Effect of emotion management and nursing on patients with painless induced abortion after operation

Abstract

BACKGROUND

With an estimated 121 million abortions following unwanted pregnancies occurring worldwide each year, many countries are now committed to protecting women’s reproductive rights.

AIM

To analyze the impact of emotional management and care on anxiety and contraceptive knowledge mastery in painless induced abortion (IA) patients.

METHODS

This study was retrospective analysis of 84 patients with IA at our hospital. According to different nursing methods, the patients were divided into a control group and an observation group, with 42 cases in each group. Degree of pain, rate of postoperative uterine relaxation, surgical bleeding volume, and postoperative bleeding volume at 1 h between the two groups of patients; nursing satisfaction; and mastery of contraceptive knowledge were analyzed.

RESULTS

After nursing, Self-Assessment Scale, Depression Self-Assessment Scale, and Hamilton Anxiety Scale scores were 39.18 ± 2.18, 30.27 ± 2.64, 6.69 ± 2.15, respectively, vs 45.63 ± 2.66, 38.61 ± 2.17, 13.45 ± 2.12, respectively, with the observation group being lower than the control group (P < 0.05). Comparing visual analog scales, the observation group was lower than the control group (4.55 ± 0.22 vs 3.23 ± 0.41; P < 0.05). The relaxation rate of the cervix after nursing, surgical bleeding volume, and 1-h postoperative bleeding volumes were 25 (59.5), 31.72 ± 2.23, and 22.41 ± 1.23, respectively, vs 36 (85.7), 42.39 ± 3.53, 28.51 ± 3.34, respectively, for the observation group compared to the control group. The observation group had a better nursing situation (P < 0.05), and higher nursing satisfaction and contraceptive knowledge mastery scores compared to the control group (P < 0.05).

CONCLUSION

The application of emotional management in postoperative care of IA has an ideal effect.

Key Words: Emotional management, Induced abortion, Anxiety, Care, Contraceptive knowledge

Core Tip: In this study, as a new type of induced abortion (IA) surgery, painless abortion has been widely used in clinical practice, but the psychological trauma caused by surgery still has a serious impact on patients prone to depression, anxiety, and other negative emotions, which is not conducive to the prognosis. This study analyzed the impact of emotional management and care on anxiety scores, coping styles, and contraceptive knowledge mastery in painless IA patients.

INTRODUCTION

Approximately 121 million unexpected pregnancies occur annually in the world, with 61% ending in induced abortions (IAs)[1]. Ipas is an organization that works with partners around the world to promote reproductive justice by expanding opportunities for abortion and contraception. It aims to break the cycle of repeated and unexpected pregnancies, and first proposed the term “Postpartum care” (PAC) in its 1991 strategic planning document[2]. PAC consists of five core components: community and service provider partnerships, counseling, treatment, and reproductive and other health services[3,4]. The 1994 International Conference on Population and Development recognized PAC as a fundamental strategy, with many countries committed to protecting women’s reproductive rights. Previous studies have found that PAC can significantly reduce maternal mortality and related social costs[5,6].

Based on drawing on successful international experiences, China launched the PAC program in 2011 and issued guidelines for post-abortion family planning services. Post-abortion family planning (PAFP) services in China refer to an overall service, including one-on-one PAFP consultation before IA, abortion care, and follow-up after abortion[7,8]. PAFP services are associated with reducing repetitive IAs, increasing women’s reproductive health knowledge, and reducing psychological anxiety in women after abortion[9,10].

Artificial abortion is a surgical method to artificially terminate pregnancy. Women who are unable to continue their pregnancy due to various reasons such as certain diseases or fetal malformations need to undergo this procedure to terminate their pregnancy[11,12]. With the continuous improvement of medicine, abortion surgery methods are also constantly improving[13]. As a new type of IA surgery, painless abortion has been widely used in clinical practice, but the psychological trauma caused by surgery still has a serious impact on patients who are prone to depression, anxiety, and other negative emotions, which is not conducive to the prognosis[14,15]. Effective nursing interventions are key to improving overall efficacy.

