
==== Front
Medicine (Baltimore)
Medicine (Baltimore)
MD
Medicine
0025-7974
1536-5964
Lippincott Williams & Wilkins Hagerstown, MD

MD-D-23-10358
00003
10.1097/MD.0000000000039682
3
5400
Research Article
Observational Study
Analysis of the nursing value of continuity care in the recovery of ureteral stone patients after Pneumatic ballistic lithotripsy: An observational study
Wang Lingying MM 153913947@qq.com
a
Wang Hong MM 153913947@qq.com
a
Fang Jianghong MM 626465090@qq.com
a
https://orcid.org/0009-0003-4039-5772
Yao Minye MM b*
a Department of Surgery, She County People’s Hospital, Huangshan, Anhui, China
b Department of Nursing, Huangshan Shoukang Hospital, Huangshan, Anhui, China.
* Correspondence: Minye Yao, Department of Nursing, Huangshan Shoukang Hospital, Huangshan, Anhui 245000, China (e-mail: 18955913592@163.com).
13 9 2024
13 9 2024
103 37 e3968219 11 2023
20 8 2024
23 8 2024
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

This study aims to assess nursing methods’ effects on ureteral stone patients post-Pneumatic ballistic lithotripsy with double J-tube placement. Through comparing interventions’ impact on recovery, complications, and overall quality of life, the study aims to establish a more effective nursing protocol for this patient group. This study investigates ureteral stone patients who underwent PL and subsequent double J-tube placement between January 2020 and October 2023. A total of 100 eligible subjects (n = 100), meeting the inclusion and exclusion criteria, were divided into an intervention group (n1 = 50) and a control group (n2 = 50) according to different treatments. The control group received routine in-hospital care combined with outpatient follow-up, while the intervention group underwent continuous care using the Omaha system. Nursing effects pre- and post-intervention were assessed using questionnaires, clinical indicators, and the Omaha evaluation system, evaluating aspects such as cognition, behavior, and status in terms of environment, psychosocial aspects, physiology, and health behavior. Additionally, complications during double J-tube placement and pain scores were compared among the patients. Prior to the intervention, no statistically significant differences were observed between the scores of both groups across environmental, psychosocial, physiological, and health behavioral domains. Subsequent to the nursing intervention on the first postoperative day, at discharge, and post-discharge, a statistically significant variance was evident between the groups across these domains (P < .05). Furthermore, the intervention group exhibited notably lower rates of infection, hematuria, and residual or fragmented stones, all significantly lower with a P-value of <.05, compared to the control group. While a reduction in tissue damage and acute kidney injury was observed in the intervention group compared to the control group, this difference did not reach statistical significance. Notably, 92% of patients in the intervention group reported no pain during the nursing intervention, in contrast to only 52% in the control group. Continuity care utilizing the Omaha system demonstrates favorable outcomes in managing double J stent placement post-PL among ureteral stone patients, notably leading to a significant reduction in both pain levels and the incidence of associated complications.

continuity care
double J stent
Pneumatic ballistic lithotripsy
postoperative care
renal calculi
ureter
OPEN-ACCESSTRUE
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pmc1. Introduction

Ureteral stones are a common condition in the urinary system, significantly impacting patients’ quality of life and work efficiency due to associated pain and complications, posing significant challenges to their health and well-being.[1] Pneumatic ballistic lithotripsy (PL) is a commonly used minimally invasive surgery that employs shock waves transmitted to the site of the stones to break them into smaller particles, facilitating their expulsion as a treatment for ureteral stones.[2] Double J-tubes, also known as “DJ tubes” or “ureteral stents,” are long, thin specially designed catheters typically placed between the kidney calyx and the bladder to ensure smooth urine outflow and support the structure of the ureter.[3,4] In PL, double J-tubes aid in facilitating the passage of larger stone fragments and reducing the risk of stone fragments causing blockage in the ureter.[5,6] Additionally, they play a role in reducing postoperative pain and preventing postoperative complications. The postoperative recovery period is crucial for ureteral stone patients. Continuity care is a comprehensive concept in healthcare, primarily referring to the consistent, seamless, and personalized care provided to patients within the continuum of healthcare services.[7,8] This nursing approach emphasizes the provision of continuous and consistent care and support to patients throughout their changing health conditions.

