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.

Key Words: 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.

INTRODUCTION

When it comes to emergency situations, elderly patients suffering from liver cirrhosis are especially at risk. There is an age-related decline in physiological reserve. There is also impaired hepatic metabolic capacity. There is a high prevalence of comorbidities. All of these things significantly reduce the ability to tolerate acute stressors. Examples of such stressors include massive hemorrhage. When acute upper gastrointestinal bleeding occurs, the risk of neuropsychiatric complications is increased by rapid haemodynamic fluctuations, hypoxia, metabolic disturbances and an unfamiliar and highly stimulating emergency environment. One of the most common and clinically challenging manifestations of these complications is agitated behaviour, which often emerges early during emergency management.

The population of China is ageing rapidly, which is leading to an increase in the number of elderly patients suffering from liver cirrhosis. The body’s ability to compensate for liver injury is reduced due to structural remodelling resulting from chronic liver injury. This makes this population highly susceptible to esophageal and gastric variceal bleeding caused by portal hypertension. The sudden onset and rapid progression of this condition is what characterises it. It is characterised by the sudden occurrence of vomiting blood and passing blood in the stools. There is an extremely high risk of death associated with this condition[1,2].

Elderly patients often experience ”agitated behaviour” during the emergency treatment phase. This is characterised by emotional restlessness, increased verbal or physical aggression, treatment refusal and uncooperative struggling. The triggers for this behaviour include acute pain, tissue hypoxia, metabolic disturbances and heightened psychological stress[3]. Such behaviour can disrupt clinical diagnosis and treatment. It can also increase the risk of in-hospital safety events. These include aspiration, falls and unplanned extubation. This can affect prognosis[4,5].

The way to deal with worried patients in the emergency room is mostly based on what has worked in the past, using physical force to restrain them and medicines to help them sleep[6]. However, these methods may not work well and can actually make things worse for elderly patients with liver cirrhosis because of how their bodies process drugs, their reduced cognitive abilities, and their increased risk of complications. This underscores the pressing need for evidence-based, comprehensive nursing strategies that seamlessly integrate psychological interventions, environmental optimisation, pain management, and family involvement.

The present study tried to find out what happens when nurses do a lot to help elderly patients with liver problems who are in hospital because of bleeding. It also looked at how these patients’ stress responses, inflammation, and how they get better or worse might be affected by the help the nurses give. We expect these findings to provide practical evidence for optimising emergency nursing care and promoting patient-centred nursing models in this high-risk group.

MATERIALS AND METHODS

General data

This study collected data from 180 elderly patients with liver cirrhosis and acute upper gastrointestinal bleeding who were hospitalized at the Emergency Medical Center of Nantong Third People’s Hospital between January 1, 2022, and December 31, 2024. The diagnosis of liver cirrhosis was determined based on the clinical symptoms and imaging, endoscopic, and histopathological results[7]. Acute upper gastrointestinal bleeding was confirmed based on the presence of hematemesis or melena, a significant decrease in hemoglobin level, and endoscopic signs of active bleeding[8]. Within 24 hours of admission, agitated behaviour was assessed using the Cohen-Mansfield Agitation Inventory (CMAI). A score of 45 or more on this scale was considered indicative of an agitated state. The rules for who could join were: The following criteria must be met for inclusion: (1) The subject must be aged 65 years or over, as defined by the World Health Organization and in accordance with standard geriatric classification; (2) A diagnosis of liver cirrhosis must be made based on the aforementioned criteria; (3) There must be a confirmed case of acute upper gastrointestinal bleeding; (4) The CMAI score must be ≥ 45; (5) The subject must have the ability to engage in basic verbal communication; and (6) Complete medical records must be available.

The exclusion criteria were as follows: (1) A serious head injury; (2) Use of strong painkillers after being admitted; (3) Human immunodeficiency virus or another autoimmune disease; and (4) Likely to live for less than 2 days. Patients were divided into control and observation groups using the random number table method, with 90 patients in each group.

