The effect of nursing intervention based on the staged behaviour change on recovery, quality of life, and self-efficacy of diabetic patients with scalds.

This study aimed to explore the impact of nursing intervention based on staged behaviour change (SBC) on the quality of life (QoL) and self-efficacy of diabetic patients with scalds. From January 2020 to January 2021, a total of 82 consecutive cases with diabetes and scalds were prospectively enrolled in this study. They were divided into the SBC group (41 cases were given SBC-based nursing intervention) and the control group (41 cases were given routine intervention) using the random number table method. The granulation tissue growth time and wound healing time were compared between the two groups. Pain intensity, QoL, self-efficacy, and score of wound exudation at 3, 7, and 15 days after intervention were observed. The granulation tissue growth time and wound healing time of the SBC group were lower than those of the control group with statistical difference (P < 0.05). The 3-, 5-, and 7-day pain intensity of the SBC group were all lower than those of the control group, with statistical difference (P < 0.05, respectively). Before intervention, there were no significant differences in mental health, role emotional, social function, vitality status, physical pain, role physical, physical function, and general health between the two groups (P > 0.05, respectively). After intervention, the above indicators of the SBC group were significantly higher than those of the control group (P < 0.05, respectively). Before intervention, there were no significant differences between the two groups in communication with doctors, emotional communication, role function, symptom management, medication as prescribed, and control of water and salt intake and nutrition (P > 0.05, respectively). After intervention, the above indicators in the SBC group were all significantly higher than those in the control group (P < 0.05, respectively). The score of wound exudation of the SBC group was lower than that of the control group after intervention (P < 0.05). SBC-based nursing intervention can effectively improve the QoL and self-efficacy of diabetic patients with scalds and can effectively promote wound healing, and can be recommended for clinical use.

INTRODUCTION

Burn injury generally refers to tissue damage caused by scalds, burn or flame, contact of heat, electric current, chemical substances, laser, and radiation. Scalds (43.19%) was found to be the primary cause of burns in a retrospective analysis of a large population in a major burn centre in China.

The population of Chinese diabetic patients was estimated to be 110 million in 2018, and currently China has the largest number of individuals affected by diabetes of any country. Because of endocrine abnormalities, high blood glucose levels, peripheral microvascular and peripheral neuropathy in diabetic patients with scalds, skin nutrition disorders and numbness in the extremities will be caused, which is easy to be damaged and has poor repair ability. Therefore, the wound healing of diabetic patients after burn is slow. In addition, the two conditions exist at the same time, and their interaction will lead to the aggravation of the disease, the physical health of patients caused by different degrees of influence. The staged behaviour change (SBC) model was proposed by American psychologist Prochaska in 1983. According to the theory, behavioural change is a gradual and continuous process composed of 10 processes: consciousness raising, self‐liberation, social liberation, self‐re‐evaluation, environmental re‐evaluation, counter conditioning, stimulus control, reinforcement management, dramatic relief, and helping relationships. This is more effective than traditional health education in helping patients change their healthy living behaviours.

In this study, SBC‐based nursing intervention was carried out for diabetic patients with scalds to evaluate the impact of this nursing mode on patients' quality of life (QoL) and wound healing.

MATERIALS AND METHODS

From January 2020 to January 2021, 82 diabetic patients with scalds were prospectively enrolled as the research subjects. The patients were divided into the SBC group and control group, with 41 cases in each group, using the random number table method.

The study was approved by the ethics committee of the First Hospital of Hebei Medical University. This study was conducted in line with the requirements of the Declaration of Helsinki of the World Medical Association.

Inclusion and exclusion criteria

The inclusion criteria were as follows: (1) patients met the diagnostic criteria for diabetes according to the China 2017 Guidelines for the Prevention and Control of Type 2 Diabetes (fasting plasma glucose ≥7.0 mmol/L, or postprandial plasma glucose ≥11.1 mmol/L) ; (2) age over 18 years; (3) patients were taking oral hypoglycemic drugs or using insulin to maintain normal plasma glucose level, and glycosylated haemoglobin <7.5%; and (4) patients signed informed consent.

The exclusion criteria were as follows: (1) patients were treated with immunosuppressive agents; (2) patients had chronic diseases such as heart, liver and kidney; (3) patients had moderate to severe inhalation injury; (4) patients had skin diseases that could affect wound healing; (5) patients had chemical burns; (6) patients had vascular diseases; (7) patients had scalds on the face and/or perineum; (8) patients had combined fracture; (9) patients had poor compliance and confusion; and (10) patients refused to participate in the study.

