Combination of comprehensive thermal care and detail-oriented nursing care in the operating room for managing gestational diabetes mellitus

Abstract

BACKGROUND

As the incidence of gestational diabetes mellitus (GDM) increases, its impact on cesarean sections has attracted widespread attention. Omni-directional, insulated care and detailed care are of great significance in this patient population, as they can effectively improve the quality of care in the operating room.

AIM

To explore the effect of the integrated use of comprehensive thermal insulation.

METHODS

Women with GDM who underwent cesarean sections at our hospital between April 2023 and February 2024 were included in this retrospective study. The participants were randomly allocated to two groups: The observation and control groups. An all-around thermal insulation nursing strategy, including preoperative, intraoperative, and postoperative temperature maintenance, was adopted. In addition, detailed nursing care measures, such as blood glucose monitoring, wound care, and psychological counseling, were implemented in the observation group.

RESULTS

Comparative observation revealed that all-around thermal insulation care can effectively prevent the incidence of maternal hypothermia caused by surgery, reduce the risk of infection, and promote blood circulation. The implementation of detailed care improved maternal satisfaction and reduced the incidence of complications via the appropriate management of fluctuations in the blood glucose levels and optimization of the nursing process before and after surgery according to the patient's characteristics.

CONCLUSION

The application of a combination of comprehensive thermal insulation and detailed nursing care improved the overall quality of perioperative care.

Key Words: Ischemic-hypoxic encephalopathy; Magnetic resonance imaging; Neonate; Diagnostic efficacy; Diabetes

Core Tip: The application of all-around thermal insulation nursing and detail-oriented nursing in the operating room to the management of women with gestational diabetes mellitus undergoing cesarean section surgery can significantly improve the surgical effect, shorten the duration of hospital stay, and improve the quality of life of the patients. Thus, its extensive implementation in clinical practice must be promoted.

INTRODUCTION

The incidence of gestational diabetes mellitus (GDM) has increased significantly in recent years owing to changes in the social environment and lifestyle. Consequently, GDM has become an important public health problem, threatening the health of mothers and infants[1]. Patients with GDM are susceptible to complications during cesarean section owing to surgical stress[2], the effects of anesthesia, and metabolic abnormalities[3]. These complications affect the surgical process and postoperative recovery. Thus, implementing scientific and effective nursing interventions in the operating room, especially for the management of the unique physiopathological characteristics of women with GDM, is important. Omni-directional thermal insulation nursing[4], a new nursing concept and practice model, recommends implementing comprehensive and continuous temperature regulation during the perioperative period to avoid the incidence of hypothermic reactions. This can reduce the risk of infection and promote the recovery of bodily function. The role of all-round thermal insulation care is particularly prominent in women with GDM undergoing cesarean section[5], as GDM affects glycolipid metabolism and decreases immunity. Detail-oriented care aims to provide personalized and refined nursing services according to the condition and specific needs of the patient, encompassing various levels ranging from disease knowledge education and dietary guidance to psychological guidance and pain management. In addition to the management of blood glucose levels, detailed care for women with GDM focuses on attending to the health of the fetus, the special needs of the mother and newborn preoperatively and postoperatively, and the rapid recovery during the postoperative period.

This study aimed to explore and analyze the specific application value and practical outcomes of all-around thermal insulation nursing and individualized nursing in cesarean delivery care for women with GDM in the operating room. The synergistic effects of these nursing strategies and how they improve the surgical prognosis of women with GDM in the operating room, reduce the development of complications, optimize the quality of perioperative nursing care, enhance patient satisfaction, and ensure the health of mothers and infants were determined via a combination of systematic theoretical analysis and clinical practice. This study provides new insights and a reference base for clinical practice to facilitate the improvement and development of the quality of operating room nursing care in the field of obstetrics and gynecology in China. The effects of applying detail-oriented care were analyzed and evaluated.