Nursing intervention protocol

Routine emergency care was received by the control group, which was as follows: (1) Vital signs, consciousness, bleeding volume and characteristics must be monitored regularly and checked for liver function and coagulation profiles; (2) Hemostatic and acid-suppressive drugs must be administered accurately as prescribed, to assist with endoscopic or Sengstaken-Blakemore tube hemostasis; (3) Airways must be kept patent, oxygen therapy must be provided, intravenous access must be rapidly established and standard oral and skin care must be performed; and (4) Patients and their families must be explained the condition, key treatment points and precautions in simple and clear language.

The following specific measures were part of the comprehensive nursing interventions given to the observation group, in addition to the routine care.

Personalized psychological intervention: Personalised help for mental health: (1) Trust building: The nursing staff employed a meticulous and considerate approach to communication, eschewing technical jargon in favour of language that was both unhurried and easily comprehensible. The patient’s sense of security was enhanced by moderate physical contact, such as holding hands or lightly touching the shoulder/back; (2) Emotional support: Tackling trepidation and unease through empathetic listening and active engagement, and directing patients to articulate their internal experiences. Explaining the controllability of bleeding and providing successful case examples reduced negative emotions; and (3) Cognitive intervention: Patients with preserved cognitive function were encouraged to regulate their emotions actively by explaining to them the adverse effects of agitated behaviour on their condition.

Environmental optimization: (1) Regulation of sonic and luminous phenomena. A low noise level was maintained in the emergency ward and loud conversations were prohibited. The alarm volumes for monitors and infusion pumps were set to the minimum audible level. Strong direct lighting was avoided with a preference for diffused light sources to reduce visual stimulation; (2) Microclimate: Room temperature was maintained at 22-24 °C and relative humidity at 50%-60%; and (3) Familiarization: Familiar personal items (e.g., family photos and frequently used clothing) were placed within the patient’s line-of-sight to reduce anxiety triggered by the unfamiliar environment.

Pain management: (1) Pain intensity was quantified using the numerical rating scale. Reports of abdominal pain, headache, etc., were immediately escalated, and pharmacological or non-pharmacological analgesia (including guided breathing exercises and music relaxation therapy) was implemented as prescribed; and (2) Bedridden patients were assisted to change position every 2 hours, with soft pillows placed at pressure points to prevent pressure injuries.

Communication strategies: (1) For patients exhibiting treatment refusal, a “step-by-step information” strategy was used, which involved explaining the purpose, procedure, and clinical significance of each operation individually to reduce information overload and decision-making conflict; (2) Patients were informed in advance of any invasive procedures, e.g., “we are about to perform a puncture; it may cause mild pain, but it will be brief”. Procedures were performed gently and accurately to minimize stress; and (3) For patients at risk of impulsivity or aggression, “one-to-one specialized companionship” was implemented, using conversation, music, etc., to divert attention. In principle, physical restraints are avoided, ensuring both treatment safety and humanistic care.

Family support intervention: Providing continuous accompaniment was something that was encouraged for family members when the patient’s condition allowed. Guidance was provided for them to participate in basic care. This included helping with feeding and sponge bathing. The patient’s confidence in their recovery and adherence to treatment was strengthened by positive verbal encouragement and continuous emotional communication. All intervention processes were recorded using the electronic nursing log system.

Observation indicators

The CMAI[9] was used to assess agitated behaviours. The scale is made up of 29 items, which cover three different dimensions: (1) Physically aggressive behaviour (13 items); and (2) Verbally aggressive behaviour (10 items); and (3) Nonaggressive motor behavior (6 items). Each item is scored based on the frequency of behavior occurrence, ranging from 1 point (never occurs) to 7 points (≥ 1 time per hour). The total score ranged from 29 points to 203 points, with a higher score indicating a more severe degree of agitation. Simultaneously, the average number of episodes per day and the duration of single behavioral episodes were recorded to assess the frequency and persistence of the behavior.

Physiological stress indicators: Fasting venous blood was collected in the morning before the intervention (T0) and on day 7 after the intervention (T7). After centrifugation, serum levels of cortisol, norepinephrine, interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were measured.