METHODS

The control group received routine intervention. The primary nurses established an electronic patient file after the patients were admitted to the hospital to record patient demographic data and diabetes‐related information. According to the patient's height, weight, and daily activity, the total daily calories and the proportion of energy supplied by carbohydrates, protein and fat were calculated, and the patients were guided to eat a healthy diet. Furthermore, the nursing staff distributed diabetes and scalds knowledge manuals, control wound exudation, protect the skin around the wounds, provide medicine for pain relief, and carry out in‐hospital health lectures on diabetes and scalds.

The SBC group received SBC‐based nursing intervention. The specific measures were as follows.

The intervention group was established with the director of the endocrinology department and the director of the scald department as the team leaders, and the head nurse of the scald department as the deputy team leader, and one nutritionist, four senior nurses, and four nurses as the team members. The team members needed to work in the scald department for at least 5 years. The team leaders conducted quality control, the head nurse conducted work coordination and resource allocation for various positions, the dietitian formulated recipes, and other members conducted pre‐intervention education, behaviour guidance and data collection. Meanwhile, endocrinologists and scald experts from our hospital and other hospitals were invited as consultants to collaborate with team members to formulate study procedures. Thereafter, the study procedures were submitted to the ethics committee for approval, examination, and verification.

After the patient was hospitalized, the intervention was divided into five stages according to the behaviour change theory, namely, pre‐contemplation stage, contemplation stage, preparation stage, action stage, and maintenance stage. At the pre‐contemplation stage, the patients did not change their behavioural intention. At this stage, the group members used diversified educational methods such as graphics, videos, and health education manuals to carry out health education for diabetic patients with scalds after they were admitted to hospital. Active communication with patients was carried out, and the patients were informed in detail of the specific methods of treating scalds and the prognosis, and attempts were made to eliminate the patients' negative psychology. For patients with a large trauma area or existing functional disorders, they were told with previous successful cases and advanced plastic surgery methods to improve their confidence in overcoming the disease. The patients were encouraged to participate in education, master the importance of healthy diet, daily life, pay attention to hygiene, and improve self‐confidence so as to change their own behaviour intention and improve their own cognitive ability. Attention was paid to the wound surface and dressing was changed in time. When the doctor changed wound dressings, the primary nurse held the patient's hand with one hand, and gently soothed the patient's non‐wound skin with the other hand. Care was taken not to touch the doctor's dressing area while the patient was comforted with words and told to adjust breathing by exhaling slowly through the mouth as much as possible, and the lips were like a flute while exhaling. The patients were told not to deal with wound without authorization, including hand scratching. At the contemplation stage, the patients had no specific behaviour changes, but there was an intention to change behaviour. At this stage, the nursing staff should deeply understand the patients' confusion about healthy diet and self‐confidence, and the reasons for not taking effective measures. The primary nurse should pay attention to establishing a relationship of mutual trust with the patients, inform them of the impact of unhealthy diet and negative mental state on plasma glucose and wounds, and strengthen patients' willingness to accept behaviour changes. The benefits of behaviour change for patients were analysed, and detailed and feasible change goals were formulated for patients and their relatives according to the specific conditions of each patient. The goals were set to be achieved within a certain period of time, so as to improve the determination and self‐confidence of the patients to change behaviour. The skin temperature and colour changes around the wound surface were observed, and the vital signs were recorded in detail daily. If there were inflammatory secretions on the wound surface, specimens were collected in time, bacterial culture and drug sensitivity test were conducted, and predictive anti‐infective care was provided. At the preparation stage, the patients had a strong intention to change behaviour and were ready to take action. At this stage, the patients had formed strong self‐confidence. A diet plan and a psychological management plan were formulated according to the patients' needs and acceptability. The patients' current unhealthy eating behaviours and negative psychology were analysed so as to conduct targeted health education. The relatives were reminded that they should care for the patients, and promptly intervene in the patient's negative psychological condition. Solutions for the expected problems were provided. At the action stage, the patients began to change their behaviours. At this stage, through encouragement and supervision, the patients were guided to feel the benefits of behaviour change so as to promote their healthy behaviours. Patients who could perform functional training were taught to perform functional training and medication care. At the maintenance stage, the behaviour change was stable. At this stage, the healthy diet behaviours were maintained by encouragement, follow‐up guidance, answering questions, and supervision of relatives. The patients were educated to apply scar hyperplasia drugs to the wound scar and use elastic bandage to compress the wound. When the patients were discharged from the hospital, they were told to avoid collar rubbing on the wound, avoid irradiation, not to stick tape, pay attention to keep the skin clean and dry, avoid excessive cold or heat, and avoid irritation of soap, iodine, and alcohol.

