1. Introduction

Peptic ulcers are chronic ulcers that occur in the stomach and the duodenal bulb. The precondition for the development of these ulcers is the action of gastric acid and pepsin secretions.[1,2] Gastric ulcers are most common in the middle-aged and elderly people. Duodenal ulcers very common. They are accompanied by weight loss, stomach pain and discomfort, poor appetite, and other clinical symptoms.[3] In recent years, the incidence of peptic ulcers has significantly increased. The disease often presents with a long course, and recurrent onset. It is often associated with other complications. It is sometimes difficult to treat this disease, and ensure a good prognosis, which will directly improve the mental and physical health of the patients.[4] Standardized perioperative nursing management is a new holistic nursing model that implements the concept of “people-oriented” in the whole nursing period. It aims to provide patients with high quality nursing services incorporating spiritual, psychological, and emotional elements.[5,6] Therefore, it is of great significance to develop a personalized nursing intervention based on a continuous model that would help fulfill the psychological needs of patients with peptic ulcer disease, and improve psychological stress and quality of life of these patients. It is difficult to obtain a good curative effect with drug therapy, which is used most commonly to treat peptic ulcer disease. In this study, we investigated whether surgical management of peptic ulcer disease and perioperative coordination with standardized nursing management can eliminate clinical unsafe factors and promote patient recovery. As an intervention, standardized perioperative nursing management can improve the quality of nursing management and ensure the effect of intervention.[7]

During the perioperative period, the nurse welcomes the patient into the surgical ward and ensures their care until they are discharged following recovery.[8,9] This period is also referred to as the whole operation period as it includes the time period before, during and after the operation. During this period the nurses can play a key role in the early stage of the surgery, in the operating room in the middle stage of surgery and in the early and late stages in the intensive care unit (ICU). The specific protocols are as follows: First, during the early stage of the surgery, psychological nursing should be done to help the patient overcome fear and anxiety related to the surgery. In addition, cardiopulmonary function should be improved. Attention should be paid during the surgery to prevent the patient from getting cold. Intermittent oxygen inhalation can increase oxygen supply to the lung tissue, improve pulmonary hypertension, reduce pulmonary vascular resistance, and improve the long-term effect of surgery. High caloric diet, which is rich in proteins, and vitamins and low in salt is beneficial for the patients. Second, nursing staff can play an important role during the early recovery period in the ICU, and when the patient is transferred to the ward once stable. In addition to nursing staff care, family members can also help monitor the heartbeat, respiratory rate, blood pressure, and even urine volume. They can also surveil analgesia, pipeline care, and appropriate nutrition management. Third, after discharge, it is necessary for the patients to perform restorative exercise. This will help ensure that there are no postoperative sequelae. In this study, 90 patients with peptic ulcer were selected. The standardized perioperative nursing management was applied to clinical practice, and the effect of nursing management was analyzed in depth.

2. Materials and methods 2.1. General information

A total of 90 patients diagnosed with peptic ulcer disease were admitted to the Wuhan Wuchang Hospital between July 2020 to July 2022 were retrospectively analyzed. These patients were included in the present study. They were divided into the observation group (n = 45) and the control group (n = 45) according to the nursing management that they received. This study followed the principles of the Helsinki Declaration. The study protocols were approved by the Medical Research Ethics Committee of Wuhan Wuchang Hospital.

Inclusion criteria: all patients met the diagnostic criteria of peptic ulcer disease including gastroscopy findings;[10] all patients voluntarily participated in the study and provided written consent; patients with rhythmic and periodic abdominal pain.

Exclusion criteria: patients with serious cardiac, hepatic, renal or other organ disease; patients with a history of gastrointestinal surgery; patients in critical condition, with major complications such as pyloric obstruction and massive gastrointestinal bleeding; patients with language and cognitive impairment; pregnant or lactating women.

2.2. Methods

The control group received routine nursing care, diet and medication guidance. They also received body mass index-based intervention and health education. They were monitored for bowel movements, vomiting, and abdominal pain, etc. Patients were advised to eat less food and take regular meals as part of diet management, and in order to improve recovery and prevent complications. The observation group received standardized perioperative nursing management, the components of which are as follows:

1.2.2. Standard management system.

This was led by the digestive department head nurse, who also had the responsibility to establish the nursing quality control group. All the nurses discussed the included patients’ care plans. To minimize the possibility of perioperative adverse events and existing nursing defects, the nurses paid attention to summarizing and recording details, based on the system of standards. This also included printing the nursing quality evaluation scale, and ensuring the effective implementation of all nursing plans. In addition, the quality control team also led all the nursing staff in holding meetings to discuss the patient summaries, analyze short term nursing problems, come up with timely solutions, and consider whether the nursing management model needed to be effectively adjusted.

