Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11265
Peer-review started: August 26, 2021
First decision: September 29, 2021
Revised: October 17, 2021
Accepted: November 14, 2021
Article in press: November 14, 2021
Published online: December 26, 2021
Severe craniocerebral injury (STBI) is a critical physical trauma caused by a sudden external force acting on the head. The condition is complex and changeable, and disability and mortality rates are high. Although the life of STBI patients can be saved through treatment, the sequelae of consciousness, speech, cognitive impairment, stiffness, spasm, pain and abnormal behavior in the early rehabilitation stage can be a heavy burden to a family. In the past, routine nursing was often used to treat/manage STBI; however, problems, such as improper cooperation and untimely communication, reduced therapeutic effectiveness.
To investigate the effect of a proposed care bundle to optimize the first aid process and assess its effectiveness on the early rehabilitation nursing of patients with STBI.
From January 2019 to December 2020, 126 STBI patients were admitted to the emergency department of Chongqing Emergency Medical Center. These patients were retrospectively selected as the research participants in the current study. The study participants were then divided into a control group (61 cases) and a study group (65 cases). The control group was treated with routine nursing. The study group adopted the proposed care bundle. The National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale (GCS) were used to evaluate neurological function before and after emergency treatment. After 3 mo of rehabilitation, experimental outcomes were assessed. These included the GCS, Barthel Index, complication rate, muscle strength grade and satisfaction.
There was no significant difference in gender, age, cause of injury and GCS between the two groups. After emergency, the National Institutes of Health Stroke Scale/Score of the study group (10.23 ± 3.26) was lower than that of the control group (14.79 ± 3.14). The GCS score of the study group (12.48 ± 2.38) was higher than that of the control group (9.32 ± 2.01). The arrival time of consultation in the study group was 20.56 ± 19.12, and the retention time in the emergency room was 45.12 ± 10.21, which were significantly shorter than those in the control group. After 3 mo of rehabilitation management, the GCS and Barthel Index of the study group were 14.56 ± 3.75 and 58.14 ± 12.14, respectively, which were significantly higher than those of the control group. The incidence of complications in the study group (15.38%) was significantly lower than that in the control group (32.79%). The proportion of muscle strength ≥ grade III in the study group (89.23%) was significantly higher than that in the control group (50.82%). The satisfaction of patients in the study group was significantly higher than that in the control group.
Care bundles are used to optimize the nursing process. During first-aid, care bundles can effectively improve the rescue effect and improve neurological function of STBI patients as well as shorten the treatment time. In early rehabilitation, they can effectively improve the consciousness of STBI patients, improve the activities of daily living, reduce the risk of complications, accelerate the recovery of muscle strength and improve their satisfaction.
Core Tip: Bundle of care have become a widely implemented new concept/strategy in the field of critical care. When we applied it to patients with severe craniocerebral injury in optimizing the first aid process and early rehabilitation nursing, we found that it can effectively improve the problems existing in routine nursing, reduce complications and improve the quality of life of patients. In subsequent studies, it is necessary to increase the sample size, add evaluation indicators and improve the nursing process to evaluate its effectiveness and feasibility.