Therefore, optimizing postoperative care to enhance patients’ recovery remains a crucial aspect worth exploring. There is reason to believe that implementing continuity care post PL in conjunction with double J-tube insertion significantly contributes to the postoperative recovery of ureteral stone patients. Concurrently, continuity care, with its consistent and personalized care delivery, is anticipated to alleviate postoperative complications such as urinary tract infections, reduce pain levels, and positively impact patients’ overall health during the recovery phase.

Against this background, this study aims to systematically assess the impact of continuity care on the recovery process of ureteral stone patients following PL in combination with double J-tube insertion. The study endeavors to analyze the effectiveness of this nursing approach in reducing postoperative complications, alleviating pain, and enhancing the overall quality of life for these patients. Through a comprehensive analysis of patient outcomes under different nursing models, the study aims to provide a more scientific and effective nursing plan for ureteral stone patients.

2. Materials and methods

2.1. Study population

This study included a total of 100 patients with ureteral stones who underwent PL and simultaneous placement of double J-tubes in the hospital from January 2020 to October 2023. Inclusion criteria: obtaining informed consent from the patient and their family to sign the informed consent form; no mental abnormalities, able to communicate normally, and have autonomy; The patient meets the relevant diagnostic criteria for ureteral stones; no coagulation dysfunction; no severe organ dysfunction such as heart, lung, or brain; successful completion of PL and double J stent placement without other urological complications during the surgery; patients meeting the relevant diagnostic criteria for ureteral stones. Exclusion criteria: inability to sign the informed consent form to participate in the clinical study, presence of other severe urinary system diseases, patients who have recently undergone surgery to remove urinary tract stones, pregnancy, patients with neurological disorders who are unable to communicate normally. This study has been approved by the Ethics Committee of She County People’s Hospital. The approval number is ES-2019-XZ-789, dated November 20, 2019. Informed consent has been obtained from the patients or their family members.

2.2. Preparation

The nursing intervention team for this study comprised 2 attending physicians with over 10 years of clinical experience and 5 nurses who had work experience ranging from 5 to 20 years. They received training on continuity care and the Omaha System. Nursing records of 80 patients who underwent double J-tube placements before discharge were collected by reviewing relevant literature. Nursing problems and symptoms observed in the records were aligned with the Omaha system. By combining expert opinions, various nursing problems encountered by patients undergoing double J-tube placement within the Omaha nursing system were documented, as illustrated in Table 1.

Table 1 Documentation of the occurrence of each nursing problem in the Omaha system of care for patients with indwelling double J-tubes.

Omaha field	Omaha issue	Nursing issues	Number of examples
(n = 80)	Percentage (n, %)	
Environmental field	Health	Infections	6	7.50%	
Income	Unable to maintain a home	2	2.50%	
Residence	Risk of accidental injury	32	40.00%	
Psychosocial field	Interpersonal relationships	Not making friends	8	10.00%	
Social spirituality	Anxiety	11	13.75%	
Gender relations	Sexual dysfunction	9	11.25%	
Community relations	Unable to integrate into the community	1	1.25%	
Physiological field	Bowel movement	Constipation	28	35.00%	
Urination	Abnormal urination	59	73.75%	
Infection	Abnormal body temperature	14	17.50%	
Health behavior field	Sleep and rest patterns	Abnormal sleep	29	36.25%	
Physical activity	Inadequate activity tolerance	21	26.25%	
Various nursing problems encountered by patients with double J-tube placement in the Omaha nursing system were documented. The figures in the table are expressed as percentages.

The table displays the 4 primary observation domains of the Omaha system: environmental, psychosocial, physiological, and health behavioral domains. The nursing problems observed in patients with double J-tube placements were categorized according to the Omaha system to provide detailed proportions for each problem category.