MATERIALS AND METHODS

General information

A total of 100 women with GDM who underwent a cesarean section at our hospital between April 2023 and February 2024 were included in this retrospective study. The participants were randomly allocated to two groups: The observation group (n = 50) and control group (n = 50). The characteristics of the women with GDM included in the observation group were as follows: Age, 23–39 years (28.74 years ± 2.22 years); gestational week, 36–39 weeks (38.51 weeks ± 0.19 weeks); and number of prior pregnancies, 1–3 (1.45 ± 0.37). The characteristics of the women with GDM included in the control group were as follows: Age, 24–38 years (28.82 years ± 2.32 years); gestational week, 37–40 weeks (38.54 weeks ± 0.20 weeks); and number of prior pregnancies, 1–3 (1.44 ± 0.36). The general characteristics of the participants in the two groups were comparable with no statistically significant differences (P > 0.05). This study was approved by the Hospital’s Medical Ethics Committee.

The inclusion criteria were as follows: Presence of clinical manifestations and diagnostic findings consistent with those of GDM; age, 18–60 years; and voluntary participation and signing of informed consent. The exclusion criteria were as follows: Presence of comorbidities; history of allergies or contraindications; presence of endometrial lesions, such as endometrial cancer; and lack of cooperation with the treatment and follow-up plans. A comparison of the baseline data between the two groups revealed no statistically significant differences.

Methodology

Routine cesarean section postoperative nursing procedures, including the monitoring of vital signs, wound care, and drainage tube care, were commenced in the control group. Although conventional thermal insulation measures, such as regulating the temperature of the operating room and covering the mother with a quilt, were implemented, all-around thermal insulation specifically tailored to the characteristics of patients with GDM was not implemented. Hence the following suggestions were proposed: (1) Introducing body temperature regulation equipment. This entails the use of a heating mattress that accurately perceives changes in a patients’ body temperature, automatically adjusts its temperature in time with changes in the patient’s temperature, and effectively maintains the patient’s temperature; (2) Provisions for personalized warm clothing. This includes offering special items such as warm belts for patients with GDM, made from high-quality materials to snugly fit the abdominal wound while providing effective warmth; (3) Organize regular training sessions to share the latest research results and practical experience; and (4) Prioritize increasing environmental humidity monitoring and regulation.

Routine cesarean section postoperative nursing procedures and all-around heat preservation nursing measures were commenced in the observation group. Targeted heat preservation measures were implemented. For instance, heating equipment was used to pre-heat surgical instruments, liquids, and blood transfusion products to ensure that the temperature of the operating room was constant and appropriate before the surgery. The non-surgical areas were covered with thermal blankets intraoperatively to prevent rapid dissipation of body heat. The temperature of the ward was maintained at a constant level, and timely replacement of cold and wet dressings was performed postoperatively to prevent chills caused by excessive energy consumption. Detailed care: Nutritional supplements were administered to meet the energy requirements, and the insulin dosage was adjusted according to the blood glucose levels to maintain them within the normal range in patients with GDM. In addition, the psychological state of the mother was monitored, and necessary psychological guidance and support were provided.

Special care: Appropriate observation and care, such as regular monitoring of wound healing and prevention and early detection of signs of infection, must be strengthened as the risk of complications, such as infections and postpartum hemorrhage, is higher in patients with GDM.

Preoperative care: Fasting blood glucose and 2-h postprandial blood glucose levels were monitored, and an appropriate amount of insulin was administered to maintain blood glucose levels within the normal range if necessary. The pre-operative examination was conducted 1 day before the operation, and the team members counseled the patients and their family members regarding GDM and cesarean sections. In addition, the nursing staff communicated positively with the patients to understand their degree of knowledge of GDM and cesarean section, their worries and anxieties about their condition and surgery, and their negative emotions. Targeted psychological counseling was commenced based on the assessment findings and the psychological state of the patient. Explanations were provided for the questions raised by the patients and family members, and assistance was provided to the patients to make preoperative preparations. The blood glucose levels were monitored, and the pre-operative blood glucose level fluctuations were noted. Prescription medications were adjusted according to the blood glucose levels.

Intraoperative care: The system of “three checks and seven checks” was implemented after the patients entered the operation room. The basic information of the patients was checked, the patients were introduced to the environment of the operating room and the various surgical instruments and equipment, the changes in their emotions were monitored, and the patients were urged to relax, channel their negative emotions, and actively cooperate with the physicians.