Observational index

The wound granulation tissue growth time and wound healing time were compared. Pain intensity, QoL, self‐efficacy, and wound exudation were observed 3, 7, and 15 days after intervention.

Granulation tissue growth time was the time from initial intervention to the growth of brightly red granulation tissue on the wound. Wound healing time was the time from initial intervention until the wound was completely epithelialized.

Pain score

Visual analogue scale was used to evaluate the severity of pain during dressing change in the two groups. The score of the scale ranges from 0 to 10 points, with 0 being painless and 10 being the most severe pain.

Quality of life

The World Health Organization QoL questionnaire (WHOQOL‐100) was used to evaluate the QoL of patients before and after intervention. The scale is divided into eight dimensions, including mental health, emotional function, social function, vitality state, physical pain, physiological function, and overall health. The score is 0 to 100, and higher scores indicate better QoL.

Self‐efficacy

The chronic disease self‐efficacy scale was used before and after intervention. The scale is divided into two dimensions, symptom management self‐efficacy (communication with doctors, emotional communication, role function, symptom management) and disease common management self‐efficacy (medicine as prescribed and control of water and salt intake, nutrition), with a total of six items. Each item uses a scale of 1 to 10, with 1 indicating complete lack of confidence, 10 indicating complete confidence, and the higher scores indicate greater self‐efficacy.

Wound exudation

Wound exudation score is 0 to 4. Among them, 0 means no exudation; 1 means very slight exudation; 2 means mild exudation and can penetrate 1 gauze; 3 means medium exudation, which can penetrate 2 or 3 gauzes; 4 means a large amount of exudation, which can penetrate 4 or more gauzes.

Statistical analysis

Data were statistically analysed using statistical software SPSS21.0. Measurement data were expressed as mean ± standard deviation (SD) and evaluated using Student's t test. Categorical data were expressed as percentage and compared using a Chi‐square test. The level of statistical significance for all the above tests was defined at a probability value of less than 0.05 (P < 0.05).

RESULTS

Baseline characteristics

The age of the SBC group was 22 to 59 years with a mean age of 44.93 ± 4.23 years, and had 26 males and 15 females. The control group were 22 to 58 years old, the mean age was 44.89 ± 4.19 years old, with 24 males and 17 females. The wound sites, wound area, and duration of diabetes in these two groups were comparable (P > 0.05; Table 1).

TABLE 1

Comparison of baseline characteristics

Index	The SBC group (n = 41)	The control group (n = 41)	χ2/t	P
Gender (male/female), n	26/15	24/17	0.205	0.651
Age, years	44.93 ± 4.23	44.89 ± 4.19	0.043	0.966
Wound site			0.945	0.623
Limbs	23	25
Trunk	11	12
Hip	7	4
Wound area	18.37 ± 3.28	18.26 ± 3.32	0.151	0.880
Duration of diabetes, years	6.83 ± 1.37	6.79 ± 1.41	0.130	0.897

Comparison of wound granulation tissue growth time and wound healing time

The granulation tissue growth time in the SBC group was 8.93 ± 1.08 days, which was shorter than that in the control group (10.89 ± 2.01 days, P < 0.001). The wound healing time in the SBC group was 21.29 ± 1.23 days, which was also shorter than that in the control group (29.98 ± 1.76 days, P < 0.001; Table 2).

TABLE 2

Comparison of granulation tissue growth time and wound healing time

Index	The SBC group (n = 41)	The control group (n = 41)	t	P
Granulation tissue growth time, day	8.93 ± 1.08	10.89 ± 2.01	−5.500	<0.001
Wound healing time, day	21.29 ± 1.23	29.98 ± 1.76	−25.914	<0.001

Comparison of pain intensity

The 3‐, 7‐, and 15‐day pain intensity scores of the SBC group were 5.11 ± 0.87, 3.27 ± 0.67, and 1.73 ± 0.59, respectively. While the 3‐, 7‐, and 15‐day pain intensity scores of the SBC group were 5.89 ± 0.91, 4.98 ± 0.72, and 3.37 ± 0.62, respectively. The 3‐, 7‐, and 15‐day pain intensity of the SBC group were all lower than those of the control group (P < 0.001, respectively) (Table 3).

