Effectiveness of Risk-Stratified Evidence-Based Nursing at Different Time Points in Cirrhosis with Upper Gastrointestinal Bleeding

Summary

In this study, 103 hospitalized patients with cirrhosis complicated by upper gastrointestinal bleeding were randomly divided into a basic nursing group and an evidence-based nursing group. Based on risk stratification at different time points, we found that evidence-based nursing can effectively enhance patients' self-care capacity and quality of life, promote recovery, and improve nursing satisfaction.

Abstract

To explore the application effect of evidence-based nursing intervention under different time risk scores in patients with liver cirrhosis complicated by upper gastrointestinal bleeding (UGIB). 103 patients with cirrhosis complicated by UGIB hospitalized (June 1, 2024 to January 1, 2025) were enrolled. They were pseudo-randomly divided into a study group (n = 52) and a control group (n = 51) according to the odd–even order of enrollment (odd numbers assigned to the study group, even numbers to the control group). The control group received basic nursing care, whereas the study group received evidence-based nursing interventions guided by time-dependent risk stratification; 100 valid cases were ultimately included for analysis. The primary outcome was self-care ability, assessed using the exercise of self-care agency scale (ESCA). Secondary outcomes included quality of life, treatment efficacy, nursing satisfaction, and complication rates. Between-group comparisons were performed using t-tests and chi-square tests as appropriate. To control for Type I error due to multiple comparisons, the Bonferroni correction was applied, with statistical significance set at P < 0.01 for secondary outcomes. Following the intervention, the study group demonstrated significantly higher scores than the control group in operational skills (41.38 ± 4.62 vs. 33.06 ± 3.89, P < 0.001), health knowledge level (55.16 ± 6.49 vs. 50.38 ± 7.55, P = 0.001), and self-concept (25.38 ± 2.06 vs. 20.78 ± 1.95, P < 0.001). Additionally, the study group exhibited superior outcomes in the physical (62.68 ± 9.52 vs. 56.64 ± 8.08, P = 0.001), psychological (61.80 ± 6.87 vs. 52.80 ± 7.46, P < 0.001), and environmental (65.20 ± 7.22 vs. 59.28 ± 9.21, P < 0.001) domains of quality of life. Furthermore, the study group achieved higher treatment efficacy (84.0% vs. 64.0%, P = 0.023) and nursing satisfaction (94.0% vs. 78.0%, P=0.021) than the control group. The results showed that, based on risk stratification at different time points, evidence-based nursing can effectively enhance patients' self-care capacity and quality of life, promote recovery, and improve nursing satisfaction.

Introduction

Liver cirrhosis is a chronic hepatic disease characterized by progressive, diffuse impairment of the liver secondary to extensive hepatocyte degeneration and necrosis, accompanied by diffuse proliferation of fibrous tissue and eventual formation of regenerative nodules and pseudolobules, leading to disruption of normal liver architecture and vascular anatomy¹. Major etiologies include viral infections (e.g., hepatitis B virus and hepatitis C virus), alcohol, drugs and toxins, and autoimmune diseases; among these, viral hepatitis remains the primary cause in China, whereas alcoholic cirrhosis is more prevalent in Western countries

Protocol

The study was approved by the Ethics Committee of Beijing You'an Hospital, Capital Medical University (Approval No. LL-2023-176-K), and written informed consent was obtained from all participants or their legal guardians.

Nursing staff

All nursing staff involved in the study received unified standardized training (8 h of theoretical learning + 4 h of clinical simulation) on time-phased risk stratification and evidence-based nursing protocols before the study, and passed the assessment (operation accuracy ≥ 95%) to ensure consistent implementation of interventions. A dedicated nursing qual....

Results

Baseline characteristics

During the intervention, 2 participants in the study group and 1 in the control group withdrew due to personal reasons. Consequently, 50 valid cases were analyzed in each group. The results showed that the study group comprised 21 women and 29 men, with a mean age of 45.56 ± 7.04 years; the control group included 23 women and 27 men, with a mean age of 45.24 ± 6.91 years. No statistically significant differences were observed between the two groups in .......

Discussion

Cirrhosis represents a chronic progressive diffuse liver disease, primarily characterized by diffuse hepatic parenchymal destruction with concomitant formation of pseudolobules and regenerative nodules. During its natural course, the disease may lead to severe complications, including hepatocellular carcinoma, hepatic encephalopathy, and GIB, with UGIB being particularly prevalent²³. Cirrhosis-associated UGIB is recognized as a critical complication due to its high recurrence rate and substantial .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
IBM SPSS Statistics	IBM Corp., Armonk, NY, USA	Version 26	Used for statistical analysis