Complete range of nursing actions for agitated behaviour in elderly patients with emergency liver cirrhosis and bleeding

Abstract

BACKGROUND

Agitated behaviour is a common and challenging complication in elderly patients with liver cirrhosis who present with acute haemorrhage in an emergency setting. It not only hinders medical care but also increases the risk of adverse clinical outcomes. Nursing interventions may play a role in managing this agitation and improving clinical outcomes. We hypothesized that a comprehensive nursing intervention combining psychological support, pain management, and family engagement would reduce agitated behavior in this population.

AIM

To investigate the efficacy of comprehensive nursing interventions on agitated behavior in elderly emergency patients with liver cirrhosis and hemorrhage.

METHODS

This randomized controlled study recruited 180 elderly patients with liver cirrhosis and hemorrhage (Cohen-Mansfield Agitation Inventory score ≥ 45) from a tertiary hospital (January 2022-December 2024). Participants were randomized to routine care (n = 90) or comprehensive nursing intervention plus routine care (n = 90). Agitated behavior, neuroendocrine stress indicators, inflammatory markers, adverse events, and patient and family nursing satisfaction were assessed before and after intervention between the groups. Statistical analyses included χ² tests, Fisher’s exact tests, and multiple linear regression analysis.

RESULTS

After the intervention, the observation group showed significantly lower Cohen-Mansfield Agitation Inventory scores, daily frequency of agitated episodes, and single-episode duration compared to the control group (all P < 0.05). Serum cortisol, norepinephrine, interleukin-6, and tumor necrosis factor alpha levels decreased significantly (all P < 0.05). The observation group had significantly lower rates of re-bleeding, unplanned extubation, and intensive care unit transfer (all P < 0.05). Regression analysis identified adherence to personalized psychological intervention (standardized β = 0.382, contribution of 42.3%), pain management effectiveness (β = 0.296, 32.7%), and family accompaniment duration (β = 0.185, 20.5%) as primary drivers of improvement. These three factors collectively explained 52.6% of the variance. Patient and family satisfaction scores were higher in the observation group (all P < 0.05).

CONCLUSION

Comprehensive nursing interventions reduce agitated behavior, neuroendocrine-immune stress response, inflammation, complications, and improve patient and family nursing satisfaction, demonstrating clinical value for elderly emergency patients with liver cirrhosis and hemorrhage.

Keywords: Liver cirrhosis; Hemorrhage; Elderly patients; Emergency care; Agitated behavior; Nursing intervention; Intervention effect

Core Tip: This study demonstrates that a comprehensive nursing protocol significantly reduces agitation. It also improves physiological markers and patient-family satisfaction. The protocol integrates psychological support, effective pain management, and family involvement. It is used in high-risk elderly emergency patients with cirrhotic hemorrhage. These findings highlight a practical approach. This approach is to manage agitated behaviours. Agitated behaviours are a common and challenging complication. This is in this vulnerable population.