Observation‐group
anxiety, Pain, pain, infection, lochia
INFECTION, CONTRACTION, COMPLICATIONS, URETHRA
Patients in the Observation‐group received the same routine nursing as the Control‐group (see above). In addition, a special IMB mode intervention team was set up and included one doctor and three nurses. The team carried out IMB mode intervention on the Observation‐group for 2 months. All team members have been trained by IMB professionals. The key points of the IMB mode intervention include the following:
Information intervention: After the patients were admitted to the hospital, the pain questionnaire and face‐to‐face communication were used to understand the cognition level of the patients, and health education was carried out based on these data. In addition to introducing the basic knowledge of routine nursing to patients (operation‐related knowledge, the environment of the operating room and the ward, precautions and cooperation points), nurses also informed the patients about the prevalence of CS, CS procedure, CS‐related complications, as well as the key points of rehabilitation after CS, which allowed patients to have a more comprehensive understanding of CS. Relevant knowledge was compiled into a health education brochure, which was distributed to the parturients for independent reading. The key points of the health education brochure were listed in Table Motivational intervention: (A) Unconscious intervention. The main goal of unconscious intervention is to establish a trust relationship with pregnant women, communicate with them cordially, encourage them to share their inner thoughts, listen patiently, express understanding and answer their questions in detail. In this case, it helped to build a trusting relationship between the nurses and the pregnant women. (B) Intention period: pregnant women were encouraged and guided to learn about the CS, with a correct understanding of the principles of CS cooperation and postpartum recovery, to improve their health awareness. (C) Preparation period. Pregnant women were helped to set up perioperative cooperation objectives and programs and were given personalized suggestions and guidance. (D) Change period. The relevant knowledge of CS was reviewed, and maternal understanding of knowledge implementation was assessed. (E) Maintenance period. Pregnant women were encouraged to make full use of the existing resources and to maintain a long‐term healthy behaviour.Behavioural intervention: (A) Before the operation, patients were informed in detail of the discomfort and complications that may occur during the operation, and operation safety and prognosis were discussed to make them cooperate actively. (B) After CS, in addition to the postoperative care mentioned in the routine nursing, the women were given behavioural skills training on how to rapidly recover from CS, enlisted social support from family members and received self‐regulation strategies. (1) Rapid recovery behavioural skills: 6 h after CS, the puerpera performed straight leg lifting exercises to enhance abdominal muscle tension, six times per minute. Three days after delivery, they performed sit‐ups, four times per minute; waist rotation exercises were performed to exercise the muscles of the lower back, six times per minute; squat upright exercise to strengthen leg muscles were done 10 times per minute. Women were guided to walk slowly to exercise the muscle strength of lower limbs, 4–5 min each time. Moreover, the puerperae were taught to exercise the pelvic floor muscles and fascia through the anal contraction exercise: the puerperae took a free position, lifted the anus, urethra and perineum as much as possible, contracted once every 5–10 s, rested for 5–10 s and then repeated the training for 5 min, three times a day, until the end of puerperium. (2) Social support from family members: ① Family members were guided to massage the lower abdomen of the puerpera after CS, with even force in a clockwise direction, from light to heavy massage, which can help to promote uterine contraction. ② Six hours after CS, the responsible nurse evaluated the situation of the women, provided semi‐liquid food rich in protein, vitamins, minerals and cellulose according to the personal situation of the women, and formulated a special and reasonable healthy diet plan for women with special needs, to adequately supplement the nutrition and energy. Family members were encouraged to strictly follow the nurse's requirements to give a nutritional supplement to the puerpera. ③ Family members received guidance on breastfeeding and helped mothers breastfeed for the first time. (3) Self‐regulation strategies: ① Self‐body management: Puerpera should pay close attention to their physical condition and timely report any discomfort after CS, and perform the rapid recovery behavioural tasks accordingly. ② Caesarean incision care: since it takes about 5 weeks for the incision to heal after CS, the mothers were provided with guidelines for incision health management and were encouraged to pay attention to exudate, infection and cleanliness of the incision. ③ Timely contraceptive measures: women were provided with the information that sexual intercourse should not be started until 42 days after the delivery and after the lochia has completely cleared.Key points of the health education brochure.Definition of CS.Differences between CS and normal vaginal delivery.When to choose CS?The prevalence of CS.Advantages and disadvantages of CS.CS‐related complications.
Patient consent.Pre‐CS preparation:
Systemic examination and necessary laboratory tests;Disinfection measures;Placement of urinary catheter;Intravenous drip;Preoperative anaesthesia.Caesarean procedure:
Open the abdominal wall;Hysterotomy;Pull out the fetus;Stripping afterbirth;Suture the uterus;Suture the abdominal wall.Preoperative precautions.Intraoperative precautions.Postoperative precautions.Pain management.Caesarean incision care.Emotion management.Dietary considerations.Precautions for exercise.Medical records of all the patients included assessment of the following observation indexes: SAS and SDS were used to evaluate the psychological and emotional state of pregnant women before and after the intervention. There were 20 items in SAS, the frequency of symptoms was mainly assessed by the 4‐level scoring method, the higher the total score, the higher the degree of anxiety. The scale has been revised in China, according to the results of the Chinese norm, and the SAS standard was divided into 50 points, of which 50–59 points are mild anxiety, 60–69 points are moderate anxiety, and 70 points and above are severe anxiety (Grigoriadis et al., 