Impact of Multi-point Nursing Strategies Under a Clinical Problem-Solving Framework on Adverse Events Associated With Thyroid Nodule Resection

Brief Report

In general, thyroid nodules are commonly diagnosed among women in clinical practices. According to the literature (Wong et al., 2018), the condition is manifested by autoimmunity, thyroid degeneration, thyroid inflammation and other thyroid diseases including benign nodules that contribute more than 95% of all the thyroid nodules. Predominantly, benign thyroid nodules are treated through nodule resection. Due to the advancements made in clinical therapies and treatment procedures along with the ever-increasing demand for medical services, there is a growing concern among the patients with thyroid nodules who prefer not only to get rid of the lesion in an effective manner, but also get treated with minimal trauma (Almquist & Muth, 2019; Yue et al., 2020).

The thyroid gland has a complex anatomical structure and is located in a delicate position, surrounded by vagus nerve, trachea and esophagus. Since the glad is supplied with peripheral blood through rich network of nerves, the post-operative recovery process is generally complex for the patients who underwent surgery (Staubitz et al., 2020; Shankar et al., 2012). In this background, it becomes inevitable for the patients to be rendered with highly supportive and appropriate nursing measures during the peri-operative period. This way, it is possible to mitigate the damage made to the organ and reduce the post-operative complications brought by the surgery to patients so that they can quickly recover.

A novel nursing model has been developed as a clinical problem-solving framework that includes a multi-point nursing strategy and concentrates on the evaluation and management of clinical problems. This model entirely focuses on the nursing care (Sheremet et al., 2018; Pan et al., 2021) provided to the patients and is segregated into three periods such as pre-operative, intraoperative and post-operative, during when the patient is provided with care; This type of segregation has multiple cognitive, psychological and physical aspects intertwined with the quick recovery of the patients. Pre-operative non-fasting as well as psychological counselling prepare the patients mentally for the surgery so that they can develop a positive mind set and get rid of negative emotions like depression, tension etc., (Kim et al., 2018). Intraoperative insulation tends to mitigate the factors that hinder the post-operative recovery of the patients and help them to achieve an optimal post-operative recovery. The post-operative complications can be reduced with the help of active care and pain management activities along with dietary guidance during the post-operative period (wang et al., 2020, Wu & Zou, 2020].

In this background, it has been established that high-quality and efficient nursing care should be provided to those patients who are undergoing thyroid nodule resection. The patients’ trauma, as a result of undergoing surgical procedure, can be reduced in this manner. Further, the post-operative adverse events can also be reduced in the patient. On the other hand, the overall nursing satisfaction can be enhanced. The current report briefs about the application of a parallel control method to assess the effectiveness of multi-point nursing strategies in thyroid nodule resection, using a clinical problem-solving framework. This is done in order to find its impact on patient outcomes.

Methods

This present study was approved and designed by ethical review board of Taizhou People ‘s Hospital Affiliated to Nanjing Medical University, Nanjing, China. The patients were asked for their consent to participate in the study. Patients who underwent thyroid nodule resection in our hospital from January 2020 to January 2021 were selected and divided into observation and control groups of 49 patients each using the random number table method.

Patients who met the diagnostic criteria of having benign thyroid nodules that was confirmed by imaging and who were scheduled for thyroid nodule resection were included in this study [2]. Those with cervical lymph node enlargement, combined with malignant tumor; immune system diseases; or coagulation dysfunction; or with organic diseases of the heart, liver, kidney and other important organs were excluded. In the control group, routine care was provided, mainly consisting of preoperative auxiliary examination; intraoperative drainage tube placement and fluid replenishment; postoperative dietary care, analgesia, and drainage tube removal. The observation group was given a multi-point nursing strategy under a clinical problem-solving framework.

Detailed nursing goals were formulated and care was implemented for the observation group according to the specific problems that existed in the patient. Before surgery, patients were given health knowledge, informed of the necessity of the surgery performed and the expected results achieved; nurses communicated fully with patients, answered their relevant questions in a timely manner, encouraged patients to face the disease with an optimistic and positive attitude, and reduced their negative emotions such as anxiety, tension and depression. Relevant education videos were played for patients before surgery.

No preoperative fasting was required for all patients, and 400 mL of Maltodextrin Fructose Solution were given orally at 22:00 the night before surgery; 200 mL of Maltodextrin Fructose Solution were given orally 2 h before surgery. During the operation, short-acting anesthetic drugs were used to carry out anesthesia, and the amount of rehydration fluid was less than 1000 mL, and attention was paid to keeping warm. A small amount of water was given to patients 3 h after surgery, and if there was no choking and coughing and any other complication, then a liquid diet was given. Patients were asked to perform neck activities such as head down, head up and neck rotation 24 h after surgery to prevent adhesions and sclerosis of the chest wall and neck. The patients were discharged only after the vital signs were stable, the wounds were free of fluid, and the drains were removed. A telephonic follow-up was performed within 2 days after discharge, and outpatient follow-up was performed in 7–10 days.

