Application value of humanized nursing in perioperative nursing of minimally invasive surgery for pediatric hernia

(整期优先)网络出版时间:2023-03-08
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Application value of humanized nursing in perioperative nursing of minimally invasive surgery for pediatric hernia

HUANG,Huimin

Ruici Hospital affiliated to Nantong University,Nantong Jiangsu 226000,China

AbstractObjective:To explore the clinical application value of humanized nursing in postoperative pain nursing of children hernia.Methods:Approved by the medical ethics Committee of our hospital,70 cases of pediatric hernia patients admitted to our hospital from January 2018 to December 2020 were included in the study.They were pided into control group and observation group by random number table method.The control group received routine postoperative pain nursing intervention.The observation group was given humanized nursing intervention on the basis of routine nursing,and recorded the length of stay in the two groups of children,the time of getting out of bed and the occurrence of complications,and evaluated the pain degree of the two groups of children.Results:The activity time(2.24±0.90)d,hospital stay(5.21±1.74)d and pain score(1.04±0.23)points in the observation group were significantly better than those in the control group(5.54±0.92)d,(8.79±1.38)d,(1.93±0.45)points,the difference was statistically significant(P<0.05);The incidence of complications in the observation group was 2.86%(1/35)lower than 20.00%(7/35)in the control group(P<0.05).The parental nursing satisfaction of the observation group(97.14%,34/35)was significantly higher than that of the control group(77.14%,27/35)(P<0.05).Conclusion:For children with hernia,humanistic nursing intervention has significant effect,which can effectively improve the pain degree of children,shorten the hospitalization time,speed up the time of getting out of bed,and improve the satisfaction of parents of children with nursing work.

Key wordsHernia in children;Humanized nursing;Pain care;Nursing value

Pediatric hernia is one of the most common diseases in pediatric surgery and hernia surgery,mainly including two types of congenital inguinal hernia and umbilical hernia,which can change according to the changes of the child's posture,movement status and mood,and may disappear automatically in the early stage of the disease,or disappear after pressing with hands.The main cause of children's hernia is congenital factors.Inguinal hernia is mainly caused by the unclosed sheath process,while umbilical hernia is mainly caused by the unclosed umbilical ring.Premature infants and low body weight infants may also cause child hernia due to incomplete development at birth.In recent years,the incidence of pediatric hernia is more frequent in clinic.A survey shows that the incidence rate of hernia in children is generally 3%~7%,and male children are more than female children,threatening the life safety of children to a certain extent.Once not treated in time,with the continuous deterioration of the disease,the hernia mass will become larger and larger,and the children will continue to cry because of their own pain,which will greatly increase the risk of the children's hernia sac incarceration or strangulated hernia,which may eventually lead to the death of the children.Based on this,surgery is often used to treat children with hernia in clinic,but surgery needs to invade the body of children,which is prone to different degrees of pain after surgery,which greatly reduces the quality of life of children.Therefore,professional,reasonable and scientific nursing intervention should be supplemented in time after operation to actively improve the pain status of children and reduce the incidence of complications.This study attempts to carry out group nursing for children with hernia admitted to our hospital from January 2018 to December 2020,with the purpose of analyzing the application effect of humanistic nursing in postoperative pain care for children with hernia.The report is as follows.

1 Data and methods

1.1 General information

This study was conducted with the consent of the hospital ethics committee and the parents of the children.70 children with hernia admitted to our hospital were included in the study from January 2018 to December 2020.They were pided into control group and observation group by random number table method,with 35 cases in each group.The ratio of boys and girls in the control group was 18∶17;The age ranged from 5 months to 11 years,with a median age of 5.03 years.The ratio of boys and girls in the observation group was 19∶16;The age ranged from 6 months to 13 years,with a median age of 5.05 years.Comparison of basic data between the two groups of children(P>0.05)is comparable.Inclusion criteria:in line with the relevant diagnostic criteria of Practical Pediatrics;There was no contraindication of surgery in the selected children;No contraindication of anesthesia.Exclusion criteria:children with coagulation dysfunction;Children with liver and kidney dysfunction;Children with diseases of blood system and immune system;Children with incomplete clinical data or withdrawal from the study.