2.2.2. Standardized nursing work at the initial admission.

At the beginning of the patients’ admission, the nursing staff explained the available medical resources, and the role of the nursing staff in peptic ulcer disease management. They encouraged the patients to watch instructional videos on the disease that demonstrated the etiology of the peptic ulcer disease as well as its progression. They explained the risks associated with peptic ulcers and the prognostic effect of the available standardized nursing care. They patiently answered to improve self-protection awareness and disease management ability. Later, the printed peptic ulcer health education guide was also presented to the patients. This included information on the pathogenesis of peptic ulcer disease, specific nursing processes and matters related to the perioperative period that required attention. The purpose was to facilitate nurse-patient communication. Patients were required to fill in the personal assessment scale that was prepared in advance. The nursing staff was responsible for assessing the patient’s past medical history, health status, psychological state and communication type according to the filled out responses. This was used to formulate targeted nursing policy.

3.2.2. Standardized preoperative and intraoperative nursing care.

Patients are likely to experience tension and anxiety 24 hours before the surgery. During this period, the nursing staff encouraged and comforted the patients, and explained the risks and procedures of the surgical treatment to the patients. Patients signed informed consent forms. On the day of the surgery, the patient’s hand was punctured and the effect of the puncture was explained to the patient. Before the operation was started, each level was formally implemented. The patient’s identity and their disease were checked and recorded. Materials required during the surgery were made available. All information was comprehensive checked and recorded. During the procedure, full records including any changes in the patient, and operation process were maintained. The indications for in vitro non traumatic foreign body removal of polyps using snare methods were carefully identified. After the polyp removal, the family members of the patient were appraised regarding the situation. They were informed of the critical role of follow-up care in ensuring improvement in the patient’s condition.

4.2.2. Standardized nursing care after the surgery.

All indicators, including the vital signs of the patients were closely monitored by the shift nurses 24 to 8 hours after the surgery. Patients were forbidden to drink or eat. If patients did not have subcutaneous emphysema, hematemesis or melena, liquid food could be gradually initiated. If there was a decline in patient’s condition during the observation period, a gastric tube could be inserted to effectively relieve the gastrointestinal pressure. In that situation, the patients were advised to not eat or drink gor a longer time period. Moreover, the nursing quality evaluation form was issued to the patients during the process of hospitalization. Patients could evaluate their satisfaction with the nursing service, hospitalization and condition recovery on the form. The nursing quality control group could develop the gradual standardization of the management system based on these scores.

2.3. Observations 1.2.3. Evaluation of clinical symptom improvement rate and recurrence rate.

All patients were followed up for 3 months. Improvement and recurrence of clinical symptoms, including loss of appetite, abdominal distension and abdominal pain, were observed and recorded in the 2 groups. The improvement rate and recurrence rate were calculated.

2.2.3. Negative emotion assessment.

Self-rating Anxiety Scale (SAS) was used to evaluate patients’ anxiety before and after the intervention, based on 20 indicators: severe anxiety: ≥70 points, moderate anxiety: 60 to 70 points, mild anxiety: 50 to 60 points.[11] The Self-rating Depression Scale (SDS) was used to evaluate depression in patients before and after the intervention, based on 16 indicators: severe depression: ≥73 points, moderate depression: 63 to 72 points, mild depression: 53 to 62 points.[11]

3.2.3. Disease management capacity assessment.

A self-management capacity scale was used for the evaluation of the 2 groups of patients before and after the procedure and nursing. The self-management capacity evaluation indicators included compliance with the orders, self-monitoring and cooperation with the disease management and drug treatment. The scale used the hierarchical level 5 grading method, increasing the frequency from 1 to 5; a higher score indicated that the patients have higher capacity for self-management.[12]

2.4. Statistical analysis

In this study, we performed all data analysis using SPSS 21.0 software. Categorical data (such as clinical symptom improvement rate and recurrence rate) are expressed as n (%). The chi-square test was used to test for statistical significance. Continuous data (such as SAS score, SDS score, and self-management capacity score) were expressed as mean ± standard deviation (SD). The Student t test or ANOVA was used to test for statistical significance. P < .05 was considered as significant, double-tailed test.

3. Results 3.1. Baseline information

In the observation group, the male to female ratio was 23:22, the mean age was 49.14 ± 3.56 years, the mean body mass index (BMI) was 23.12 ± 3.15 kg/m2, and the mean disease course was 5.89 ± 2.41 years long. Patients were diagnosed with gastric ulcers in 5 cases, compound ulcers in 8 cases, esophageal ulcers in 5 cases, and duodenal ulcers in 27 cases. In the control group, the male to female ratio was 24:21, the mean age was 48.79 ± 3.68 years, the mean BMI was 22.97 ± 3.37 kg/m2, and the course of disease was 5.57 ± 2.35 years long. Patients were diagnosed with gastric ulcers in 6 cases, compound ulcers in 7 cases, esophageal ulcers in 6 cases, and duodenal ulcers in 26 cases. There was no significance difference in the baseline information of the 2 groups (P > .05) (Table 1).

