Scientific Papers

Effects of “two-heart” nursing mode on the psychological state and quality of life of stroke patients | BMC Neurology

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We selected a total of 92 stroke patients admitted to our hospital from February 2021 to July 2022 following inclusion and exclusion criteria. The patients were divided into two groups: the Traditional Group (n = 46) and the Two-Heart Group (n = 46).

Inclusion criteria were: [1] stroke diagnosis confirmed by cranial CT, cranial magnetic resonance imaging, cerebral angiography, and differential diagnosis; [2] complete and accurate clinical data, informed consent, and voluntary participation; [3] acceptance of irregular follow-up.

Exclusion criteria included: [1] inability to continue participation or withdrawal; [2] hearing or vision impairments, disability of grade 3 or above [19], or communication difficulties; [3] mental illness or inability to communicate normally; [4] severe damage to vital organs; [5] presence of other severe diseases (e.g., neoplastic diseases, cardiovascular diseases, cerebrovascular diseases, renal failure, uremia, liver failure).


Traditional group: conventional nursing care

The Traditional Group received conventional nursing care. This included maintaining a clean and ventilated ward, explaining ward rules to patients and their families, and regularly changing the patients’ bedding. The patients’ conditions were monitored, and they were advised to follow the doctor’s medication instructions. In case of adverse reactions, the medical staff was informed to intervene and adjust treatment as needed. Health education, symptomatic nursing, and rehabilitation guidance were provided to enhance physical fitness and accelerate recovery.

Two-heart group: “two-heart” nursing mode

Patients in the Two-Heart Group received the “Two-Heart” EBN nursing method in addition to routine nursing. The evidence-based nursing procedure was as follows:

Questioning proposing

  1. A.

    How to effectively improve the patient’s cognitive and limb functions after stroke.

  2. B.

    How to implement effective psychological suggestion to reduce anxiety and depression for patients with stroke.

  3. C.

    How to improve the patient’s post-stroke quality of life and nursing effect.

Evidence-based method

We retrieved relevant stroke nursing literatures by searching the Web of Science, PubMed, Wanfang database, Cochrane Evidence-based Medicine Network, and other databases for evidence from the research field. Stroke, anxiety, depression, limb and cognitive functions, quality of life, living ability etc were among the search terms. We consulted relevant data and excluded literatures including nursing methods lacking accuracy, non‐statistical treatment, and indicators without evaluation.

Evidence-based support

The same treatment protocol was implemented, which covers the following aspects.

Assist treatment

Nurses actively cooperated with doctors during treatment and rounds, recorded patient condition changes in detail, and observed recovery progress. They also educated patients and their families on potential adverse reactions, the importance of adherence to prescribed treatment plans, and the correct limb placement to prevent abnormal muscle tension according to individual patients need.

Active communication

Nurses established trust with patients and their families through effective communication using techniques such as speaking softly and showing kindness. They assessed patients’ psychological states, provided guidance, and offered support through various communication methods, including contrast, incentive, transfer, and confusion-solving techniques. Nurses also used praise to motivate patients and build their confidence in fighting the disease.

Improve environment

Nurses created a comfortable and quiet environment for patients by maintaining proper ward brightness, temperature, and humidity. They introduced patients to the surrounding environment and medical equipment, explaining their therapeutic purposes and precautions, to reduce anxiety and promote a sense of security.

Health education

Nurses provided tailored health education to patients and their families within 7 days after the patient’s hospitalization according to their needs while considering their educational levels and preferences. The education included the following subjects: First, the patients’ and their family members received instruction on the fundamentals of stroke, including risk, causes, symptoms, therapies, and managements of stroke; Second, family members were taught on how to support patients in managing stress, anxiety, depression, and other unsteady moods; Third, family members were educated on healthy diets and appropriate feeding methods in order to increase patients food appetite; and lastly the family members were taught necessary skills to help patients perform daily rehabilitation training. Nurses used various methods, such as videos, images, printed materials, and simple language, to improve patients’ understanding of their condition, treatment methods, prevention measures, nursing methods, and precautions. Nurses also patiently answered questions and corrected misconceptions.