At present, routine nursing lacks targeted and systematic care, and the relief effect on patients’ negative emotions is not significant. The overall effect in clinical applications is not ideal. Psychological nursing intervention focuses on guiding the psychological state of patients, and alleviates negative emotions such as anxiety and depression through various intervention measures[16,17]. The aim of this study was to analyze the impact of emotional management and care on anxiety scores, coping styles, and contraceptive knowledge mastery in painless IA patients[18].

MATERIALS AND METHODS

Clinical data

Eighty-four patients who underwent painless abortion in our hospital from January 2022 to January 2023 were selected, and divided into an observation group (42 cases) and a control group (42 cases) using a random number table method.

After comparing the general information of the two groups of patients, there was no statistically significant difference (P > 0.05; Table 1). Subsequent comparisons could, therefore, be made. This study was approved by the Medical Ethics Committee of our hospital.

Table 1 Comparison of general data between two groups of patients.

Variable	Observation group, n = 42	Control group, n = 42	t/χ2	P value
Age in yr	26.35 ± 2.14	27.36 ± 2.12	5.654	< 0.001
BMI in kg/m2	54.84 ± 2.23	53.16 ± 3.68	6.943	< 0.001
Menstrual cessation time	57.24 ± 5.79	59.38 ± 6.80	6.462	< 0.001

Data are mean ± standard deviation. BMI: Body mass index.

Inclusion criteria: (1) Normal speech organization ability; (2) Without mental illness; and (3) Ability/willingness to provide informed consent regarding this study.

Exclusion criteria: (1) Inability to cooperate with the investigator of this study; (2) Important organ dysfunction; and (3) Poor compliance, etc.

Method

The control group patients underwent vaginal ultrasound, electrocardiogram, blood routine, and vaginal discharge microecology examinations, and those with normal results underwent surgery. Patients received routine care, including preoperative preparation, intraoperative care, and notification of postoperative precautions.

Based on the control group, the observation group underwent emotional management and care interventions. The specific measures were as follows: (1) Preoperative care: Most patients may experience anxiety and fear emotions before surgery, especially those who have had multiple miscarriages or scars. Nursing staff should provide thoughtful, caring, and enthusiastic care to establish trust with the patients. Nursing staff should pay attention to protecting the personal privacy of patients to alleviate their tension and establish a harmonious nurse patient relationship; (2) Intraoperative care: For patients with dentures, to prevent suffocation caused by inhalation of dentures into the trachea, it is necessary to cooperate with an anesthesiologist to monitor during the surgery, paying special attention to blood oxygen saturation and blood pressure monitoring, paying close attention to the patient’s chest undulation, lip and limb color, and relieving the patient’s intraoperative tension through physical comfort postoperative care. The patient’s reaction should be closely observed after surgery, and corresponding nursing measures should be taken to prevent the occurrence of complications. If the patient experiences adverse reactions such as unrelieved abdominal pain or vaginal bleeding after surgery, they should communicate with the doctor in a timely manner and undergo psychological counseling. Patients undergoing abortion surgery are prone to adverse psychological reactions such as excessive anxiety and fear, which can affect their mental health. Nursing staff should communicate effectively with patients in a timely manner, understand the patient’s thoughts and dynamics through conversation and listening, and provide appropriate guidance; and (3) Health education: During the nursing process, nursing staff provide health education to patients with their professional skills, inform patients of postoperative precautions, develop healthy behavior habits, and do regular follow-up work.