Table 1 - Comparison of the baseline information between the 2 groups. Group Age Sex (male/female) BMI (kg/m2) Course of diseases (yr) Site of diseases Gastric ulcer Esophageal ulcer Duodenal ulcer Compound ulcer Observation group (n = 45) 49.14 ± 3.56 23/22 23.12 ± 3.15 5.89 ± 2.41 5 5 27 8 Control group (n = 45) 48.79 ± 3.68 24/21 22.97 ± 3.37 5.57 ± 2.35 6 6 26 7  χ2/t 1.357 0.045 0.519 0.943 0.267  P .621 .832 .619 .725 .966
3.2. Improvement rate and recurrence rate of clinical symptoms

The improvement rate of clinical symptoms including loss of appetite, abdominal distension, and abdominal pain in the observation group was 44 (97.78%), 44 (97.78%), and 43 (95.56%), respectively, while it was 39 (86.67%), 38 (84.44%), and 37 (82.22%), respectively in the control group. These results demonstrated that the improvement rate of clinical symptom in the observation group was significantly higher than that in the control group (P < .05). The recurrence rate in the observation group was significantly lower than in the control group (P = .026) (Table 2).

Table 2 - Comparison of the improvement rate and recurrence rate of clinical symptom between the 2 groups. Group N Clinical symptom improvement rate The recurrence rate Loss of appetite Abdominal distension Abdominal pain Observation group 45 44 (97.78) 44 (97.78) 43 (95.56) 1 (2.22) Control group 45 39 (86.67) 38 (84.44) 37 (82.22) 7 (15.56)  χ2 3.873 4.939 4.05 4.939  P .049 .026 .044 .026
3.3. Negative emotions

Before the initiation of nursing care, there was no significant difference in the negative emotions of the 2 group (P > .05). After receiving nursing care, the SAS score and SDS score in the observation group was significantly lower than those in the control group (P < .05) (Table 3).

Table 3 - Comparison of anxiety and depression between the 2 groups before and after nursing. Group N SAS score SDS score Before nursing After nursing Before nursing After nursing Observation group 45 65.83 ± 7.49 46.73 ± 6.41 66.96 ± 8.53 43.79 ± 6.74 Control group 45 65.12 ± 7.31 53.14 ± 6.75 66.24 ± 8.91 54.16 ± 6.28  t 0.455 4.619 0.392 7.551  P .65 <.001 .696 <.001

SAS = Self-rating Anxiety Scale, SDS = Self-rating Depression Scale.

3.4. Disease management capacity score

Before the initiation of nursing care, there was no significant difference in the negative emotions of the 2 group (P > .05). After receiving nursing care, the observation group had significantly enhanced disease management capacity as compared with the control group (P < .05) (Table 4).

Table 4 - Comparison of disease management ability scores between the 2 groups before and after nursing. Group N Take the medicine as directed Self-monitoring Cooperate with disease treatment Before nursing After nursing Before nursing After nursing Before nursing After nursing Observation group 45 35.16 ± 3.69 43.03 ± 4.86 32.56 ± 3.58 42.10 ± 5.27 30.67 ± 3.41 40.59 ± 4.67 Control group 45 35.67 ± 3.72 39.65 ± 4.71 32.14 ± 3.73 38.85 ± 5.16 30.96 ± 3.72 37.41 ± 4.53  t 0.653 3.35 0.545 2.956 0.385 3.279  P .516 .011 .587 <.001 .701 .002
4. Discussion

Peptic ulcer disease is a common disease of the gastrointestinal tract. It is mainly caused by the Helicobacter pylori infection.[13] Peptic ulcer disease usually presents with recurrent ulcers in the duodenum and the stomach. The incidence of peptic ulcer disease is still increasing yearly in the elderly population.[14,15] Many elderly patients do not have sufficient knowledge and understanding regarding the peptic ulcer disease. They experience anxiety and stress easily due to their poor self-management ability, which affects their treatment cooperation and compliance. This leads to prolongation of the treatment time, and the clinical effect of the therapy is also not guaranteed.[16,17] Nursing management is a branch of management science, belonging to the discipline category. It involves the application of the principles and methods of management science to the field of nursing. It is an important discipline that comprises nursing education and guides nursing practice. Nursing management is important in health service management.[18] The level of nursing management directly affects the quality of medical care, the level of hospital management and the development of health service. With the advances in science and technology leading to the development of scientific management methods in various professional fields, nursing management has also gradually moved from the past experience management to the stage of scientific management. In order to promote the development and improvement of nursing management, nurses at all levels, especially senior nurses and nursing management workers, are required to master the theoretical knowledge, methods and application of nursing management. Nursing management in peptic ulcer disease management through minimally invasive treatment of the perioperative patients can improve the treatment effect. The lack of reasonable nursing management and overall planning, at all levels is likely to lead to a lack of detailed handover, as well as breakdown of the cohesion of the working process, reduced work efficiency, and disconnect. The patients experience worse prognosis postoperatively and it is difficult to obtain good treatment effect. This can eventually result in the occurrence of adverse events. In serious situations, it is likely to conflict with the best interests of the patients including the protection of their life and health.[9,19,20] Therefore, it is necessary to develop and implement good intervention methods based on the actual situation of patients to ensure good prognostic effect.