Clinical outcomes: (1) Re-bleeding; (2) Aspiration; (3) Unplanned extubation; (4) Intensive care unit (ICU) transfer; and (5) Mortality.

Patient and family subjective experience and nursing satisfaction analysis: A self-compiled “questionnaire on nursing experience of critically Ill emergency patients” (Cronbach’s α = 0.86) was used to survey patients (those with clear consciousness) and family members in both groups. The scale covers three dimensions: (1) Sense of security experience; (2) Information communication satisfaction; and (3) Perception of humanistic care. Each dimension uses an 11-point Likert scale (1 point representing “extremely dissatisfied”, 10 points representing “very satisfied”). The total scale score ranges from 3 points to 30 points, with a higher score indicating a better subjective care experience.

Statistical analysis

All data were processed using SPSS 26.0. Measurement data are presented as mean ± SD, and intergroup differences were assessed using independent samples t-tests. Count data were described as n (%), and intergroup comparisons were performed using the χ² test or Fisher’s exact test. Multiple linear regression analysis was used to analyze the contribution and degree of impact of each intervention module on the outcome variables. P < 0.05 were considered statistically significant for all analyses.

RESULTS

Baseline characteristics of the study population

The control group included 58 males and 32 females, aged 60-82 years (68.59 ± 5.23 years). Cirrhosis etiologies included hepatitis B (n = 38), hepatitis C (n = 12), alcoholic liver disease (n = 25), and other causes (n = 15). Bleeding severity was mild (blood loss < 500 mL, n = 28), moderate (500-1000 mL, n = 42), and severe (> 1000 mL, n = 20). Child-Pugh classification was grade A (n = 22), grade B (n = 45), and grade C (n = 23). Comorbidities included hypertension (n = 38) and diabetes (n = 21).

The observation group included 56 males and 34 females, aged 61-83 years (69.21 ± 5.56 years). Cirrhosis etiologies included hepatitis B (n = 36), hepatitis C (n = 14), alcoholic liver disease (n = 23 cases), and other causes (n = 17 cases). Bleeding severity was mild (n = 30), moderate (n = 40), and severe (n = 20). Child-Pugh classifications include: (1) Grade A (n = 24); (2) Grade B (n = 43); and (3) Grade C (n = 23). Comorbidities included hypertension (n = 40) and diabetes (n = 19).

Comparison of general data between the two groups showed no statistically significant differences (P > 0.05), indicating comparability (Table 1).

Table 1 Comparison of baseline characteristics between the control group and the observation group, n (%)/mean ± SD.

Characteristic	Control group (n = 90)	Observation group (n = 90)	P value
Sex
Male	58 (64.4)	56 (62.2)	0.120
Female	32 (35.6)	34 (37.8)
Age (years)
Range	60-82	61-83
	68.59 ± 5.23	69.21 ± 5.56	0.082
Etiology of cirrhosis
Hepatitis B	38 (42.2)	36 (40.0)	0.921
Hepatitis C	12 (13.3)	14 (15.6)
Alcoholic liver disease	25 (27.8)	23 (25.6)
Others	15 (16.7)	17 (18.9)
Severity of bleeding
Mild (< 500 mL)	28 (31.1)	30 (33.3)	0.381
Moderate (500-1000 mL)	42 (46.7)	40 (44.4)
Severe (> 1000 mL)	20 (22.2)	20 (22.2)
Child-Pugh classification
Grade A	22 (24.4)	24 (26.7)	0.743
Grade B	45 (50.0)	43 (47.8)
Grade C	23 (25.6)	23 (25.6)
Comorbidities
Hypertension	38 (42.2)	40 (44.4)	0.234
Diabetes mellitus	21 (23.3)	19 (21.1)

Comparison of agitated behavior between the two groups

Before the intervention, there were no statistically significant differences between the two groups in terms of CMAI total score, mean daily frequency of agitated episodes, or duration of single episodes (all P > 0.05), indicating comparable baseline agitation severity (Table 2).

