RETRACTED: Effects of comprehensive nursing interventions on wound pain in patients undergoing catheter insertion for peritoneal dialysis
Chao Chen and Xiang-Lei Wang contributed equally to this work.
Abstract
This study investigates the effects of comprehensive nursing interventions on wound pain in patients undergoing catheter insertion for peritoneal dialysis. Sixty patients who underwent catheter insertion for peritoneal dialysis from January 2021 to January 2023 at our hospital were selected as subjects and randomly divided into an experimental group and a control group using a random number table method. The control group received routine nursing care, while the experimental group was subjected to comprehensive nursing interventions. The study compared the impact of nursing measures on visual analogue scale (VAS), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and nursing satisfaction between the two groups. The analysis revealed that on the third, fifth and seventh days post-intervention, the experimental group's wound VAS scores were significantly lower than those of the control group (p < 0.001). Furthermore, levels of anxiety and depression were markedly lower in the experimental group compared with the control group (p < 0.001). In addition, the nursing satisfaction rate was significantly higher in the experimental group than in the control group (96.67% vs. 73.33%, p = 0.011). This study indicates that the application of comprehensive nursing interventions in patients undergoing catheter insertion for peritoneal dialysis is highly effective. It can alleviate wound pain and negative emotions to a certain extent, while also achieving high patient satisfaction, thus demonstrating significant clinical value.
1 INTRODUCTION
In recent years, the prevalence of chronic kidney disease (CKD) has been increasing annually, presenting a formidable global public health challenge.1, 2 Due to the subtle early symptoms and irreversible nature of kidney damage, CKD patients often miss the optimal treatment window, leading to the development of End-Stage Renal Disease (ESRD).3-5 Renal replacement therapy is the primary clinical method to sustain the lives of ESRD patients, comprising peritoneal dialysis, haemodialysis, and kidney transplantation.6-8
Peritoneal dialysis utilises the body's own peritoneum as a dialysis membrane.9, 10 It involves the exchange of solutes and water between dialysate introduced into the peritoneal cavity and plasma in the capillaries on the other side of the peritoneum, removing retained metabolic products and excess fluid from the body while replenishing essential substances through the dialysate.11, 12 Continuous renewal of peritoneal dialysis fluid achieves the purpose of renal replacement therapy.13 The simplicity of peritoneal dialysis, the ability to perform it at home without special equipment, the non-requirement for anticoagulants, minimal impact on hemodynamics, effective clearance of middle molecules and preservation of residual kidney function make it an increasingly accepted and widely used option for ESRD patients.14-16
Peritoneal dialysis patients usually undergo catheterization surgery, a traumatic procedure that damages abdominal tissues and releases chemical substances like bradykinin, proteolytic enzymes, and serotonin, stimulating nerve endings and causing pain and discomfort.17, 18 Post-operative swelling and dull pain at the catheter exit site significantly impact the patient's psychological state and postoperative recovery.19 Therefore, timely and effective measures to alleviate pain and adverse emotions are clinically significant. Comprehensive nursing care, based on holistic care that fully considers the physical and psychological needs of patients during treatment, can provide all-encompassing, continuous care services, promoting postoperative recovery.20 This paper explores the impact of comprehensive nursing interventions on wound pain in patients undergoing catheter insertion for peritoneal dialysis.
2 MATERIALS AND METHODS
2.1 Study subjects
Sixty patients undergoing catheter insertion for peritoneal dialysis from January 2021 to January 2023 in our hospital were randomly divided into an experimental group and a control group, with 30 patients each. Inclusion criteria were as follows: (i) age 18 and above; (ii) undergoing peritoneal dialysis catheterization for the first time; (iii) signed informed consent. Exclusion criteria were as follows: (i) severe preoperative pain; (ii) impaired cognitive function or mental disorders; (iii) coexisting cancer, severe organic diseases, or other serious conditions. All enrolled patients were informed and signed consent forms, complying with the requirements of the World Medical Association Helsinki Declaration; the study was approved by the ethics committee of our hospital.
2.2 Methods
The control group received standard clinical nursing interventions, which included monitoring the patient's condition, educating them about the disease and dialysis, and basic intervention for adverse emotional states. In addition to these measures, the experimental group received comprehensive nursing interventions, detailed as follows: (i) Health education and psychological counselling: the responsible nurse, based on the initial nursing assessment upon admission, would actively provide personalised explanations to the patients about the procedure of peritoneal dialysis catheterization, perioperative precautions and expected outcomes. For postoperative psychological issues like anxiety, depression and irritability, it was crucial to proactively care for the patient, understand the reasons behind various negative emotions and provide psychological care through reasoning, examples, psychological suggestions and encouragement. This approach aimed to help patients build confidence and adopt an optimistic attitude towards their condition. (ii) Pain management: pain management was tailored to the specific intensity of the patient's pain, with different analgesic methods selected based on the severity of the pain. Additionally, patients were offered music therapy, cognitive intervention therapy, and other such methods suited to their preferences to divert their attention and alleviate pain. (iii) Postoperative monitoring and examination: close monitoring of various postoperative indicators was conducted, with careful observation of the peritoneal dialysis catheter to ensure it was not under pressure or twisted, thus preventing any pulling on the catheter.