Observation indicators and judgment standards

(1) Anxiety Self-Assessment Scale (SAS)[8], Depression Self-Assessment Scale (SDS)[9], and Hamilton Anxiety Scale (HAMA) scores: SAS scores were used to evaluate the anxiety level of two groups of patients before and after nursing, with a total score of 100 points and a critical value of 50 points. The lower the score, the lower the anxiety level of the mother. Before and after nursing, SDS scores were used to evaluate the depressive mood of two groups of patients, with a total score of 100 points and a critical value of 53 points. The lower the score, the lower the degree of maternal depression. The total score of the scale is 100 points, and the score is positively correlated with the degree of depression. The HAMA score ranges from 0 to 64, with a score of > 29 indicating severe anxiety; 21-29, obvious anxiety; > 14, certain anxiety; > 7, possible anxiety; and < 7, no anxiety. The lower the score, the less anxious the patient; (2) Pain level: Before and after nursing, a visual analog scale (VAS) was used for evaluation[19], with a score of 0-10, where 0 indicates no pain and 10 indicates severe pain. The higher the score, the more severe the pain; (3) We compared and analyzed the relaxation rate of the uterine opening, surgical bleeding volume, and 1 h postoperative bleeding volume of two groups of patients after nursing care; (4) Mastery of contraceptive knowledge: After nursing care, patients were evaluated using a self-made questionnaire from our hospital. The score was 0-100 points, and the higher the score, the better the patient’s mastery of contraceptive knowledge; and (5) Satisfaction: We used a self-made survey questionnaire from our hospital to evaluate the satisfaction of the two groups of patients. The scale includes satisfaction, basic satisfaction, and dissatisfaction, with total satisfaction = 1 - dissatisfaction.

Statistical analysis

SPSS 22.0 statistical software was used to analyze and study the data that met the normal distribution. The counting data is expressed in n (%), the χ² test was used, and the measurement data is expressed in mean ± SD, using a t-test. P < 0.05 indicates a statistically significant difference.

RESULTS

SAS, SDS, and HAMA scores between two groups of patients

Before nursing, there was no statistically significant difference in SAS, SDS, and HAMA scores between the two groups of patients (P > 0.05), indicating comparability. Compared with before nursing, the SAS, SDS, and HAMA scores of the two groups decreased after nursing. Compared between the groups, the observation group had a lower score, and the difference was statistically significant (P < 0.05; Table 2).

Table 2 Comparison of Self-rating Anxiety Scale Self-Rating Depression Scale and Hamilton anxiety scores between two groups of patients.

Group	SAS		SDS		HAMA
	Before	After	Before	After	Before	After
Control	51.18 ± 2.81	45.63 ± 2.66a	55.57 ± 2.33	38.61 ± 2.17a	34.33 ± 3.12	13.45 ± 2.12a
Observation	51.06 ± 2.25	39.18 ± 2.18a,b	55.14 ± 2.67	30.27 ± 2.64a,b	35.33 ± 3.13	6.69 ± 2.15a,b

Data are mean ± standard deviation.

^aP < 0.05 compared with before.

^bP < 0.05 compared with the control group.

HAMA: Hamilton anxiety. SAS: Self-rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Pain levels between two groups of patients

Before nursing, there was no statistically significant difference in VAS scores between the two groups (P > 0.05). After nursing, the VAS scores of the two groups were lower than before nursing, and the scores of the observation group were lower than those of the control group, with statistical significance (P < 0.05; Table 3).

Table 3 Comparison of visual analog scale scores between two groups of patients.

Group	n	VAS		t value	P value
		Before	After
Control	42	5.79 ± 1.51	4.55 ± 0.22	32.511	< 0.001
Observation	42	5.77 ± 1.42	3.23 ± 0.41	4.638	< 0.001
t value		-0.070	-12.396
P value		0.695	0.002

Data are mean ± standard deviation. VAS: Visual Analog Scale.

Uterine relaxation rate, surgical bleeding volume, and 1 h postoperative bleeding volume

Compared with the control group, the observation group had a significantly higher rate of uterine relaxation after nursing care, and significantly lower surgical bleeding volume and postoperative bleeding volume at 1 h (P < 0.05; Table 4).

Table 4 Comparison of uterine relaxation rate, surgical bleeding volume, and postoperative bleeding volume at 1 hour between two groups of patients.