Table 2 Comparison of core indicators of agitation behavior changes between the two groups, mean ± SD.

Group	n	Cohen-Mansfield Agitation Inventory score		Mean number of episodes per day (times/day)		Duration of once (minutes)
		Before	After	Before	After	Before	After
Control	90	69.20 ± 8.12	53.89 ± 6.73	4.21 ± 0.82	3.32 ± 0.76	28.57 ± 6.32	20.17 ± 4.52
Observation	90	70.89 ± 9.10	42.56 ± 5.25	4.15 ± 0.90	1.85 ± 0.53	27.90 ± 6.15	10.27 ± 2.82
t value		1.315	12.593	0.468	15.051	0.721	17.629
P value		0.190	0.000	0.641	0.000	0.472	0.000

After the intervention, all agitation-related indicators showed significant improvements in both groups; however, the magnitude of improvement was substantially greater in the observation group. Specifically, the post-intervention CMAI score in the observation group was markedly lower than that in the control group (42.56 ± 5.25 vs 53.89 ± 6.73, P < 0.001). In addition, the mean number of agitated episodes per day decreased more prominently in the observation group (1.85 ± 0.53 times/day) compared with the control group (3.32 ± 0.76 times/day, P < 0.001). Similarly, the duration of single agitated episodes was significantly shorter in the observation group than in the control group (10.27 ± 2.82 minutes vs 20.17 ± 4.52 minutes, P < 0.001).

Comparison of neuroendocrine and inflammatory indicators between the two groups

Before the intervention, there were no significant differences in cortisol, norepinephrine, IL-6, and TNF-α levels between the two groups (P > 0.05). After the intervention, all indicators in the observation group were lower than those in the control group (P < 0.05; Table 3).

Table 3 Comparison of neuroendocrine and inflammatory index changes in two groups, mean ± SD.

Group	n	Cortisol (μg/dL)		Norepinephrine (pg/mL)		Interleukin-6 (pg/mL)		Tumor necrosis factor alpha (pg/mL)
		Before	After	Before	After	Before	After	Before	After
Control	90	22.42 ± 5.11	18.56 ± 4.13	842.46 ± 156.67	678.69 ± 134.25	89.36 ± 20.12	61.21 ± 14.35	45.67 ± 10.29	32.67 ± 7.83
Observation	90	22.15 ± 4.92	14.36 ± 3.22	835.89 ± 162.23	436.78 ± 98.10	88.76 ± 21.37	32.52 ± 8.76	44.85 ± 11.12	18.32 ± 5.16
t value		0.361	7.608	0.276	13.802	0.194	16.189	0.513	14.518
P value		0.718	0.000	0.783	0.000	0.846	0.000	0.608	0.000

Comparison of clinical complications and outcomes between the two groups

The risks of re-bleeding, unplanned extubation, and ICU transfer in the control group were 2.80 times, 3.63 times, and 2.32 times those in the observation group, respectively, and the differences in these indicators between the groups were statistically significant (all P < 0.05). There were no statistically significant differences between the two groups in terms of aspiration or mortality (all P > 0.05; Table 4).

Table 4 Comparison of clinical complications and outcomes between the two groups, n (%).

Group	n	Re-bleeding	Aspiration	Unplanned extubation	Change over to intensive care unit	Death
Control	90	15	10	13	33	11
Observation	90	6	3	4	18	5
χ² value		4.367	-	-	6.156	-
P value		0.037	0.081	0.039	0.013	0.189
Odds ratio		2.800	3.625	3.630	2.316	2.367
95%CI		1.033-7.588	0.963-13.650	1.135-11.610	1.183-4.532	0.787-7.117

Analysis of the contribution of different intervention modules to agitation improvement in the observation group

Adherence to personalized psychological intervention, effectiveness rate of pain management, and duration of family accompaniment had significant positive effects on the improvement of agitated behaviors, with adherence to personalized psychological intervention contributing the most (Table 5, Figure 1).

Figure 1  Adherence to personalized psychological intervention, effectiveness rate of pain management, and duration of family accompaniment had significant positive effects on the improvement of agitated behaviors, with adherence to personalized psychological intervention contributing the most.