The length of stay, hospital costs, the psychological status of patients before and after care using the Self-Assessment Scale for Anxiety (SAS) and the Self-Rating Scale for Depression (SDS) [3], with scores ranging from 0 to 100 for each scale, with higher scores indicating a worse psychological status (Yue et al., 2020). The occurrence of complications, including swallowing discomfort, anterior neck area pain, neck tightness, neck numbness, incisional adhesions, and subcutaneous nodules, adverse events, including falls, doctor-patient quarrels and mis aspiration, was observed and recorded in both groups, and the incidence was calculated. All statistical calculations were performed using SPSS Statistics version 22.0 (SPSS Inc., Chicago, IL, USA). Quantitative variables are presented as the mean ± standard deviation (SD). Significant variations between variables were assessed using Student’s t-test for comparison between two groups, and paired t-test was used for intra-group comparison. A probability values (p values) ≤0.05 were considered statistically significant.

Results

There were 20 males and 29 females in the observation group, with an age range of 32–78 years and a mean age of (46.52 ± 3.97) years. The disease duration ranged from 5 months to 2 years, with a mean duration of (1.46 ± 0.42) years. Lesion sites included 23 cases of left thyroid, 26 cases of left thyroid. The type of surgery performed in the study included partial thyroidectomy in 20 cases, subtotal thyroidectomy in 16 cases, and total thyroidectomy in 13 cases.

In the c ontrol group, there were 21 males and 28 females. The age range was 31–76 years, with a mean age of (46.97 ± 3.28) years. The duration of the disease ranged from 5 months to 2 years, with a mean duration of (1.51 ± 0.38) years. Lesion sites included 24 cases of left thyroid, 25 cases of left thyroid. The type of surgery counts partial thyroidectomy in 22 cases, subtotal thyroidectomy in 15 cases, and total thyroidectomy in 12 cases.

The differences in gender, disease duration and nature of lesion sites in both groups were not statistically significant (p > .05). The length of stay and hospitalization cost of the observation group were longer than those of the control group, and the differences were statistically significant (p < .001) (Table 1). Before nursing care, there was no significant difference in SAS and SDS scores between the two groups (p > .05); after nursing care, both scores decreased in both groups, and the difference were statistically significant (p < .05) in the observation group compared with the control group (Table 1).

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Table 1.

Comparison of Various Study Factors Between the Two Groups (Mean ± SD)

Group	n	Hospital Stay (Days)	Hospitalization Cost (Yuan)	SAS		SDS
				Pre-Nursing	Post-Nursing	Pre-Nursing	Post-Nursing
Observation group	49	4.12±0.36	12353.86±326.43	55.39±5.47	41.28±3.49*	53.49±5.55	33.28±3.12*
Control group	49	4.98±0.38	16539.42±325.30	54.98±5.20	47.53±3.40*	53.42±5.28	46.59±4.19*
t	—	11.501	63.577	0.380	8.979	0.064	17.835
P	—	0.000	0.000	0.705	0.000	0.949	0.000

Group	n	Nursing attitude	Knowledge promotion	Psychological support	Operating proficiency
Observation group	49	91.36±6.36	94.37±5.49	92.38±5.09	90.58±5.44
Control group	49	83.28±5.98	81.26±5.41	83.27±5.10	81.23±5.43
χ 2	—	6.479	12.006	8.850	8.515
P	—	0.000	0.000	0.000	0.000

All nursing satisfaction scores in the observation group were higher than those in the control group, and the differences were statistically significant (p < .05) (Table 1). The incidence of complications in the observation group (8.16%) was lower than that in the control group (22.45%), and the difference was statistically significant (p < .05) (Table 1). The incidence of adverse events in the observation group (2.04%) was significantly lower than that in the control group (14.29%) (p < .05) (Table 1).

Discussion

The current study outcomes confirmed that those experimental group patients, who received multi-point care strategy that was drawn on the basis of problem-solving clinical framework, incurred low costs at the hospital, short stay time at the hospital, high nursing satisfaction scores, better post-operative psychological status and low complications and adverse events. This outcome was compared with that of the patients who received the traditional care process. The study results infer that the multi-point care strategy is effective in all aspects.

The current study implications are briefed herewith. In general, the nursing practice should have a multi-pronged approach nurturing problem-solving and deductive reasoning skills among the nurses who provide care to the patients. In the studies conducted earlier, various complexities have been discussed and the attempts made to uncover such thinking processes. As per the findings, the problem-solving approaches have been handled from the perspectives of cognitive approach (Pan et al., 2021). But no single research approach has been developed or identified so far to address a common problem-solving model that works across the tasks or disciplines (Taylor, 2000). In spite of the fact that the patients included in this study had different backgrounds, compared to that of the earlier studies, the results found a low level of incidence in terms of complications and adverse events among the observation group than the control group. This finding aligns with that of the previous studies’ outcomes i.e., when the risk factors and adverse events are identified at the earliest, it helps the nurses to provide quality care to the patients throughout their clinical-therapeutic pathway. This in turn increases the treatment outcomes and mitigates the reduction/discontinuation of the treatment (De Leo et al., 2021).

Conclusion

The multi-point care strategy drawing on a problem-solving clinical framework demonstrated excellent results. It helped to shorten the length of stay, reduce the cost of hospitalization, improve their psychological status, improve nursing satisfaction, and reduce the occurrence of complications and adverse events in patients undergoing thyroid nodule resection demonstrating its worth in clinical application and promotion.