TABLE 3

Comparison of pain intensity

Time	The SBC group (n = 41)	The control group (n = 41)	t	P
3 days after intervention	5.11 ± 0.87	5.89 ± 0.91	−3.967	<0.001
7 days after intervention	3.27 ± 0.67	4.98 ± 0.72	−11.133	<0.001
15 days after intervention	1.73 ± 0.59	3.37 ± 0.62	−12.270	<0.001

Comparison of QoL

Before intervention, there was no significant difference in mental health, role emotional, social function, vitality status, physical pain, role physical, physical function, and general health between the two groups (P > 0.05, respectively). After intervention, the above indicators in the SBC group were significantly higher than those in the control group (P < 0.05, respectively) (Table 4).

TABLE 4

Comparison of quality of life

Index	Time	The SBC group (n = 41)	The control group (n = 41)	t	P
Mental health	Before intervention	53.92 ± 3.48	53.89 ± 3.53	0.039	0.969
	After intervention	78.93 ± 4.52	71.02 ± 5.31	7.263	<0.001
	t	−28.073	−17.202
	P	<0.001	<0.001
Role emotional	Before intervention	52.91 ± 4.23	52.87 ± 4.32	0.042	0.967
	After intervention	72.19 ± 5.28	67.39 ± 5.09	4.191	<0.001
	t	−18.247	−13.926
	P	<0.001	<0.001
Social function	Before intervention	49.84 ± 4.09	49.78 ± 4.38	0.064	0.949
	After intervention	71.98 ± 6.38	66.39 ± 5.83	4.142	<0.001
	t	−18.706	−14.585
	P	<0.001	<0.001
Vitality status	Before intervention	50.93 ± 5.11	51.03 ± 5.09	−0.089	0.929
	After intervention	73.29 ± 6.03	68.93 ± 6.11	3.252	0.002
	t	−18.114	−18.114
	P	<0.001	<0.001
Physical pain	Before intervention	50.34 ± 5.63	51.29 ± 4.28	−0.860	0.392
	After intervention	72.98 ± 6.11	66.93 ± 6.01	4.520	<0.001
	t	−17.448	−13.573
	P	<0.001	<0.001
Role physical	Before intervention	50.21 ± 5.28	50.37 ± 5.21	−0.138	0.891
	After intervention	74.39 ± 6.34	67.93 ± 6.03	4.728	<0.001
	t	−18.765	−14.110
	P	<0.001	<0.001
Physiological function	Before intervention	50.93 ± 5.34	51.08 ± 5.43	−0.126	0.900
	After intervention	72.92 ± 6.01	68.93 ± 6.39	2.912	0.005
	t	−17.514	−13.630
	P	<0.001	<0.001
General health	Before intervention	51.29 ± 5.64	51.34 ± 5.59	−0.040	0.968
	After intervention	74.02 ± 5.49	69.93 ± 6.43	3.097	0.003
	t	−18.491	−13.971
	P	<0.001	<0.001

Comparison of self‐efficacy

Before intervention, there was no significant difference between the two groups in communication with doctors, emotional communication, role function, symptom management, medication as prescribed, and control of water and salt intake and nutrition (P > 0.05, respectively). After intervention, the above indicators in the SBC group were all significantly higher than those in the control group (P < 0.05, respectively; Table 5).

TABLE 5

Comparison of self‐efficacy between the two groups

Index		The SBC group (n = 41)	The control group (n = 41)	t	P
Communication with doctors	Before intervention	3.29 ± 0.47	3.22 ± 0.49	0.660	0.511
	After intervention	7.32 ± 0.54	6.51 ± 0.56	6.667	<0.001
	t	−36.045	−28.311
	P	<0.001	<0.001
Emotional communication	Before intervention	3.18 ± 0.42	3.21 ± 0.44	−0.316	0.753
	After intervention	7.27 ± 0.49	6.83 ± 0.52	4.015	<0.001
	t	−40.580	−34.028
	P	<0.001	<0.001
Role function	Before intervention	3.45 ± 0.56	3.40 ± 0.54	0.412	0.681
	After intervention	7.19 ± 0.51	6.43 ± 0.52	8.379	<0.001
	t	−31.617	−25.880
	P	<0.001	<0.001
Symptom management	Before intervention	3.63 ± 0.61	3.57 ± 0.63	0.438	0.663
	After intervention	7.43 ± 0.56	6.62 ± 0.49	6.970	<0.001
	t	−29.384	−24.469
	P	<0.001	<0.001
Medication as prescribed	Before intervention	3.48 ± 0.66	3.42 ± 0.61	0.427	0.671
	After intervention	7.21 ± 0.48	6.72 ± 0.53	4.388	<0.001
	t	−29.266	−26.149
	P	<0.001	<0.001
Control water and salt intake, nutrition	Before intervention	3.51 ± 0.48	3.48 ± 0.52	0.271	0.787
	After intervention	7.33 ± 0.56	6.78 ± 0.49	4.733	<0.001
	t	−33.163	−29.574
	P	<0.001	<0.001