2.3. Research methods

This study explores different nursing methods for double J-tube indwelling in ureteral stone patients after PL using an observational experimental research approach. The study collected data from 100 eligible subjects (n = 100) meeting inclusion and exclusion criteria between January 2020 and October 2023, randomly assigning them into an intervention group (n1 = 50 cases) and a control group (n2 = 50 cases). The intervention group received a continuous care plan based on the Omaha System, strictly implemented in terms of health education, case management, treatment protocols, and supervision. The control group underwent routine in-hospital care combined with regular outpatient follow-ups. Data collection encompassed general information questionnaires (such as gender, age, residence), health information (such as diagnostic results, surgical methods), and clinical assessment indicators (occurrence of complications during stent placement, subjective and objective indicators). Simultaneously, nursing effects were assessed in the 4 domains of the Omaha system: environment, psychosocial aspects, physiology, and health behavior. Finally, the collected data were analyzed using SPSS 23.0 software (SPSS Inc., Chicago), employing chi-square tests, analysis of variance (ANOVA), and rank-sum tests to conduct statistical analysis on the data from the 2 groups and derive results. The research workflow is illustrated in Figure 1.

Figure 1. Research roadmap.

2.4. Research tools

The assessment tools utilized in this study primarily include a general information questionnaire, health information, clinical evaluation indicators, and the Omaha system. General information encompasses parameters such as subjects’ gender, age, occupation, among others. Health information comprises indicators like surgical methods, duration of double J-tube placement, medication usage during surgery, and similar aspects. Clinical evaluation indicators consist of complications during stent placement, subjective indices, and objective measurements. The main components of the clinical evaluation indicator system are outlined in Table 2.

Table 2 Clinical evaluation index system.

Clinical evaluation system	Type of evaluation	Specific evaluation	
Presence of complications	Surgical complications	The occurrence of a surgical complication was noted as yes, and the absence of a surgical complication was noted as no	
Subjective evaluation indicators	Pain visual analog score	Self-assessment was performed based on the patient oral content, and the pain level was categorized as 1 to 10. Zero was classified as no pain, 1 to 3 was classified as mild pain, 4 to 6 was classified as moderate pain, and 7 to 10 was classified as severe pain	
Hematuria	The color of hematuria was observed visually. The color of hematuria is divided into 4 grades: blood in the urine, light red urine, dark red urine, and bright red urine	
Frequent urination	Frequent urination if you urinate more than 6 times during the day and more than 2 times at night	
Urinary urgency	Inability to control the discharge of urine	
Painful urination	Pain in the perineum, suprapubic area, and urethra during urination	
Objective evaluation indicators	Hematochezia	Increased White blood cell count or neutrophil ratio suggests the presence of infection. Red blood cell count or hemoglobin suggests blood loss	
Urinalysis	A clean urine culture in the urine suggests a bacterial count > 10/ml or the patient presents with symptoms of a urinary tract infection	
Urethrogram	Plain radiographs revealed an attachment or stone shadow in the double J-tube, and extraction of the double J-tube revealed a stone or stone scale attached to the wall of the tube	
This table contains the main components of the clinical evaluation index system.

Table 2 provides a detailed breakdown of the clinical evaluation indicator system. Apart from employing the general information questionnaire and clinical evaluation indicators for assessment, analysis is also carried out using the Omaha evaluation system. The cognitive, behavioral, and status scores of patients in both the intervention and control groups are assessed before and after nursing interventions using the Omaha evaluation system.

2.5. Data processing methods

The data collected during this experiment were analyzed using SPSS 23.0 software (SPSS Inc., Chicago). Measurement data were presented as mean ± standard deviation, while count data were expressed as frequency ± percentage. The relationship between the 2 groups of data was analyzed using the chi-square test, analysis of variance, and rank-sum test.

3. Analysis of research results

3.1. Comparison of general information

Comparisons were made using general indicators such as gender, age, residence, diagnosis results, and surgical approach to derive the general analysis results for both groups of patients, as presented in Table 3.

Table 3 Comparison of patients’ general information.