Standardized perioperative care management is an intervention model based around the patient requiring surgical treatment. It starts with a comprehensive assessment of the patient’s therapeutic needs, results in initiatives to provide integrated care for the patient in terms of care and environmental resources, as well as physical and psychological care.[21] In view of the current situation, it is necessary to plan the evaluation indicators, handover methods, work responsibilities and feedback mechanism among the different levels in advance.[22] Standard management application starting from before the patients are admitted to the hospital, can help establish a good relationship between the nursing staff and the patients. This facilitates the nursing staff to gain a more accurate understanding of the patients. With the implementation of pertinent nursing guidelines, and standardization of preoperative and intraoperative work, the patients will experience an effective reduction in the operation risk. Nursing conditions can effectively impact the review of patients. Standardized nursing management can reduce the probability of adverse events, and ensure timely medical intervention in case of disease changes. Nursing staff can refer to the opinion form filled in by patients and reflect on their own work, so as to effectively improve and adjust the management system.[23,24]

The results of this study demonstrated that the observation group experienced significantly reduced recurrence rate, and increased improvement rate of clinical symptoms, as well as alleviated anxiety and depression when compared with the control group. These findings are consistent with those reported by Wu et al.[25] Another study[26] has also demonstrated that standardized perioperative care management significantly improved negative physical and mental conditions, and medical compliance behavior. It also reduced the incidence of adverse events, which is consistent with our findings and the results of several other studies.[27–29] Our results demonstrated that the observation group experienced significantly enhanced disease management ability, which is consistent with the findings observed by Wang et al and Chen et al.[27,28] It can be observed that the standardized perioperative nursing management has a significant effect, which is suitable for the nursing needs of patients. It helps achieve good control of complications and clinical symptoms, avoid adverse risks, and ensure a good prognosis. Studies have demonstrated that patients with peptic ulcer will experience different degrees of nursing problems 1 week after discharge from the hospital postoperatively. This involves complications associated with self-activity, diet and medication.[30] It is necessary to ensure a good follow up after discharge, implement follow-up nursing management, improve patients’ disease management ability, and reduce the incidence of complications. In addition, our care program emphasizes the importance of removing and avoiding factors that can cause peptic ulcer disease, such as mental stimulation, overwork, irregular living situation, poor diet, smoking and alcohol consumption. Patients also need to continue maintenance drug treatment for 1 to 2 years, to achieve symptom relief, and ulcer healing. It also has positive significance in preventing ulcer recurrence. The treatment for Helicobacter pylori infection related gastroduodenal ulcers includes drugs to reduce gastric acid secretion, as well as effective antibiotics, The eradication of Helicobacter pylori infection is important in preventing ulcer recurrence. In addition, gastrinoma or multiple endocrine adenomas, hyperparathyroidism, Meckel’s diverticulum, Barrett’s esophagus and other diseases can often be associated with peptic ulcer disease. These conditions should also be diagnosed and treated promptly.

In conclusion, the implementation of standardized perioperative nursing management for patients with peptic ulcer is conducive to reducing patients’ anxiety and depression. It also strengthens the disease management ability of patients, ensuring the improvement of clinical symptoms, prognosis. Hence, standardized perioperative nursing management should be further promoted.

Author contributions

Conceptualization: Man Jian.

Data curation: Man Jian.

Formal analysis: Man Jian.

Funding acquisition: Man Jian, Rui-jie Xu.

Investigation: Man Jian, Rui-jie Xu.

Methodology: Wei Ding, Man Jian, Rui-jie Xu.

Project administration: Wei Ding, Man Jian.

Resources: Wei Ding, Man Jian.

Software: Wei Ding, Man Jian.

Supervision: Wei Ding, Rui-jie Xu

Validation: Wei Ding.

Visualization: Wei Ding.

Writing – original draft: Wei Ding, Rui-jie Xu.

Writing – review & editing: Wei Ding, Rui-jie Xu.

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