The nursing staff helped the patients assume positions for anesthesia and surgery and ensured that they were comfortable in these positions. The nursing staff were present throughout the process and continuously monitored the changes in the signs and stress indicators. Any abnormalities detected were reported to the physicians in charge. In addition, the nursing staff provided intraoperative insulation care and prevented the exposure of the patient's private parts. The changes in the blood glucose levels were monitored continuously, and glucose or insulin was administered according to the physician’s instructions if a hypoglycemic reaction was observed intraoperatively.

Postoperative care: The blood glucose levels were recorded at the end of the surgery, and the risk of developing ketoacidosis and non-ketotic hyperosmolar coma was assessed.

The postoperative care and precautions were explained to the family members while transferring the patient to the ward. The body temperature and blood glucose levels of the neonate were closely monitored, and 10% glucose was administered to those with a blood glucose level < 2.2 mmol/L.

Observation indicators

Blood glucose level: The fasting blood glucose and glycosylated hemoglobin levels of the patients in both groups were measured before and aftercare. The findings were analyzed statistically between and within groups.

Hemodynamics: The heart rate, systolic blood pressure, and diastolic blood pressure of the two groups were recorded and compared during 30 minutes after the surgery.

Statistical analysis

All statistical analyses were conducted using Statistical Package for the Social Sciences version 24.0 (https://www.downxia.com/downinfo/358379.html). Normally distributed data are represented as the mean ± SD and were analyzed using a t test. Count data are represented as cases and rates and were analyzed using χ² test. Statistical significance was set at P < 0.05.

RESULTS

Comparison between the blood glucose levels of the two groups

A comparison of the fasting blood glucose and glycated hemoglobin levels of the two groups before care revealed no statistically significant differences (P > 0.05). However, the fasting blood glucose and glycated hemoglobin levels of the two groups were reduced after implementing care. The fasting blood glucose and glycated hemoglobin levels of the observation group were lower than those of the control group, and the difference was statistically significant (Table 1).

Table 1 Comparison between the blood glucose levels of the two groups.

Groups	Timing	Fasting blood glucose (mmol/L)	Glycosylated hemoglobin
Observation group	Pre-nursing	7.12 ± 1.11	7.88 ± 1.05
	Aftercare	5.13 ± 0.56	5.25 ± 0.34
Control group	pre-nursing	7.14 ± 1.24	7.90 ± 1.22
	Aftercare	6.42 ± 0.78	6.46 ± 0.48
t value/P value		2.736/0.008	6.115/P < 0.001
t value/P value		8.912/P < 0.001	13.267/P < 0.001
t value/P value		0.066/0.946	0.069/0.945
t value/P value		7.480/P < 0.001	11.453/P < 0.001

t value/P value: The t value is a statistic calculated on the basis of sample data, which is especially suitable for small samples (small sample size) or unknown overall standard deviation; the P value (usually < 0.05) means that the results are statistically significant.

Comparison between the hemodynamic indexes of the two groups

The heart rate, systolic blood pressure, and diastolic blood pressure of the observation group were significantly lower than those of the control group 30 minutes after surgery (Table 2).

Table 2 Comparison between the hemodynamic indices of the two groups.

Groups	Timing	Heart rate (beats/min)	Systolic blood pressure (mmHg)	Diastolic blood pressure (mmHg)
Observation group	Immediately after the surgery	75.45 ± 5.45	132.25 ± 7.48	81.15 ± 5.56
	The 30 minutes after the surgery	76.59 ± 6.36	134.56 ± 7.94	84.23 ± 5.11
Control group	Immediately after the surgery	75.84 ± 5.56	132.22 ± 7.96	81.26 ± 5.37
	The 30 minutes after the surgery	93.23 ± 6.47	165.53 ± 7.47	92.59 ± 5.80
t value/P value		11.349/P < 0.001	16.989/P < 0.001	7.981/P < 0.001
t value/P value		0.757/0.452	1.179/0.243	2.271/0.026
t value/P value		0.278/0.781	0.015/0.987	0.079/0.937
t value/P value		10.212/P < 0.001	15.817/P < 0.001	6.022/P < 0.001

t value/P value: The t value is a statistic calculated on the basis of sample data, which is especially suitable for small samples (small sample size) or unknown overall standard deviation; the P value (usually < 0.05) means that the results are statistically significant.