Table 5 Analysis of intervention module contributions to improving agitated behavior in the observation group.

Intervention module	β	t value	P value	Contribution ratio (%)
Individualized psychological intervention compliance	0.382	5.217	< 0.001	42.3
Effective rate of pain management	0.296	4.053	< 0.001	32.7
Time spent with family	0.185	2.641	0.003	20.5
Implementation of environmental optimization	0.097	1.562	0.121	-
Communication and coordination guidance success rate	0.082	1.384	0.168	-

Analysis of patient and family subjective experience and nursing satisfaction

A total of 82 valid questionnaires were collected from the control group and 86 from the observation group. All scores in the observation group were significantly higher than those in the control group (P < 0.05; Table 6).

Table 6 Comparison of subjective experience scores between two patient groups and their families (points), mean ± SD.

Group	n	Safety rating	Communication satisfaction	Humanistic care perception	Total points
Control	82	6.21 ± 1.35	5.89 ± 1.42	5.67 ± 1.53	17.77 ± 3.86
Observation	86	8.53 ± 0.98	8.72 ± 0.85	8.91 ± 0.76	26.16 ± 2.13
t value		12.790	15.758	17.505	17.550
P value		0.000	0.000	0.000	0.000

DISCUSSION

This study evaluated the effects of comprehensive nursing interventions. It focused on agitated behaviour, physiological stress responses, inflammatory activity and short-term clinical outcomes. These outcomes were in elderly emergency patients with liver cirrhosis. The patients also had acute upper gastrointestinal haemorrhage. It was demonstrated by the results that, compared with routine nursing care, agitated behaviour was significantly reduced in severity, frequency, and duration by comprehensive nursing interventions, while neuroendocrine-immune indicators were improved and the incidence of major adverse clinical events was reduced.

This study evaluated the effects of comprehensive nursing interventions, with the aim of improving patient outcomes[10]. It focused on agitated behaviour. It also focused on physiological stress responses. And it focused on inflammatory activity. Finally, it focused on short-term clinical outcomes. These findings pertained to elderly patients presenting with hepatic cirrhosis as an emergency. The patients also presented with acute upper gastrointestinal haemorrhage[11]. The results demonstrated that, compared with routine nursing care, comprehensive nursing interventions significantly reduced the severity, frequency and duration of agitated behaviour, while improving neuroendocrine-immune indicators and reducing the incidence of major adverse clinical events[12]. Moreover, in times of crisis, it is not uncommon for people to encounter increased sensory input, severe discomfort, and emotional upheaval. The body’s sympathetic nervous system can be triggered by these factors, resulting in increased agitation. Comprehensive nursing interventions can reduce both internal and external stressors. These interventions integrate psychological support, environmental optimisation, pain control and family involvement. This can alleviate agitation.

Individualised psychological interventions were found to be the most significant factor contributing to improvement in agitation[13]. Trust is built through communication where you can see the feelings of the other person and the right amount of body language. Examples of this could be hand-holding or a gentle touch. Such actions can rapidly stabilise emotional responses. The patients’ sense of security can also be enhanced. Using active listening and reassurance techniques can correct catastrophic disease perceptions and reduce fear-driven agitation. This approach follows what was already found out, which said that it is very important to be able to understand others when dealing with bad behaviour[14]. Sensory overload and cognitive burden can be reduced by optimising the environment. This can be done by reducing noise, controlling light and maintaining a comfortable microclimate. The result is a reduction in unplanned restlessness and impulsive behaviours[15].

It was found that pain management had the most significant impact on agitation improvement. Physical agitation and emotional distress can be triggered by acute pain. This pain can be associated with gastrointestinal bleeding. It can also be associated with invasive procedures. Prolonged immobilisation can also trigger physical agitation and emotional distress. Physical discomfort is alleviated and stress-induced behavioural responses are mitigated by timely pain assessment and multimodal analgesia[16]. Agitation management is all about keeping an eye on pain levels. This is especially important for elderly patients because they often have a lower pain threshold and find it harder to deal with stress.

