Effects of high-quality neurosurgical nursing care on improving clinical nursing quality

Abstract

BACKGROUND

With continuous advancements in medical technology, neurosurgical nursing is constantly developing and improving to provide higher-quality nursing services.

AIM

To explore the effects of different types of high-quality nursing care on clinical nursing quality and patient satisfaction in neurosurgical nursing.

METHODS

Eighty patients who received neurosurgical treatment in the Affiliated Hospital of Southwest Medical University from June to December 2020 were selected as study participants and categorised into study and control groups. The study group comprised 40 patients who received 4 different types of high-quality nursing care, whereas the control group comprised 40 patients who received conventional nursing care. After a specific period, nursing satisfaction levels and adverse event and complication rates were compared between the two groups.

RESULTS

Satisfaction with high-quality care was higher than that with conventional care, and high-quality health services and regional services showed the highest satisfaction levels, with an average score of 12 on the Glasgow scale. The satisfaction levels of the study and control groups were 75% and 57%, respectively, with a statistically significant difference (t = 7.314, P < 0.05). During the nursing period, the adverse event and complication rates were the highest in patients with level III pathology grade and those who underwent neurosurgery (40.02% and 85.93%, respectively), and the difference was statistically significant.

CONCLUSION

In neurosurgical nursing, employing appropriate high-quality nursing methods can effectively reduce adverse event and complication rates in patients, thereby improving the quality of nursing care and increasing clinical nursing value.

Key Words: High-quality nursing; Neurosurgery; Quality care; Adverse event; Complication

Core Tip: This study aims to explore the impact of different nursing qualities on nursing quality and patient satisfaction in neurosurgical nursing. Eighty patients were divided into a study group and a control group, respectively. Based on research data, we compared the nursing satisfaction, adverse behavior, and incidence of complications between two groups of patients using the discrete variable method and binary logistic regression model. Our results showed that satisfaction with high-quality nursing was significantly higher than satisfaction with traditional nursing. Therefore, through high-quality nursing methods, the occurrence of adverse events and complications can be effectively reduced, thereby improving the quality of neurosurgical nursing work.

INTRODUCTION

Neurosurgical nursing is a highly specialised and sensitive field of nursing, and the quality of care for patients who underwent neurosurgery directly affects their treatment outcomes and quality of life. With continuous advancements in medical technology, neurosurgical nursing is constantly developing and improving to provide high-quality nursing services[1-3]. Several scholars and research institutions have put forward their opinions on appropriate nursing methods during neurosurgery. Domestic neurosurgical nursing technology is constantly advancing, allowing the medical staff to learn a series of skills such as neurological assessment, pain management and neurological monitoring[4-6]. Simultaneously, nursing concepts are gradually changing by becoming more humanised and diversified. Some hospitals have developed nursing monitoring systems, which are more convenient for evaluating and monitoring the evolution of patients’ conditions and nursing processes[7-9].

In some developed countries, neurosurgical nursing is a separate nursing profession, making the professional level and awareness of nursing staff more refined and specialised[10-13]. Some hospitals have independently established applications of nursing technology, such as electroencephalogram monitoring and automatic patient positioning[14,15]. The introduction of these technologies further enhances the safety and comfort of nursing. Although many domestic and international studies have achieved desirable results, systematic and in-depth research on the improvement of clinical nursing quality by implementing high-quality nursing care in neurosurgery is lacking[16]. Thus, this study may provide valuable information to further understand the impact of implementing high-quality nursing care in neurosurgery on clinical nursing quality and supplement existing research gaps.

MATERIALS AND METHODS

General information

After obtaining approval from the Affiliated Hospital of Southwest Medical University’s ethics committee, 80 patients who received neurosurgical treatment from June to December 2020 were selected as study participants for retrospective analysis. Based on the study type, the patients were categorised into control and study groups, with 40 patients in each group. The inclusion criteria for the control group were as follows: mean age of 56.182 ± 5.174 years; male -to -female ratio of 22:18 and main disease types including traumatic brain injury, cerebrovascular disease and brain tumours. The inclusion criteria for the study group were as follows: mean age of 56.744 ± 4.956 years; male -to -female ratio of 23:17 and main disease types including traumatic brain injury, cerebrovascular disease and brain tumours. Written informed consent was obtained from all participants on an equal and voluntary basis, and no other neurological diseases were detected during the examination. Comparing various data between the two groups yielded no statistically significant difference (P > 0.05), indicating that a comparative experiment can be conducted. Basic information regarding the study participants is shown in Table 1.

