minimally invasive lumbar disc herniation based on Interaction Model of Client Health Behavior,and formed an expert consultation questionnaire.According to the objective sampling method,16 nursing experts from orthopedics,pain department and other related specialties were selected for two rounds of Delphi expert correspondence consultation.SPSS25.0 statistical software was used for analysis.The opinions of experts were deleted and revised,and integrated through discussion by the research group,finally a nursing plan for minimally invasive postoperative patients with lumbar disc herniation based on Interaction Model of Client Health Behavior was constructed.Part three: A Quasi-experimental studyThis study selected 64 postoperative patients with lumbar disc herniation from a tertiary hospital in Guangzhou,China,as the research subjects.The enrolled patients were divided into an experimental group and a control group,with 32 cases in each group.The control group received routine nursing care,while the experimental group received a nursing program based on the Interaction Model of Client Health Behavior in addition to routine care.The study compared the Japanese Orthopaedic Association Back Pain Evaluation Score and pain score of the patients at admission,one week after surgery,one month after surgery,and three months after surgery.It also assessed the anxiety and depression status of the patients at admission,one week after surgery,and three months after surgery.Furthermore,the study evaluated the knowledge score of lumbar disc herniation at admission,one day after surgery,and at discharge.Other measures included the behavior score of lumbar disc herniation at three months after surgery,patient satisfaction,and complications.The clinical application effects were analyzed using SPSS 25.0 statistical software.ResultsPart one: Literature ReviewOn the basis of literature review,through sorting and summarizing,the research team preliminarily extracted the nursing intervention contents for patients post-minimally invasive surgery for lumbar disc herniation: including 5 first-level items,10 second-level items,16 third-level items.Part two: Delphi MethodThe study conducted two rounds of expert consultations,achieving an 94.1%response rate for the questionnaires in both rounds.The experts demonstrated positive attitudes with enthusiasm scores of 0.941 and 0.312,respectively.The expert authority coefficients(Cr)were 0.866 and 0.909.The Kendall’s W coefficients were 0.129 and0.149,indicating a high degree of consensus and concentration of expert opinions.The Kendall’s coefficient was statistically significant(P<0.001).Ultimately,5first-level items,11 second-level items and 16 third-level items were formed.Part three: A Quasi-experimental study1.Comparison of general characteristics,such as gender and age,between the two groups of patients showed no statistically significant differences(P>0.05),indicating comparability.2.Comparison of the two patient groups using repeated measures analysis of variance,based on the Japanese Orthopaedic Association Back Pain Evaluation Scores,revealed statistically significant differences in time effect(F=3501.619,P=<0.001),group effect(F=14.661,P<0.001),and interaction effect(F=27.391,P<0.001)at admission,one week after surgery,one month after surgery,and three months after surgery(P<0.05).3.Comparison of hospital anxiety and depression scores between the two groups,repeated measurement analysis of variance at admission,one week and three months after surgery showed that:(1)Anxiety scores were statistically significant in the time effect(F=363.439,P<0.001),group effect(F=7.193,P=0.009)and interaction effect(F=15.579,P < 0.001).(2)Depression scores were significantly different in time effect(F=321.681,P<0.001),group effect(F=8.263,P=0.006)and interaction effect(F=17.854,P<0.001).4.Comparison of pain scores between the two groups,repeated measurement variance analysis at admission,one week after surgery,one month after surgery,and three months after surgery showed that time effect(F=1065.916,P<0.001),group effect(F=11.917,P=0.001),interaction effect(F=7.384,P<0.001)were statistically significant(P<0.05).5.Comparison of knowledge questionnaire scores between the two groups of patients,repeated measurement analysis of variance at admission,one day after surgery and discharge showed that time effect(F=2587.368,P<0.001),group effect(F=28.377,P < 0.001),interaction effect(F=9.913,P=0.001)were statistically significant(P<0.05).6.The incidence of complications was compared between the two groups,and there was no significant difference in nerve root anomalies,constipation,fat liquefaction and urine retention(P > 0.05).7.The scores of the lumbar disc herniation behavior questionnaire were compared between the two groups of patients,and it was observed that the experimental group had significantly higher scores than the control group(Z=-4.109,P<0.001),indicating a statistically significant difference.8.Comparison of patient satisfaction between the two groups,the results showed that scores of each dimension of satisfaction in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.001).ConclusionsThis study utilized a literature review and the Delphi method to develop a nursing protocol for postoperative patients with minimally invasive lumbar disc herniation,based on the Interaction Model of Client Health Behavior.The protocol was implemented,and during its implementation,the experimental group reduced levels of anxiety and depression,and improved pain management compared to the control group.Furthermore,the experimental group exhibited superior outcomes in terms of the Japanese Orthopaedic Association Back Pain Evaluation Scores,lumbar disc herniation health knowledge scores,lumbar disc herniation behavior scores,and patient satisfaction,when compared to the control group.These improvements in clinical health indicators indicate the superior effectiveness and feasibility of the protocol in clinical practice.