Program	Intervention group (n, %)	Control group (n, %)	t/χ2	P	
Sex	Men	(31, 62%)	(25, 50%)	0.125	.961	
Women	(19, 38%)	(25, 50%)	
Age	Under 50	(12, 24%)	(13, 26%)	0.582	.932	
50 years old and above	(38, 76%)	(37, 74%)	
Diagnosis	Ureteral stone	(50, 100%)	(50, 100%)	0.643	.596	
Surgery	PL in patients with ureteral stones	(50, 100%)	(50, 100%)	1.856	.812	
Comparison of general information between the 2 groups of patients, P < .05 was considered significant. The basic information in the table is represented by proportional cases and percentages, and chi-square test is used for comparison between groups.

In Table 3, continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequency ± percentage. The analysis employed the chi-square test for gender, age, diagnosis results, and surgical approach, revealing no statistically significant differences. This indicates a resemblance in the overall characteristics between the intervention and control groups of patients, allowing for further investigation.

3.2. Repeated measures ANOVA results for Omaha domain score indicators in the 2 group of patients

This study conducted a repeated measures analysis of variance on the 4 domains of the Omaha system: environment, socio-psychological, physiological, and health behavior. Different postoperative nursing interventions were implemented for the 2 patient groups, and data analysis was conducted using Mauchly sphericity test with Huynh–Feldt correction. The results of the repeated measures analysis for the domain-specific scores before and after Omaha system intervention in the 2 groups are presented as follows: Environmental domain analysis results in Table 4, socio-psychological domain analysis in Table 5, physiological domain analysis in Table 6, and health behavior domain analysis in Table 7.

Table 4 Repeated ANOVA results before and after patient intervention under the environmental domain score indicator.

Environmental field	Time effects	Intervention effect	Interaction effect	
F	P	F	P	F	P	
Hygiene cognition	512.152	.001	9.265	.001	8.156	<.001	
Hygiene behavior	426.154	.003	9.215	<.001	12.326	.003	
Hygiene status	953.236	.001	95.261	.001	26.215	.003	
Residence perceptions	566.153	<.001	68.312	.002	41.265	<.001	
Residence behavior	612.052	<0.001	18.326	.001	4.261	.002	
Residence status	852.112	.001	51.241	.001	38.264	.005	
Income perception	756.321	<.001	59.326	<.001	18.321	.001	
Income behavior	882.105	<.001	75.623	.001	25.056	.002	
Income status	847.189	<.001	61.236	<.001	9.341	.001	
Each index in the table was the data of patients before and after intervention by 1-way analysis of variance, and P < .05 was significant

Table 5 Repeated ANOVA results of patients before and after the intervention under the psychosocial domain score indicators.

Psychosocial field	Time effects	Intervention effect	Interaction effect	
F	P	F	P	F	P	
Relationship cognition	275.261	.001	56.321	.001	66.325	.002	
Relationship behavior	349.211	.0022	31.055	.001	16.128	.001	
Relationship status	389.624	.001	28.157	.001	23.015	.001	
Social spiritual cognition	394.254	.001	38.276	<.001	58.179	.001	
Social spiritual behavior	421.319	.001	105.411	.001	22.154	.001	
Social spiritual status	458.743	.001	27.547	.001	20.108	.002	
Gender relationship cognition	347.859	.001	121.054	<.001	23.579	.001	
Gender relationship behavior	394.014	.002	195.061	.001	153.218	.002	
Gender relationship status	425.108	.001	21.142	.002	59.478	.001	
Community relationship cognition	318.542	<.001	28.247	.003	24.056	<.001	
Community relationship behavior	408.365	.001	31.788	.001	128.269	.001	
Community relations status	429.011	.001	33.215	<.001	34.248	.001	
Each index in the table was the data of patients before and after intervention by 1-way analysis of variance, and P < .05 was significant.

Table 6 Repeated ANOVA results of the patients before and after the intervention under the physiological domain score indicators.