Table 1 Comparison table of basic data of research subjects, n (%).

	Study group (n = 40)	Control group (n = 40)	χ2/t	P value
Age (year)	56.182 ± 5.174	56.744 ± 4.956	0.496	0.621
Sex (number of people)			0.051	0.822
Male	23 (57.5)	22 (55.0)
Female	17 (42.5)	18 (45.0)
Pathological examination (number of people)			0.212	0.976
Craniocerebral trauma	13 (32.5)	12 (30.0)
Cerebrovascular disease	10 (25.0)	11 (27.5)
Brain tumor	11 (27.5)	10 (25.0)
Others	6 (15.0)	7 (17.5)
Pathological grading (number of people)			0.347	0.841
Level I	6 (15.0)	8 (20.0)
Level II	16 (40)	15 (37.5)
Level III	18 (45.0)	17 (42.5)
Surgical method (number of people)			0.120	0.942
Emergency neurosurgical surgery	13 (32.5)	12 (30.0)
Vascular neurosurgery	10 (25.0)	11 (27.5)
Tumor neurosurgery surgery	11 (27.5)	10 (25.0)
Average duration of illness (year)	3.212 ± 0.028	3.214 ± 0.016	0.392	0.696
Hospitalization days (day)	120.212 ± 0.321	120.221 ± 0.241	0.142	0.888
Follow up time (month)	8.654 ± 0.352	8.587 ± 0.314	0.898	0.372
Adjuvant therapy (number of people)	20 (50.0)	18 (45.0)	0.201	0.654

Research methods

The control group received conventional nursing care, including acute phase vital sign and consciousness testing, prevention and treatment of complications and standardised drug use. In addition, after admission, the nursing staff helped record patient information, including body temperature, blood pressure, breathing and mental state; guided patients to exercise and rest appropriately; regularly provided health knowledge and psychological care to patients and reported the condition to the physician at any time. In contrast, the study group received high-quality neurosurgical nursing care, which included four common types of high-quality care. The first type was high-quality nursing services. Patients who underwent neurosurgery have higher neural sensitivity than those in other departments, requiring high-quality nursing care services, including increased awareness and operational levels of the nursing staff. The second type was high-quality health education services, which provide appropriate health education for different patients to improve their compliance and satisfaction with nursing care. The third type was high-quality regional services, which are mainly manifested by the nursing staff who are monitoring each area in a timely manner to prevent pressure ulcers, falls and bed falls. The fourth type was high-quality psychological services, which aim to manage varying extents of psychological burden of patients who underwent neurosurgery; thus, comprehensive psychological care should be provided. All patients were interviewed and investigated from June to mid-December 2020, and monthly statistical data were collected to understand the performance and effectiveness of patients using a 3-month nursing model.

Observation indicators

Using the adverse event and complication rates as reference indicators, the performance of the two groups over 3 months was statistically analysed. The Glasgow scoring system was used to determine the satisfaction level of patients in both groups. The satisfaction score ranges from 3 to 15, and the higher the score, the higher the satisfaction. The abovementioned four high-quality nursing methods were employed in this experiment.

Statistical methods

This study used Statistical Package for Social Sciences 22.0 software to archive and statistically analyse the valid data entered, and the counting data were represented as percentages. Differences between the two groups were compared using tests and P value. P values of < 0.05 were considered to indicate statistical significance. Based on one-way analysis of variance of the basic information of study participants, further analysis of the incidences of bed falls, falls, medication errors, postoperative infections, gastrointestinal bleeding and central high fever was conducted. Patient satisfaction and the impact of different high-quality services were analysed using the discrete variable method and binary logistic regression model.

RESULTS

Comparison of adverse event and complication rates between the two groups during nursing care

As shown in Table 2, the adverse event and complication rates during nursing care were 5.00% and 5.00% in the study group and 20.0% and 27.5% in the control group, respectively. Therefore, the study group had significantly lower rates than the control group (P < 0.05).

Table 2 Comparison of incidence of adverse events and incidence rate of complications, n (%).

	Study group (n = 40)	Control group (n = 40)	χ2	P value
Adverse event occurrence rate	2 (5.00)	8 (20.0)	4.114	0.043
Falling bed	0 (0.00)	3 (7.50)
Fall	2 (5.00)	5 (12.5)
Medication errors	0 (0.00)	0 (0.00)
Incidence rate of complications	2 (5.00)	9 (27.50)	4.877	0.027
Postoperative infection	1 (2.50)	3 (7.50)
Gastrointestinal bleeding	1 (2.50)	1 (2.50)
Central hyperthermia	0 (0.00)	5 (12.50)

Regression analysis of adverse event and complication rates under various factors

This study analysed the factor variables in basic patient information through the discrete variable method and binary logistic regression model. As shown in Table 3, the factors influencing adverse event rates in patients were mainly related to level III pathological grading, emergency neurosurgical surgery, conventional nursing and adjuvant therapy. In contrast, the factors influencing complication rates were mainly associated with level III pathological grading, vascular neurosurgery and conventional nursing.