Comparison between the postpartum hemorrhages observed in the two groups

The amount of bleeding in the observation group was significantly lower than that in the control group at 2 hours and 24 hours postpartum (Table 3).

Table 3 Comparison between the amount of postpartum hemorrhage between the two groups.

Groups	Bleeding 2 hours after delivery	Bleeding 24 hours after delivery
Observation group	87.58 ± 6.56	156.52 ± 12.34
Control group	156.48 ± 10.18	187.47 ± 13.16
t value	31.676	9.552
P value	< 0.001	< 0.001

t value: A statistic calculated on the basis of sample data, which is especially suitable for small samples (small sample size) or unknown overall standard deviation; P value: The P < 0.05 means that the results are statistically significant.

Comparison of body temperature stability compliance rate and wound infection rate between the two groups

The results of the comparison between the two groups of the temperature stability compliance rate and the wound infection rate are shown in Table 4; the difference between the two groups was significant (P < 0.05).

Table 4 Comparison of temperature stability compliance rate and wound infection rate.

Groups	Stable body temperature compliance rate	Wound infection rate
Observation group	40	42
Control group	12	2
χ²	8.62
P value	< 0.005

DISCUSSION

GDM is an obstetric comorbidity with a high incidence rate in clinical practice. The etiology and pathogenesis of GDM are complex, with no unified conclusion on the specific pathogenesis yet. However, its incidence may be attributed to insulin resistance and relative insufficiency of insulin secretion, the changes in maternal dietary structure during pregnancy, the increase in dietary volume, and the increase in dietary sugar intake[6-8]. In addition, a family history of diabetes mellitus and advanced maternal age have been identified as risk factors for developing GDM.

Most pregnant women with GDM experience severe psychological stress and psychological burden before delivery; this can prolong the labor process and increase the risk of requiring intermediate a cesarean section, thereby increasing the risk of related complications[9]. In recent years, an increasing number of women with GDM have opted for cesarean section to complete their labor. A cesarean section can help complete labor smoothly and quickly; however, it is associated with certain dangers that must be considered. Thus, it is necessary to strengthen the nursing interventions for these patients during cesarean section[10].

Routine nursing is widely used in the care of operating rooms and various clinical departments; however, routine nursing lacks pertinence and detail in the context of GDM owing to the increased focus on the overall condition of the patient and lack of attention to the individual states, especially the lack of attention to the mental health, of the patients, which affects the overall nursing effect. In contrast, detailed nursing comprises more targeted and focused nursing measures that focus on the detailed nature of nursing work. Thus, detailed nursing enables the implementation of detailed nursing measures, thereby providing patients with more detailed and comprehensive nursing services[11]. The findings of this study suggest that the fasting blood glucose and glycosylated hemoglobin levels exhibited a substantial reduction after the implementation of detailed nursing care; the magnitude of the changes in the heart rate and blood pressure of the patients was relatively small, and the amount of postpartum bleeding reduced (P < 0.05). These findings reflect the effects and advantages of implementing detailed nursing care. Detailed nursing fully practices the principle of patient-centered work via the implementation of targeted nursing interventions for mothers at different time points. This reduces the burden of maternal thinking and negative emotions. Furthermore, targeted nursing care for mothers in the preoperative, intraoperative, and postoperative phases accomplished all the nursing care for nursing staff in the operating room and helped patients complete their physical and mental treatment. Detailed care enables patients to enjoy the process of a cesarean section and reduces psychological pressure; therefore, the operation can be completed in their best psychological and physical states. This enables patients to obtain individualized, targeted care services that are more consistent with the current maternal requirements for clinical care, such that the patient’s physical and psychological status is comfortable[12].

CONCLUSION

The application of detailed care to the clinical care of patients with GDM undergoing cesarean sections exhibited significant advantages. The implementation of detailed care has clinical relevance and value; thus, its implementation must be promoted.