Physiological field	Time effects	Intervention effect	Interaction effect	
F	P	F	P	F	P	
Defecation cognition	485.265	.001	195.624	.001	59.367	.002	
Defecation behavior	455.214	.001	6.261	.018	5.218	.023	
Defecation status	385.249	.001	25.362	<.001	6.321	.030	
Urinary cognition	374.215	.001	245.654	.001	145.221	.001	
Urinary behavior	332.049	<.001	17.025	.001	16.028	<.001	
Urinary status	289.134	.001	18.483	.001	11.381	.001	
Infection cognition	389.329	0.001	284.120	.003	189.324	<.001	
Infection behavior	252.147	<.001	22.361	.001	15.249	<.001	
Infection status	364.851	<.001	19.248	.002	10.058	.001	
Each index in the table was the data of patients before and after intervention by 1-way analysis of variance, and P < .05 was significant.

Table 7 Repeated measures ANOVA results for the health behavior domain score indicators before and after intervention in the 2 group of patients.

Health Behavioral Field	Time effects	Intervention effect	Interaction effect	
F	P	F	P	F	P	
Sleep and rest patterns cognitive	284.259	<.001	364.271	.001	105.309	.001	
Sleep and rest pattern behavior	374.156	.001	90.238	<.001	21.626	.001	
Sleep and rest pattern status	328.027	<.001	19.324	<.001	25.483	.001	
Physical activity cognitive	340.108	<.001	265.201	<.001	125.055	<.001	
Physical activity behavior	290.527	<.001	65.249	<.001	18.226	<.001	
Physical activity status	214.403	<.001	33.557	.001	25.105	.001	
Each index in the table was the data of patients before and after intervention by 1-way analysis of variance, and P < .05 was significant.

In Table 4, by employing Mauchly sphericity test and Huynh–Feldt correction to analyze the cognitive, behavioral, and status scores of the hygiene, residence, and income indicators in the environmental domain during nursing interventions, it was observed that there were differences in the time effect, intervention effect, and interaction effect on the environmental scores between the 2 groups (P < .05). Taking the hygiene index as an example, the specific scores for hygiene in terms of cognition, behavior, and status before and after the intervention for both groups are illustrated in Figure 2.

Figure 2. Graph of changes in scores of hygiene perception, behavior, and status.

The Figure 2 illustrates the variation in hygiene cognition, behavior, and status scores for both groups of patients at different intervention intervals. From Figure 2(A)–(C), it is evident that with the extension of intervention duration, there was an improvement in hygiene cognition, behavior, and status scores for both groups. However, the intervention group demonstrated higher scores compared to the control group.

In Table 5, utilizing Mauchly sphericity test and Huynh–Feldt analysis to assess the cognitive, behavioral, and status scores in the social-psychological domain for relationship, social spiritual, gender relationship, and community indicators during nursing interventions, it was found that there were significant differences (P < .05) in the time effect, intervention effect, and interaction effect of the social-psychological domain scores between the 2 patient groups. Taking the relationship indicator in the social-psychological domain as an example, the specific scores for cognitive, behavioral, and status aspects of interpersonal relationships before and after intervention for both groups are depicted in Figure 3.

Figure 3. Graph of changes in the scores of cognitive, behavioral, and status of human–computer relationships in the 2 group before and after the intervention.

Figure 3 illustrates the variations in cognitive, behavioral, and status scores for interpersonal relationships across different intervention periods for both patient groups. Observing Figure 3(A)–(C), it is evident that with an increase in intervention sessions, both groups exhibit an escalation in relationship cognitive, behavioral, and status scores. The intervention group scores gradually surpass those of the control group.

In Table 6, the cognitive, behavioral, and status scores for defecation, urinary, and infection in the physiological domain were analyzed using Mauchly sphericity test and Huynh–Feldt correction for both patient groups during nursing interventions. The scores in the physiological domain for both groups exhibited differences in time effect, intervention effect, and interaction effect (P < .05).

In Table 7, the cognitive, behavioral, and status scores for sleep and rest, as well as physical activity, in the health behavior domain were assessed using Mauchly sphericity test and Huynh–Feldt correction for both patient groups during nursing interventions. The scores for both groups exhibited differences in time effect, intervention effect, and interaction effect (P < .05).