Table 3 Analysis results of discrete variable method and binary logistic regression model.

Factor variables		Adverse event occurrence rate		Incidence rate of complications
		χ2	P value	χ2	P value
Age	Study group	2.347	0.128	2.357	0.124
	Control group	2.312	0.115	2.416	0.123
Sex	Study group	1.879	0.086	1.991	0.115
	Control group	1.892	0.088	2.046	0.114
Pathological examination	Craniocerebral trauma	3.816	0.567	5.552	0.689
	Cerebrovascular disease	4.881	0.621	8.887	0.992
	Brain tumor	6.287	0.847	6.884	0.846
Pathological grading	Level I	4.352	0.568	5.884	0.703
	Level II	3.221	0.504	3.846	0.576
	Level III	4.968	0.322	1.032	0.052
Surgical method	Emergency neurosurgical surgery	12.117	0.031	15.874	0.868
	Vascular neurosurgery	5.869	0.698	4.992	0.017
	Tumor neurosurgery surgery	17.425	0.039	13.448	0.984
Nursing methods	Routine care	9.554	0.037	8.772	0.021
	High quality nursing services	7.687	0.787	8.996	0.986
	High quality health education	6.886	0.846	7.369	0.916
	High quality regional services	11.125	0.884	16.845	0.789
	High quality psychological services	8.467	0.656	6.997	0.693
Adjuvant therapy	Yes	2.312	0.042	3.568	0.521
	No	7.221	0.579	6.741	0.075

The curve of adverse event and complication rates with different factor variables

Combined with the study results of 2.2 on the factors influencing the adverse event and complication rates, this study selected the most important pathological levels and surgical types for high-quality and conventional nursing and analysed the results, as presented in Figure 1. The results revealed that with prolonged time, the adverse event and complication rates in patients who underwent tumour neurosurgery were the highest, reaching 85.93% and 70.23%, respectively. Simultaneously, the adverse event and complication rates in patients with level III pathology were also the highest. Overall, compared with conventional care, high-quality care showed lower values of characterisation data in all aspects over time.

Figure 1 Curve of incidence of adverse events and incidence rate of complications with different factor variables. A: The incidence rate curve of adverse events from June to December using conventional nursing mode under different case grades and surgical methods; B: The incidence rate curve of adverse events from June to December using high-quality nursing mode under different case grades and surgical methods; C: The curve of incidence rate of complications from June to December in the conventional nursing mode under different case classifications and surgical methods; D: The curve of incidence rate of complications from June to December in the high-quality nursing mode under different case classifications and surgical methods.

Subsequently, adverse event and complication rates of patients who underwent tumour neurosurgery and those with level III pathology under conventional and high-quality care, respectively, were determined, and the results are shown in Figure 2. Using these data, the minimum probability of two types of events occurring in patients under high-quality nursing care was approximately 10%, and the maximum probability of two types of events occurring in patients under conventional nursing care was approximately 50%.

Figure 2 Testing results of different nursing modes in patients undergoing tumor surgery and level III pathological patients. A: The incidence of adverse events in 5 nursing modes for patients undergoing tumor surgery; B: The incidence of adverse events in 5 nursing modes for patients with grade III pathology; C: Incidence rate of complications under five nursing modes for patients undergoing tumor surgery; D: Incidence rate of complications in 5 nursing modes for patients with grade III pathology.

Comparison of satisfaction levels between conventional care and four different types of high-quality care using the Glasgow scoring system

This study compared the satisfaction level of conventional care with that of four different types of high-quality care and employed the Glasgow scoring system for determining satisfaction levels. The results are shown in Figure 3. Based on these data, among the five types of nursing care, the three scoring values of conventional nursing were relatively low, with scores of 8, 8 and 10, respectively. However, regarding exercise response, the scores of conventional nursing care were slightly higher than those of high-quality psychological services. The rankings of the three test scores were equivalent to the scores of high-quality health services and high-quality regional services, respectively. We found that the scores of high-quality nursing services were higher than those of high-quality psychological services, and the scores of high-quality psychological services were higher than those of regular services. Satisfaction with high-quality care was generally higher than that with conventional care, and high-quality health services and high-quality regional services showed the highest satisfaction levels, with an average score of 12 on the Glasgow scale. The satisfaction levels of the study and control groups were 75% and 57%, respectively, with statistically significant differences (t = 7.314, P < 0.05). This score can explain the main needs of patients who underwent neurosurgery and optimise psychological services based on health services.