2.3 Observation indicators
- Pain intensity and psychological state: The Visual Analog Scale (VAS) was used for assessing pain intensity.21 This scale ranges from 0 to 10, where 0 represents no pain, 1–3 indicates mild pain, 4–6 denotes moderate pain and 7–10 signifies severe pain. The score is inversely related to the degree of pain experienced. Negative emotions were evaluated using the Self-Rating Anxiety Scale (SAS)22 and the Self-Rating Depression Scale (SDS),23 with scores directly proportional to the levels of anxiety and depression experienced by the patient.
- Nursing effectiveness: A nursing satisfaction survey was devised based on the nursing care provided. This survey was completed independently by patients and their family members post-care. The total score of the survey was 100, with 80–100 indicating very satisfied, 60–79 signifying satisfied, and scores below 60 suggesting dissatisfaction. The nursing satisfaction rate was calculated as the sum of the percentages of patients who were very satisfied and satisfied.
2.4 Statistical analysis
Statistical analysis was performed using SPSS 25.0. Quantitative data were expressed as mean ± standard deviation and analysed using t-tests; qualitative data were expressed in percentages (%) and analysed using the Chi-square test. A p-value <0.05 was considered statistically significant.
3 RESULTS
3.1 Baseline information
There were no statistically significant differences between the control and experimental groups of peritoneal dialysis patients in terms of age, sex, duration of dialysis, disease staging and primary disease (p > 0.05, Table 1).
| Items | Experimental group (n = 30) | Control group (n = 30) | t/χ2 | p-value |
|---|---|---|---|---|
| Age (years) | 52.63 ± 8.12 | 51.21 ± 8.43 | 0.665 | 0.509 |
| Sex | ||||
| Male | 18 (60.00) | 15 (50.00) | 0.606 | 0.436 |
| Female | 12 (40.00) | 15 (50.00) | ||
| Dialysis time (month) | 15.32 ± 5.90 | 16.34 ± 7.12 | 0.604 | 0.548 |
| Disease stages | ||||
| Phases 1–3 | 14 (46.67) | 12 (40.00) | 0.272 | 0.602 |
| Phases 4–5 | 16 (53.33) | 18 (60.00) | ||
| Primary disease | ||||
| Diabetic nephropathy | 10 (33.33) | 8 (26.67) | 0.752 | 0.861 |
| Hypertension kidney disease | 7 (23.33) | 6 (20.00) | ||
| Chronic nephritis | 9 (30.00) | 10 (33.33) | ||
| Other | 4 (13.34) | 6 (20.00) | ||
3.2 Wound pain intensity
Before nursing intervention, the experimental group's VAS score was 7.28 ± 1.43. After 3, 5 and 7 days of nursing, the VAS scores for the experimental group were 4.13 ± 0.98, 2.29 ± 0.48 and 1.11 ± 0.34, respectively. Before nursing intervention, the control group's VAS score was 7.32 ± 1.57, and the scores after 3, 5 and 7 days of nursing were 5.68 ± 1.08, 3.82 ± 0.64 and 2.88 ± 0.74, respectively. There was no significant difference between the two groups in terms of VAS scores before nursing intervention (p > 0.05). However, after 3, 5 and 7 days of nursing, the VAS scores of the experimental group were significantly lower than those of the control group (p < 0.001), as shown in Table 2.
| Groups | BN | AN-3 days | AN-5 days | AN-7 days |
|---|---|---|---|---|
| Experimental group (n = 30) | 7.28 ± 1.43 | 4.13 ± 0.98 | 2.29 ± 0.48 | 1.11 ± 0.34 |
| Control group (n = 30) | 7.32 ± 1.57 | 5.68 ± 1.08 | 3.82 ± 0.64 | 2.88 ± 0.74 |
| t-value | 0.103 | 5.821 | 10.475 | 11.905 |
| p-value | 0.918 | <0.001 | <0.001 | <0.001 |
- Abbreviations: AN, After nursing; BN, Before nursing.