3.3. Complication incidence rate and visual analog pain score results during the double J-tube placement period

The complication incidence rate and visual analog pain score results during the double J-tube placement period after PL were compared as in Table 8.

Table 8 Patient complication rate and pain visual analog score results during double J-tube indwelling period.

Pain visual analog scoring items	Intervention group (n1 = 50)
(n, %)	Control group
(n1 = 50)
(n, %)	Z	P	
Score 0 (no pain)	46, 92%	26, 52%	-5.124	<.001	
1 to 3 points (mild pain)	2, 4%	13, 26%	
4 to 6 points (moderate pain)	2, 4%	7, 14%	
7 to 10 points (severe pain)	0, 0%	4, 8%	
Complication items	Intervention group (n1 = 50)
(n, %)	Control group
(n1 = 50)
(n, %)	t/χ2	P	
Infection	(4, 8%)	(18, 36%)	18.107	.015	
Hematuria	(3, 6%)	(16, 32%)	16.856	.016	
Remaining stones or fragments	(1, 2%)	(9, 18%)	13.026	.023	
Damage to surrounding tissues	(1, 2%)	(5, 10%)	5.226	.103	
Acute kidney injury	(0, 0%)	(2, 4%)	3.248	.125	
Total	(9, 18%)	(50, 100%)	13.457	<.001	
Counting data in the table were expressed as frequency and percentage. Chi-square test was used for comparison between groups, and P < .05 was considered significant.

In Table 8, parametric data are presented as mean ± standard deviation, while categorical data are depicted as frequency ± percentage. Statistical analysis comparing pain scores and complication rates between the 2 groups during double J stent insertion revealed significantly lower pain scores in the intervention group compared to the control. Additionally, the intervention group exhibited lower rates of infection, hematuria, residual stones, and fragment occurrence compared to the control group (P < .05). However, there were no statistically significant differences observed in the occurrence rates of peritubular tissue damage and acute kidney injury between the intervention and control groups.

4. Discussion

The Omaha system has been widely applied in various fields, including community, clinical, and education, across multiple countries.[9,10] Scholars have noted that the Omaha System can provide assessment standards for individuals, families, and communities, comprehensively evaluating nursing problems at personal, family, social, and environmental levels, thereby playing a role in comprehensive health assessment and health management.[11,12] Several experts in practice have confirmed that the Omaha system can exhibit changes in patient care needs, serving as a reference for healthcare professionals when determining treatment plans.[13,14] In this study, the Omaha system was integrated with the concept of continuity of care to generate a problem form for patients with double J-tube placement within the Omaha nursing system. By reviewing previous literature, the probability of problems occurring in the environmental, social-psychological, physiological, and health behavior domains was calculated. The primary nursing problems observed in patients with double J-tube placement closely aligned with the assessment indicators in the Omaha system, as indicated by the outcomes. Continuity of care, based on the Omaha nursing system, effectively reduced pain and complication incidence rates in patients undergoing PL for ureteral stones. Consequently, the application of the Omaha nursing system can facilitate the development of more effective intervention measures for postoperative care plans for ureteral stone patients, continuously monitor the implementation of intervention measures, and significantly enhance patient compliance.