The investigation revealed that nursing interventions had a significant impact on cortisol and norepinephrine levels in the blood. The results suggest that these interventions can help to reduce excessive stress responses in the body's neuroendocrine system. Researchers have closely linked agitated behaviour to dysregulation of the neuro-immune-endocrine network[17]. Psychological interventions can reduce hypothalamic corticotropin-releasing hormone secretion, thereby lowering cortisol synthesis and attenuating hypothalamic-pituitary-adrenal axis hyperactivity[18]. The sympathetic nervous system is activated. This is reduced by environmental regulation and pain relief. This leads to decreased norepinephrine release. It also leads to the stabilisation of portal venous pressure. This is of particular pertinence in the prevention of re-bleeding in patients with cirrhosis[19].

Hypothalamic corticotropin-releasing hormone secretion can be reduced by psychological interventions, thereby lowering cortisol synthesis and attenuating hypothalamic-pituitary-adrenal axis hyperactivity[18]. The sympathetic nervous system is activated, which results in a number of physiological changes. This can be reduced through environmental regulation and pain relief. This leads to decreased norepinephrine release, which in turn affects the body’s response to stress. It also stabilises portal venous pressure. This is particularly relevant in preventing re-bleeding in patients with cirrhosis[19,20]. Comprehensive nursing can inhibit inflammatory signalling. It can also restore immune balance. Comprehensive nursing does this by reducing psychological stress. It also reduces sympathetic overactivation. The process is made better by the involvement of the family unit. Research has shown that caregivers who are known to the patient can provide emotional support. This support can increase vagal activity and promote anti-inflammatory responses[21]. This process is particularly important for elderly people with liver problems, as ongoing inflammation can exacerbate the condition and lead to a poor outcome[22].

From a medical point of view, keeping these things under control led to a much lower number of people bleeding again, needing to be taken out of the breathing machine and sent to the intensive care unit in the observation group. Sudden surges in intra-abdominal pressure are reduced by a drop in agitation, thereby lowering the risk of variceal re-rupture. Conversely, lower stress hormone levels contribute to better blood pressure stability and reduce the risk of blood clots[23]. The fact that unplanned extubations are now less common is a clear sign that patients are working more closely together and that the way in which airways are managed is now more secure. This is thanks to communication strategies that work well and supervision that is not interrupted. The collective impact of these improvements suggests that emergency care safety can be improved and the burden of critical complications can be reduced by comprehensive nursing interventions.

Regression analysis showed that the main reason for the improvement in agitation was compliance with personalised psychological interventions. This was followed by effective pain management and the duration of family accompaniment. These findings underscore the significance of prioritising psychological stabilisation and alleviation of symptoms in the management of agitation in elderly emergency patients, as opposed to relying exclusively on physical restraint or pharmacological sedation. The improvement of quality of care and communication in emergency situations has been shown to be the result of trust-based relationships between nurses and patients[24]. The favourable outcomes of familial participation, as gauged in this investigation, are presumably attributable to emotional reassurance, familiarity and uninterrupted encouragement, as opposed to the time spent in solitude.

Finally, the patients and their families in the observation group said they felt much safer, were more satisfied with how they were communicated with, and experienced more humanistic care. The emotional and psychological needs of elderly patients are often overlooked in traditional emergency nursing, which focuses on rapid technical interventions. Comprehensive nursing, on the other hand, adopts a patient-centred and humanistic approach with the aim of improving information transparency, emotional comfort and treatment adherence[25]. These improvements, while subjective, have been shown to enhance satisfaction and potentially improve clinical cooperation and recovery.

CONCLUSION

In summary, the nursing interventions used to treat this patient were highly effective. They alleviated the patient’s excessive anxiety, reduced the risk of other complications, improved the patient’s prognosis, and enhanced the patient’s sense of well-being by regulating the nervous system and hormone levels. This study provides a potential reference for managing agitated behaviour in elderly emergency patients with liver cirrhosis and bleeding.