3.3 SAS and SDS scores
Before nursing intervention, the experimental group's SAS score was 62.23 ± 6.91. After 3, 5 and 7 days, the SAS scores were 42.47 ± 4.27, 32.69 ± 3.84 and 22.68 ± 3.1, respectively. Before nursing intervention, the control group's SAS score was 60.25 ± 6.42, and the scores after 3, 5 and 7 days were 52.26 ± 5.38, 42.02 ± 4.63 and 37.64 ± 4.62, respectively. There was no significant difference in SAS scores between the groups before nursing intervention (p > 0.05). However, after 3, 5 and 7 days of care, the SAS scores of the experimental group were significantly lower than those of the control group (p < 0.001). Before nursing intervention, the experimental group's SDS score was 55.46 ± 4.90. After 3, 5 and 7 days, the SDS scores were 46.67 ± 4.26, 33.65 ± 4.06 and 24.31 ± 2.42, respectively. Before nursing intervention, the control group's SDS score was 57.13 ± 6.04, and the scores after 3, 5 and 7 days were 52.53 ± 4.94, 42.13 ± 4.73 and 33.06 ± 3.25, respectively. There was no significant difference in SDS scores between the groups before nursing intervention (p > 0.05). However, after 3, 5 and 7 days of nursing, the SDS scores of the experimental group were significantly lower than those of the control group (p < 0.001), as shown in Table 3.
| Items | BN | AN-3 days | AN-5 days | AN-7 days |
|---|---|---|---|---|
| SAS score | ||||
| Experimental group (n = 30) | 62.23 ± 6.91 | 42.47 ± 4.27 | 32.69 ± 3.84 | 22.68 ± 3.11 |
| Control group (n = 30) | 60.25 ± 6.42 | 52.26 ± 5.38 | 42.02 ± 4.63 | 37.64 ± 4.62 |
| t-value | 1.150 | 7.807 | 8.496 | 14.713 |
| p-value | 0.237 | <0.001 | <0.001 | <0.001 |
| SDS score | ||||
| Experimental group (n = 30) | 55.46 ± 4.90 | 46.67 ± 4.26 | 33.65 ± 4.06 | 24.31 ± 2.42 |
| Control group (n = 30) | 57.13 ± 6.04 | 52.53 ± 4.94 | 42.13 ± 4.73 | 33.06 ± 3.25 |
| t-value | 1.176 | 4.92 | 7.451 | 11.828 |
| p-value | 0.244 | <0.001 | <0.001 | <0.001 |
- Abbreviations: AN, After nursing; BN, Before nursing.
3.4 Nursing satisfaction
Nursing satisfaction in the experimental group was 96.67%, compared with 73.33% in the control group. The nursing satisfaction rate of the experimental group was significantly higher than that of the control group (p = 0.011), as shown in Table 4.
| Groups | Very satisfied | Satisfied | Dissatisfied | Total satisfaction rate |
|---|---|---|---|---|
| Experimental group (n = 30) | 15 (50.00) | 14 (46.67) | 1 (3.33) | 29 (96.67) |
| Control group (n = 30) | 12 (40.00) | 10 (33.33) | 8 (26.67) | 22 (73.33) |
| χ2-value | 6.405 | |||
| p-value | 0.011 |
4 DISCUSSION
Peritoneal dialysis catheterization, a common procedure for ESRD patients undergoing peritoneal dialysis, can improve the quality of life and control disease progression.24, 25 However, the surgery is traumatic and can mechanically damage abdominal tissues, leading to the release of proteolytic enzymes, bradykinin and serotonin, which stimulate nerve endings and cause pain.26, 27 This trauma affects not only the skin but also muscle tissues and organs, resulting in postoperative pain that significantly impacts the patient's psychological health and recovery.28, 29 Therefore, high-quality nursing intervention is necessary alongside active treatment to facilitate early recovery in patients.
Comprehensive nursing intervention is a holistic care approach, addressing various aspects of treatment to provide targeted nursing measures. This approach improves patient compliance with medical advice, helping to reduce the occurrence of various complications.30, 31 The results of this study show that after 3, 5 and 7 days of comprehensive nursing intervention, the experimental group had lower VAS, SAS and SDS scores and a higher rate of nursing satisfaction compared with the control group. The reasons are as follows: firstly, health education increases patients' awareness of their disease, alleviating fears and anxieties and enhancing compliance with treatment.32 Secondly, understanding the causes of patients' negative emotions and providing targeted psychological counselling can improve their emotional state and build their confidence in treatment.33 Thirdly, in terms of pain management, non-pharmacological methods such as medication, verbal communication, motivational support, and distraction effectively alleviate pain.34
5 CONCLUSION
In summary, it is evident that comprehensive nursing intervention for patients undergoing catheter insertion for peritoneal dialysis can relieve postoperative pain, improve negative emotions, enhance satisfaction with the quality of clinical nursing, and facilitate postoperative recovery. This approach has significant clinical nursing practice value.
CONFLICT OF INTEREST STATEMENT
The authors declare that there are no conflicts of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