1.2 Nursing methods

The control group received routine postoperative pain care,including basic care,closely monitoring the condition,such as vital signs and surgical incision status,clarifying the operation precautions to the parents of the children,and explaining the guidance matters related to the children's diet,activities and rest after the operation;Operation nursing:accompany the child to the operating room,assist in adjusting the operation position of the child,ensure the normal blood circulation,monitor the changes of vital signs,and timely assist the doctor to deal with the abnormal conditions of the child.If the gas perfusion of the child is blocked,it is necessary to assist the doctor to explore the tightness of the abdominal muscles,judge whether the puncture needle can enter the abdominal cavity,and do not blindly deal with it;Discharge guidance,instructing children to avoid strenuous exercise,work and rest reasonably,and change dressing on time;Dietetic guidance:After the child is anesthetized and awake,a small amount of warm water can be fed.If there is no dysphagia,semi-liquid food or liquid food can be given.For children with nausea and vomiting reactions,feeding should be stopped in time.Pay attention to high-protein and high-fiber foods to promote the recovery of the child's condition.

The observation group received humanized nursing on the basis of the control group.①Psychological intervention:communicate with the family members of the children in time before operation,understand the basic information and psychological characteristics of the children,comfort and encourage the children,and improve the cooperation of the children through small games and small rewards;Strengthen the communication with children's families,do a good job in health education and publicity,and ensure the recognition and cooperation of children's families;At the same time,select professional nursing staff to provide relaxation training for children,do a good job of psychological guidance and language encouragement,touch children more,strengthen physical contact with children,and play cartoons or nursery rhymes for children properly to pert children's attention and reduce their pain feelings.②Pain nursing:place soft cushion in time before the child wakes up,mainly under the knee of the child,to ensure the lower limb flexion of the child,reduce tension,and relieve pain;Regularly clean the ward,adjust the indoor temperature and humidity,do a good job in environmental care,create a good rest environment for children,and visually relieve their own pain.③Basic nursing:After the operation,help the child to lie flat,with the head tilted to one side,do a good job in oral care,ensure smooth breathing,and prevent suffocation and respiratory tract infection caused by aspiration;Closely monitor the vital signs of children to ensure their life safety during anesthesia;After the child wakes up under anesthesia,do a good job of safety nursing for the child in time.④Posture nursing:After the operation is completed,assist the child to take a flat lying position,tell the parents of the child not to hug the child directly,and patiently explain the reason,that is,the child is under anesthesia after the operation,and the blood flow rate is slow,plus the implementation of the operation,part of the blood loss,at this time,the blood flow in the brain of the body can be significantly reduced,and the phenomenon of cerebral hypoxia is more likely to occur,At the same time,it will cause throat stenosis and induce dyspnea.Discharge guidance:carry out personalized discharge guidance according to the actual condition and basic condition of the child;Ask the parents of the child to help the child clean his mouth,change his dressing regularly,pay attention to the wound to avoid water and prevent wound infection;Keep abreast of the weather conditions and increase or decrease clothing appropriately.

1.3 Observation indicators

The time of getting out of bed and the time of hospitalization were recorded,and the Prince-Hence scoring system was used to evaluate the postoperative pain of the two groups of children.The score was 0 to 4 points.The lower the score was,the less pain the children had.The postoperative complications of the two groups were recorded,including urinary retention and incision infection.The nursing service satisfaction questionnaire made by our department was used to evaluate the satisfaction degree of parents of two groups of children with nursing services.The questionnaire included 10 questions related to nursing,with two options of satisfaction and dissatisfaction.The parents of the children chose the satisfaction option by themselves.Selecting the satisfaction option with more than 8 questions means that the parents of the children are very satisfied,6 questions and more mean that they are generally satisfied,and 5 questions and less means that they are not satisfied,Compare the parents'satisfaction with nursing service in the two groups.

1.4 Statistical treatment

SPSS 20.0 statistical software was used to analyze the data.The measurement data were expressed by(x±s),and the inter-group comparison was performed by t-test;The counting data is expressed in[n(%)],and the comparison lines between groupsχ2 Inspection;P<0.05 indicates that the difference is statistically significant.