Comparison of wound exudation

The 3‐, 7‐, and 15‐day wound exudation score of the SBC group were 1.97 ± 0.23, 1.62 ± 0.29, and 1.38 ± 0.18, respectively. Meanwhile, the 3‐, 7‐, and 15‐day wound exudation score of the control group were 2.53 ± 0.32, 2.28 ± 0.35, and 1.89 ± 0.21, respectively. The wound exudation scores of the SBC group were all significantly lower than those of the control group (P < 0.001, respectively; Table 6).

TABLE 6

Comparison of wound exudation scores

Time	The SBC group (n = 41)	The control group (n = 41)	t	P
3 days after intervention	1.97 ± 0.23	2.53 ± 0.32	−9.099	<0.001
7 days after intervention	1.62 ± 0.29	2.28 ± 0.35	−9.298	<0.001
15 days after intervention	1.38 ± 0.18	1.89 ± 0.21	−11.807	<0.001

DISCUSSION

As the prevalence of diabetes continues to increase, the incidence of diabetes combined with burns has also continued to increase over the recent years. Scalds in diabetic patients, especially large‐area scalds, can aggravate diabetes and cause complications. The aggravation of diabetes and complications will affect burn treatment and wound repair, forming a vicious circle and increasing the difficulty of treatment. , Diabetes causes metabolic derangements, wound healing disorders, immune dysfunction, and vascular damage via glycosylation. Damage to the skin of diabetic patients will delay wound healing, and the wound will recur after healing, showing pathological manifestations such as excessive inflammation repairing obstacles, poor granulation formation, fragile tissues, and epithelial retardation. Sweat glands, hair follicles, and other tissues remain on the wounds of second‐degree deep burns, and sweat glands and hair follicles are the habitat for bacterial colonization. If infection occurs, the wounds often become progressively deeper. Clinically, diabetic patients with second‐degree deep burns are prone to wounds and invasive infections, and the wounds are prolonged and unhealed, which has become a key clinical issue that needs to be solved urgently. A previous study showed that the long treatment cycle of diabetic patients with scalds reduces the QoL of patients, affects treatment compliance, increases the incidence of postoperative complications, and is not conducive to recovery. Therefore, for targeted treatment of diabetic patients with scalds, active and effective nursing care should be given, which can effectively shorten the wound healing time and promote wound recovery, which is of great clinical significance.

Gu et al found that effective nursing intervention for patients with deep burns can shorten wound healing time, reduce wound pain, and help functional recovery after surgery. The results of this study showed that the granulation tissue growth time and wound healing time in the SBC group were shorter than those in the control group, suggesting that SBC‐based nursing intervention can effectively shorten wound granulation growth time and healing time of diabetic patients with scalds, which is beneficial to wound healing. This may be because of the fact that SBC‐based nursing interventions can better regulate patients' dietary patterns, daily life, hygiene habits, and improve patients' self‐confidence. Moreover, observing the wounds of patients and changing the dressings in time can promote would healing in diabetic patients with scalds.