PL is the major treatment strategy for ureteral stones, offering safety and effectiveness as advantages. However, postoperative recovery remains a crucial factor influencing patients’ quality of life and long-term stone recurrence rates.[15,16] This study integrated the Omaha system with continuity of care intervention to explore its nursing value in the postoperative recovery of patients with ureteral stones treated with PL. The Omaha system primarily comprises 3 components: a problem classification system, an intervention system, and an outcome evaluation system.[17] Within the problem classification system, interventions are implemented for patients’ health issues across 4 domains: environment, social-psychological, physiological, and health. The study compared traditional nursing methods with continuity of care methods, examining cognitive, behavioral, and status changes in the postoperative intervention between the control and intervention groups within the 4 domains: environment, social-psychological, physiological, and health behavior. In the environment domain, following Huynh–Feldt correction, the cognitive, behavioral, and status coefficients of 3 environmental factors (hygiene, housing, income) in the Omaha continuity of care intervention demonstrated differences in time effect, intervention effect, and interaction effect between the 2 groups (P < .05). In the social-psychological domain, after correction, the cognitive, behavioral, and status score coefficients of 4 social-psychological factors (interpersonal relationships, social interaction, sexual relationships, community relationships) in the Omaha continuity of care intervention exhibited significant differences in time effect, intervention effect, and interaction effect between the 2 groups (P < .05). In the physiological domain, following correction, the cognitive, behavioral, and status score coefficients of the 3 physiological factors (defecation, urination, infection) in the Omaha continuity of care intervention indicated significant differences in time effect, intervention effect, and interaction effect between the 2 groups (P < .05). Finally, within the health behavior domain, after correction, the cognitive, behavioral, and status score coefficients of the 2 health factors (sleep and rest patterns, physical activity) in the Omaha continuity of care intervention also displayed significant differences in time effect, intervention effect, and interaction effect between the 2 groups (P < .05). In conclusion, the Omaha continuity of care intervention system offers solutions for patients’ hygiene and housing problems, enhances patients’ understanding of family hygiene, improves the home environment, and reduces the risk of urinary tract infection and displacement associated with double J-tube placement. Additionally, the system utilizes communication tools to provide medical consultation for patients, teaching them how to prevent complications of the double J-tube through means such as phone calls and WeChat. It also aids in identifying and addressing emotional and sexual issues, thereby promoting the well-being of patients in the social and psychological domains and improving their quality of life.

Patients with indwelling double J-tubes may experience ureteral spasm, bladder reflux, and increased renal pelvic pressure during the initial 2 weeks due to the body response to the foreign body, potentially causing lower urinary tract symptoms and low back pain.[18] Over time, the body gradually adjusts to the double J-tube, alleviating the mentioned symptoms, yet infection and hematuria may persist. This study compared complications and pain scores during double J-tube placement between traditional nursing and the Omaha continuity of care intervention groups. The intervention group exhibited lower incidence rates of infection, hematuria, and residual stones or fragments compared to the control group (P < .05). Nursing plays a crucial role among ureteral stone patients undergoing PL with double J stent placement, particularly in providing continuous care, significantly affecting postoperative stone clearance. This study revealed a significantly higher residual stone clearance rate in the continuous care group compared to the control group (P < .05), aligning with prior research that indicates improving patient lifestyle, pain management, and rehabilitative care positively impacts stone expulsion and enhances quality of life. However, further comprehensive research is needed to precisely understand how specific nursing interventions influence stone expulsion. Notably, 92% of intervention group patients reported no pain during care, while only 52% in the control group experienced painlessness. Additionally, severe pain during care was reported by 0% and 8% of patients in the intervention and control groups, respectively.

In conclusion, common physiological problems in patients with double J-tube placement include pain, abnormal urinary function, and infection. This study utilized the Omaha scoring system to evaluate patients’ specific issues and offer tailored nursing interventions, resulting in a notable reduction in pain incidence and complications. However, given the maximum observation time for double J-tube placement in this study was 30 days, the majority of interventions were concentrated within this duration, limiting the study generalizability. Future research should explore nursing interventions post-tube removal to further enhance our understanding in this area.

Author contributions

Conceptualization: Lingying Wang, Minye Yao.

Data curation: Lingying Wang, Hong Wang, Minye Yao.

Formal analysis: Lingying Wang, Hong Wang, Jianghong Fang, Minye Yao.

Investigation: Lingying Wang, Minye Yao.

Methodology: Lingying Wang, Minye Yao.

Visualization: Jianghong Fang.

Validation: Minye Yao.

Writing – original draft: Lingying Wang, Hong Wang, Minye Yao.

Writing – review & editing: Lingying Wang, Hong Wang, Jianghong Fang, Minye Yao.

Abbreviation:

PL Pneumatic ballistic lithotripsy

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Wang L, Wang H, Fang J, Yao M. Analysis of the nursing value of continuity care in the recovery of ureteral stone patients after Pneumatic ballistic lithotripsy: An observational study. Medicine 2024;103:37(e39682).
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