Figure 3 Glasgow rating results for different nursing methods.

DISCUSSION

With improved quality of life, people’s demand for nursing services is increasing. High -quality nursing is widely used in the field of clinical nursing owing to its unique advantages and service quality[17]. Patients who underwent neurosurgery are generally characterised by severe illness, sudden onset of illness and slow recovery[18]. Nursing care provided by the nursing staff objectively faces certain safety risks and has high requirements for the quality of nursing work. In this environment, implementing high-quality nursing care in neurosurgical nursing can effectively improve the service awareness of the nursing staff, stimulate their work enthusiasm and minimise the rate of adverse events through standardised nursing measures and responsibility management. In this study, the study group received comprehensive high-quality nursing care. The nursing staff analysed the current problems in nursing work from the perspectives of nursing technology and ward management and formulated corresponding nursing goals, effectively improving the quality of nursing work.

The current study results revealed that the incidence of various adverse events, such as bed falls, falls and medication errors, in patients using high-quality nursing services was 5%, whereas the incidence of various complications, such as postoperative infection, gastrointestinal bleeding and central high fever, was 5%. The difference between the two types of events was statistically significant. Ersek et al[19] investigated the implementation of high-quality services in 36 hospitals and reported that patient satisfaction with high-quality services was higher than that with conventional services. Compared with pathological examination and adjuvant treatment, surgical treatment and pathological grading are the main factors affecting the adverse event and complication rates. Surgical treatment is the best choice for clinical physicians to address neurosurgical diseases, such as cerebrovascular disease and brain tumours[20]. The pathological grading from level I to level III represents the severity of the patient’s condition from mild to severe[21]. The results of the regression model analysis showed that the dominant factors for adverse event rates in patients were level III pathological grading and emergency neurosurgery. In contrast, the dominant factors for complication rates were level III pathological grading and vascular neurosurgery. Relevant clinical research reports have indicated the crucial role of surgical and pathological conditions in patient recovery[22-24]. Luo et al[25] conducted an interview with 56 rehabilitation patients from Harbin Medical University Affiliated Hospital to explore the rehabilitation effects of high-quality nursing. Patients with level III pathology, such as those with chronic kidney failure, had significantly lower rehabilitation status than those with general level I pathology, and their mood was more complex and depressed. Based on the influence curve of different pathological grades and surgical types on adverse event and complication rates, it was determined that the adverse event rate in patients with level III pathological grades was the highest. Under the conventional nursing mode, the highest probability of adverse events for patients who underwent tumour surgery was 85.93%, and the highest complication rate was 70.23%. Under the high-quality nursing mode, the highest adverse event and complication rates for patients who underwent tumour surgery were 50.36% and 63.27%, respectively. Based on the two types of nursing modes, the rates of adverse events occurring in high-quality nursing were generally lower than those occurring in conventional nursing. In neurosurgical nursing services, implementing high-quality nursing can stimulate work enthusiasm and service awareness of the nursing staff and exert a positive effect on patients for rehabilitation, minimising unnecessary problems to the greatest extent[26-28].

Under high-quality care, the minimum and maximum probabilities of the two types of events occurring in patients under high-quality health and conventional care services were approximately 10% and 50%, respectively. Certain differences in high-quality nursing models should be considered. The most appropriate health education should be provided for different types of patient, and assistance should be provided to patients at different stages to further understand their inner needs. This can establish a trust bridge between patients and the nursing staff and improve satisfaction. Among the five nursing modes, based on the Glasgow scoring system, the highest ratings were reported for high-quality health services and high-quality regional services, whereas the lowest rating was reported for conventional care. This result is consistent with the finding of Ryu et al[29], who revealed that the average Glasgow score for high-quality healthcare was 12.

CONCLUSION

Implementation of high-quality nursing in neurosurgical nursing can effectively reduce the adverse event and complication rates. Patients with level III pathological grading and those who underwent tumour surgery showed the highest rate of adverse events, indicating that the severity of the condition can directly affect the effectiveness of follow-up nursing in patients. High -quality healthcare services and nursing services can maximise patient satisfaction levels.