Pain has been listed as the fifth vital sign, and, along with blood pressure, respiration, pulse, and body temperature, is used as an indicator to evaluate patients. Burn pain is mainly caused by direct damage to the epidermis and dermis because of heat, which stimulates exposed tissue and abundant nerve endings. Superficial second‐degree burns and the basal layer and dermal papillary layer make pain more sensitive. Early treatment of burns requires timely replacement of dressings and removal of necrotic tissue, which is beneficial to wound repair and can reduce the incidence of infection. Most nurses believe that changing dressing is the most painful, and cleaning wound is the second. For burn patients, they not only need to face the bloody dressing change scene, but also need to withstand severe pain caused by tearing the dressing and the debridement of the skin tissue during dressing change. These will cause negative psychology and affect the sleep and appetite, resulting in a decline in the QoL. Although analgesic drugs can relieve pain to a certain extent, nursing intervention as part of auxiliary pain management has attracted substantial attention in recent years. , , Effective nursing intervention can effectively relieve severe pain caused by dressing change on burn wounds, which is of great significance to patients' psychology and physiology. Najafi Ghezeljeh et al found that music, massage, and a combination of both interventions were effective in reducing pain and anxiety intensity and increasing relaxation level. Keivan et al indicated that religious and spiritual care can help decrease pain intensity caused by dressing change and can increase the satisfaction by these patients with pain control. Liu et al suggested that effective nursing intervention can effectively relieve pain in the treatment of burn wounds. The results of this study showed that the pain intensity of the SBC group was lower than that of the control group after intervention for 3, 7, and 15 days (P < 0.05, respectively), suggesting that SBC‐based nursing intervention can effectively alleviate the pain of diabetic patients with scalds. This may be because of the fact that the SBC‐based nursing intervention applied handshake comfort and breathing guidance for patients, combined with mental comfort, can relieve the tension of the patients' muscles, facilitate blood circulation, and distract the patients' attention so as to achieve the effect of analgesia.

QoL is an important indicator for evaluating patients' recovery from illness, mainly including psychological, physical, and social support. In recent years, many nursing staff have explored the impact of different nursing models on improving the QoL of burn patients. Rezaei et al showed that both telenursing and face‐to‐face training can be used to improve the QoL of survivors of burn injuries during rehabilitation. Another prospective study found that at‐dismissal self‐care compact disk‐based instruction program can increase physical performance and QoL of patients with burns. The results of this study showed that after the intervention, the mental health, emotional functioning, social functioning, vitality status, physical pain, physical functioning, physical functioning, and general health of the SBC group were all higher than those of the control group (P < 0.05, respectively), suggesting that SBC‐based nursing intervention could effectively improve the QoL of diabetic patients with scalds. This may be because of the fact that the SBC‐based nursing intervention changed the unhealthy behaviour of diabetic patients with scalds, and helped to develop good and healthy behaviours, which could promote would healing and improve the QoL of the patients.

Self‐efficacy refers to the belief of an individual's ability to successfully implement and complete a certain behaviour goal or cope with a certain difficult situation. The individual has a higher sense of self‐efficacy; the higher the confidence in completing a certain behaviour, the more able to carry out practical actions.

The level of self‐efficacy in patients with type 2 diabetes has a direct impact on change of their own behaviour. Jia et al proved that nursing intervention can effectively improve medication compliance and self‐efficacy of patients with type 2 diabetes. The results of this study showed that after intervention, communication with doctors, emotional communication, role function, symptom management, medication as prescribed, and control of water and salt intake, and nutrition were all higher in the SBC group than those in the control group (P < 0.05, respectively), suggesting that SBC‐based nursing intervention can effectively improve the self‐efficacy of diabetic patients with scalds. This may be because SBC‐based nursing intervention can provide individualized guidance, help to improve their self‐confidence, strengthen the willingness to accept behaviour changes, strengthen and maintain the purpose of healthy diet and life, and mobilize and change patients' intrinsic motivation, thereby improving the level of self‐efficacy. This study further observed the wound exudation of diabetic patients with scalds. The results showed that the 3‐, 7‐, and 15‐day wound exudation scores of the SBC group were lower than those of the control group, suggesting that SBC‐based nursing intervention could effectively reduce the wound exudation score in diabetic patients with scalds and promote wound healing.

Although this study showed that SBC‐based nursing intervention is helpful for the recovery of diabetic patients with scalds, but the relatively small sample size is a problem that cannot be ignored.

In conclusion, SBC‐based nursing intervention can effectively shorten granulation tissue growth time and wound healing time, promote wound recovery, relieve pain, improve QoL and self‐efficacy, and reduce wound exudation in diabetic patients with scalds, which is conducive to the rehabilitation of patients.

CONFLICT OF INTEREST

The authors declared no potential conflicts of interest.

AUTHOR CONTRIBUTIONS

CKL and MY contributed to the conception and design of the study; ZHC and BQG performed the experiments, MMY, LQR, JL and YLZ collected and analysed data; CKL and MY wrote the manuscript. All authors reviewed and approved the final version of the manuscript.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The study was approved by the ethics committee of the First Hospital of Hebei Medical University. Written informed consent was obtained from all the study subjects before enrolment.