Group	n	Uterine opening relaxation rate	Surgical bleeding volume in mL	1-hour postoperative bleeding volume in mL
Control	42	36 (85.7)	42.39 ± 3.53	28.51 ± 3.34
Observation	42	25 (59.5)	31.72 ± 2.23	22.41 ± 1.23
t/χ2		7.244	-16.672	-28.644
P value		0.07	0.015	< 0.001

Data are n (%) or mean ± standard deviation.

Contraceptive knowledge mastery

There was no statistically significant difference in contraceptive knowledge mastery scores between the two groups of patients before nursing (P > 0.05), indicating comparability. After nursing, the observation group had a higher contraceptive knowledge mastery score than the control group, indicating a statistically significant difference (P < 0.05; Table 5).

Table 5 Comparison of contraceptive knowledge mastery between two groups of patients.

Group	n	Contraceptive knowledge mastery		t value	P value
		Before	After
Control	42	68.28 ± 3.23	78.98 ± 4.13	-20.799	0.040
Observation	42	69.12 ± 4.12	88.74 ± 4.56	-13.310	0.030
t value		0.981	10.153
P value		0.202	0.010

Data are mean ± standard deviation.

Nursing satisfaction

The satisfaction of the observation group after nursing was higher than that of the control group, with a statistically significant difference (P < 0.05; Table 6).

Table 6 Comparison of nursing satisfaction between two groups of patients.

Group	n	Dissatisfied	Satisfied	Very satisfied	Satisfaction rate
Control	42	8 (19.0)	22 (52.4)	12 (28.6)	34 (81.0)
Observation	42	2 (4.8)	10 (23.8)	30 (71.4)	40 (95.2)
χ2					15.814
P value					< 0.001

Data are n (%).

DISCUSSION

Artificial abortion, as an important remedial measure for contraceptive failure or unexpected pregnancy, mainly involves surgical and medication abortion[20]. Infection and incomplete abortion are common complications after artificial abortion, which can damage the patient’s physical and mental health. Some women may experience multiple unintended pregnancies due to their weak awareness of contraception, and repeated miscarriages can cause serious harm to their physical health. According to research[19,21], there are currently 40 million women worldwide who undergo IAs every year, while in China, there have been approximately 9.8 million IAs annually in the past decade, and IAs have shown a significant trend toward youthfulness. Women of the right age lack the relevant knowledge of safe sex and cannot master correct contraceptive methods. They often choose calendar-based contraceptive methods or coitus interruptus, or even take many emergency contraceptives, resulting in a high contraceptive failure rate. After artificial abortion, the patient’s awareness of related complications is also not high, and they often cannot receive proper contraceptive guidance after terminating their pregnancy[22,23]. Therefore, it is easy to have another pregnancy and increase the risk of miscarriage[24].

There are many publications on the psychological consequences of abortion in international journals, most of which focus on various indicators of mental health. Although most studies have not found evidence that IA increases the likelihood of persistent psychological disorders, some studies attribute different clinical situations to the consequences of abortion and summarize these hypotheses as “post-abortion syndrome”[25-27]. Therefore, finding appropriate ways to reduce the incidence of complications and recurrent miscarriage after IA has become a focus of clinical work. Reasonable nursing interventions can reduce the incidence of complications related to IA, help patients master correct contraceptive knowledge, and promote safe sexual behavior[28-30].