2 Results

2.1 Comparison of hospitalization time,time of getting out of bed and pain degree between the two groups

Compared with the control group,the observation group was significantly better than the control group in terms of the time of hospitalization,time of getting out of bed and pain score(P<0.05).See Table 1.

group

Number of cases

Time to get out of bed(d)

Length of stay(d)

Pain score(points)

control group

35

5.54±0.92

8.79±1.38

1.93±0.45

Observation group

35

2.24±0.90

5.21±1.74

1.04±0.23

T value

15.1693

9.5369

10.4187

P value

0.000

0.000

0.000

2.2 Comparison of parents'satisfaction with nursing work between the two groups

The total satisfaction rate of the observation group was 97.14%,including 20 cases of very satisfactory,14 cases of general satisfactory and 1 case of unsatisfactory.The control group was 77.14%,17 cases,10 cases and 8 cases(2=6.2477,P=0.0124)。

3 Discussion

Pediatric hernia is a disease type caused by the separation of some tissues in the body and the original site,which leads to the heterotopic space between the body and the body.It usually occurs in boys.Relevant data show that the incidence ratio of pediatric hernia between boys and girls is 25∶1.The main feature of children's hernia is pain in the lower abdomen or scrotum,which can affect the umbilical cord,the heart pit and the back of the waist of the child,and even accompanied by symptoms such as limb chills and paralysis.If not treated in time,the mass will become larger and larger,and may even cause incarceration,affecting the daily life of the child.Therefore,surgery should be performed as soon as possible after diagnosis.Although the surgical treatment of this disease is relatively simple,it will still damage the body of the child to a certain extent,and it is very easy to have pain after surgery.In addition,the postoperative children will also have dry stool and continuous crying,which will make the contents of the abdominal cavity impact the tight hernia sac buckle to a certain extent,causing the suture to fall off and increasing the risk of disease recurrence.Therefore,effective nursing intervention must be taken during the treatment to ensure the quality of life of the patients.

With the continuous development of society and the continuous transformation of medical model,humanized nursing model has emerged.Humanized nursing model,as a new nursing model,advocates patient-centered,humanistic nursing services to meet the needs of patients in all aspects,including physical,psychological,spiritual and social aspects,and to provide high-quality services to patients to the maximum extent[22-24].The results of this study showed that the time of getting out of bed,the time of hospitalization and the score of pain in the observation group were significantly better than those in the control group,the incidence of complications was lower than that in the control group,and the parents'nursing satisfaction was higher than that in the control group(P<0.05).This shows that,compared with conventional pain care,humanistic care has a more significant effect in the application of pain care after pediatric hernia surgery,which can greatly shorten the hospital stay of children,relieve pain,promote children to get out of bed as soon as possible,reduce the risk of wound infection and urinary retention,and ensure that parents of children recognize the nursing work.The reasons are as follows:in the process of humanized nursing intervention,strengthen the position nursing of the children,let the parents of the children clearly know that they should not hug the children when they are not awake under anesthesia,which helps to reduce the secondary injury opportunities of the children and ensure the treatment effect;At the same time,do a good job of monitoring the vital signs,reasonably adjust the indoor temperature and humidity,and pay attention to the warmth of the children,so that the medical staff can know the abnormal conditions of the children in time,and deal with the symptoms in the first time to maintain the life safety of the children;In addition,the combination of humanized pain nursing intervention can help to reduce the excessive damage of anesthesia to children's body,and the combination of multiple methods(cartoons,nursery rhymes,small rewards)can help to pert children's attention and reduce their pain level;Good diet guidance will help to ensure the body nutrition of children and lay the foundation for early recovery;Touch the child more and increase the number of physical contact,which can make the child fully feel the attention of the outside world,obtain the best comfort from the spiritual level,make the child relax the muscles of the whole body,thus reducing the pain feeling of the child after surgery;Discharge guidance can help children and their families feel the care of the hospital,increase their parents'satisfaction with nursing work,and help the hospital establish a good image.

To sum up,humanistic nursing has a significant application effect in the post-operative pain care of children with hernia,especially in shortening the hospitalization time of children,speeding up the activities of getting out of bed,alleviating pain,reducing the incidence of complications and improving the nursing satisfaction of parents of children.It is a clinically feasible and effective nursing method.

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