Rehabilitation training

Rehabilitation training for patients included:

  1. (A)

    Cognitive function training: Nurses instructed patients to identify people, places, and times; guided them in number training and reasoning skills; and provided training in item classification, language, and recall abilities.

  2. (B)

    Limb function training: Nurses guided patients through a progressive exercise program, starting with simple in-bed exercises and progressing to balance training, alternating exercises, and eventually walking and stair climbing.

  3. (C)

    Training of living abilities: Nurses trained patients to perform daily activities, such as washing, bathing, using the toilet, eating, and dressing.

Discharge intervention

After discharge, patients received telephone follow-ups every month up-to one year to monitor their condition, provide guidance on diet and exercise, and assess medication compliance. Every two months, patients were evaluated for disease progression, mental state, and quality of life, and their cognitive function, physical function, and life abilities were tested.

Observation indicators

Cognitive function

The Montreal Cognitive Assessment Scale (MoCA) was used to evaluate cognitive function before and after care in eight areas: orientation, calculation, abstract thinking, visuospatial skills, language, memory, executive function, and attention and concentration. The scale consists of 11 items with a total score of 30 points. Cognitive impairment is indicated by a total score between 0 and 25 (0 ≤ total score < 26), while a normal cognitive function is indicated by a total score between 26 and 30 (26 ≤ total score ≤ 30).

Limb function

The Fugl-Meyer Motor Function Assessment Scale (FMAS) was used to evaluate patients’ limb function in both groups before and after nursing care. The scale consists of 50 assessment items, including 33 for upper limb function and 17 for lower limb function. Each item is scored as 0, 1, or 2, with a maximum score of 100 points. Limb dysfunction is categorized as severe (0 ≤ total score < 50), moderate (50 ≤ total score < 96), mild (96 ≤ total score < 100), or normal (total score = 100).

Activities of daily living (ADL)

The Modified Barthel Index (MBI) rating scale was used to evaluate patients’ ADL in both groups before and after nursing care. The scale includes 10 items (eating, bathing, grooming, dressing, bowel control, bladder control, toilet use, transfer, ambulation, and stair climbing) with a total score of 100. Levels of dependence are classified as extreme (total score < 40), moderate (41 ≤ total score < 60), mild (60 ≤ total score < 99), or none (total score = 100).

Quality of life

The Stroke-Specific Quality of Life Scale (SS-QOL) was used to evaluate the quality of life before and after care across 12 aspects: physical health, family role, language, mobility, emotion, personality, self-care, social role, thinking, upper limb function, vision, and work ability. The scale includes 49 items, each with five response options. Higher scores indicate a better patient quality of life.

Psychological state

The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate the mental state (anxiety and depression) of patients in both groups before and after nursing care. The SAS comprises 20 items with four response options, scored as 0, 1, 2, 3, and 4. The total score ranges from 0 to 80, with classifications of no anxiety (0 ≤ total score < 50), mild anxiety (50 ≤ total score < 60), moderate anxiety (60 ≤ total score < 70), and severe anxiety (total score ≥ 70). The SDS also includes 20 items with four response options, scored as 0, 1, 2, 3, and 4. The total score ranges from 0 to 80, with classifications of no depression (0 ≤ total score < 50), mild depression (50 ≤ total score < 60), moderate depression (60 ≤ total score < 70), and severe depression (total score ≥ 70).

Nursing satisfaction

The hospital-designed Nursing Satisfaction Survey was used to evaluate the satisfaction of both patient groups concerning nursing care in the following areas: service attitude, nursing knowledge, nursing skills, and nursing outcomes. The survey used a weighted average scoring system with a total score of 100 points. Satisfaction levels were classified as: satisfied (90 ≤ total score ≤ 100), somewhat satisfied (80 ≤ total score < 90), neutral (60 ≤ total score < 80), dissatisfied (0 < total score < 60), and very dissatisfied (total score = 0). Overall patient satisfaction was calculated as follows: (satisfied cases + somewhat satisfied cases)/total cases × 100%.

Statistical analysis

We used SPSS 20.0 software for statistical analysis. Counting and measurement data were expressed as percentages and mean (± standard deviation), respectively. Chi-square (x²) and t-tests were performed, with a p-value of < 0.05 considered statistically significant.

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