Emotional management and care, as one of the nursing priorities, can reduce the occurrence of miscarriage events by promoting contraceptive knowledge for women undergoing IA, supervising and implementing relevant contraceptive measures. The results of this study showed that, before nursing, there was no statistically significant difference in SAS, SDS, and HAMA scores between the two groups (P > 0.05). After nursing, the SAS, SDS, and HAMA scores of the two groups decreased, and the scores of the observation group were lower than those of the control group, with a statistically significant difference (P < 0.05). Emotional management and care can effectively improve the psychological state of patients after IA surgery, and, through humanized nursing interventions, patients can fully feel the care of nursing staff, thereby improving their cooperation with clinical treatment and nursing. The results of this study also showed that the nursing satisfaction and contraceptive knowledge mastery scores of the observation group were higher than those of the control group, with statistical significance (P < 0.05). The clinical application value of emotional management and care is significant. At present, there are many scientific contraceptive methods and there are many ways to obtain contraceptive related knowledge, but there is relatively little professional guidance. Women of appropriate age lack understanding of scientific and effective contraceptive methods. Therefore, nursing staff can provide professional guidance to improve awareness of contraceptive methods. In addition, we found that the observation group had a significantly higher rate of uterine relaxation, significantly lower surgical bleeding volume, and postoperative bleeding volume at 1 h (P < 0.05). The data from this study indicates that preoperative psychological interventions can significantly improve patient cooperation and nursing effectiveness. The implementation of preoperative preparation can assist patients in completing relevant preoperative preparations, including uterine relaxation, to improve the rate of uterine relaxation and enable the surgery to proceed more smoothly.

Preoperative psychological interventions for patients before surgery can significantly reduce their negative psychological emotions, enable them to trust medical staff, actively cooperate with clinical work, effectively promote the relationship between nurses and patients, and promote the harmonious development of nurse patient relationships. In the clinical nursing of patients undergoing painless abortion surgery, a preoperative psychological intervention was undertaken to explain the internal environment of the hospital to the patients after admission, and relevant medical personnel were introduced to reduce the patients’ strange feelings for the hospital, while providing a quiet and comfortable ward environment for the patient[31]. Actively communicating with patients after admission can significantly bridge the gap between nurses and patients, enabling patients to trust medical staff[32]. Strengthening preoperative health education for patients can correct their misconceptions about diseases, and enable them to understand the importance of surgical treatment and successful cases, thereby enhancing their confidence in disease treatment and actively cooperating with clinical surgical procedures. The process of communication, based on the severity of the patient’s negative psychology, should strengthen observation of the patient, enable targeted intervention measures, and improve the patient’s negative psychological emotions through family cooperation and companionship. Compared with traditional interventions, preoperative psychological intervention is more beneficial for the treatment of diseases and can significantly improve patient negative psychological emotions[14]. Assisting patients in preoperative preparation and informing them of relevant precautions, while maintaining a stable psychological state before surgery, can ensure smooth progress of the surgery, and enable patients to be aware of any abnormalities that may occur after the surgical treatment is completed in advance. This enables patients to prepare mentally in advance and promptly notify medical staff when they feel abnormal after surgery[15]. A good preoperative psychological state has an important impact on the patient’s physical and mental health. Nursing staff should actively participate in the management and counseling of patients’ emotions, which can help patients have a correct understanding of the disease, fully understand the pain and risks caused by surgery, and actively respond to potential psychological problems that may arise after surgery[14,33]. Psychological nursing intervention is based on psychological theories, providing targeted intervention measures to patients, encouraging and comforting them before surgery, and enhancing their confidence in the surgery[34]. Nursing staff should communicate with patients enthusiastically and in a friendly manner, establish trust, patiently listen, respect the patient, and regulate their psychological state through professional psychological counseling, to provide psychological support and alleviate negative emotions such as anxiety and depression. At the same time, nursing interventions must meet the psychological needs of patients in special circumstances.

This study had some limitations, including the small sample size and the fact that the single source of the sample was not representative of a larger range of patients.

CONCLUSION

During surgery, appropriate communication with patients is carried out, attention is shifted, and physical comfort is provided. Furthermore, mental support is provided to patients, reducing their excessive fear of surgery, and ensuring the smooth progress of the surgery. After surgery, attention should be paid to whether the patient has any adverse reactions, and patients should be informed of relevant postoperative precautions, effectively improving the cooperation and thereby improving nursing satisfaction.

ACKNOWLEDGEMENTS

The authors would like to thank the medical institution of Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology.