The application of information-motivation-behavior skill model in patients with moderate to severe ovarian hyperstimulation syndrome

2.1 Data Sources

A total of 90 patients with moderate to severe OHSS who receive in vitro fertilization and embryo transfer in Fujian Maternity and Child Health Hospital were selected as the study subjects, and they were divided into the normal control and the intervention group with 45 patients in each group according to the random number table method. Women in normal control were (30.47 $\pm$ 5.11) years old on average, and body mass index (BMI) was (20.89 $\pm$ 1.39) kg/m${}^2$. The duration of infertility was (4.16 $\pm$ 1.58) years. Causes of infertility were listed as following: oviduct factors in 12 cases, endometriosis in 12 cases, polycystic ovary syndrome in 11 cases, and unknown causes in 10 cases. Severity of disease included 27 cases of moderate and 18 cases of severe. The average age of women in the intervention group was (30.22 $\pm$ 4.57) years, and the body mass index (BMI) was (21.22 $\pm$ 1.43) kg/m${}^2$. The duration of infertility was (4.22 $\pm$ 1.74) years. Causes of infertility included: fallopian tube factors in 10 cases, endometriosis in 12 cases, polycystic ovary syndrome in 12 cases, and unknown causes in 11 cases. Severity of disease included moderate in 30 cases and severe in 15 cases. There was no significant difference in age, BMI, infertility time and other general information between the two groups (all p $>$ 0.05), which were comparable.

2.2 Inclusion and exclusion criteria

Inclusion criteria: the diagnostic criteria for moderate and severe OHSS were met [9], and the cognitive function was normal. All the patients who participated in the study were informed of the study and signed the informed consent. The age of patients included in this study was mainly between 25–40 years old, and the age of all patients was $>$18 years old and $<$45 years old. All patients were not infertility caused by uterine abnormalities, congenital and systemic factors, and these patients who received embryo transfer were eventually pregnant after IVF. Exclusion criteria: combined with prenatal depression, anxiety and other mood disorders; Combined with schizophrenia and other mental disorders; Complicated with pneumonia and other systemic infectious diseases; Complicated with malignant neoplastic disease; Patients requiring intensive care unit (ICU) treatment, multiple organ failure, thrombosis, and severe pregnancy termination without remission after multiple treatments; People who don’t use the WeChat app in their smartphones; Lose contact and give up.

2.3 Intervention methods

In 90 patients, the conventional gonadotropin releasing hormone agonist/follicle stimulating hormone/chorionic gonadotropin (GnRHa/FSH/HCG) long and short regimens were used for hyperovulation. The eggs were collected 36 h after injection of HCG, and embryo transfer was performed 2–3 days after operation.

The normal control followed the nursing points of moderate and severe ovarian hyperstimulation syndrome include: reasonable rest, high protein diet, recording the amount of body fluids in and out for 24 hours, regular measurement of body weight and abdominal circumference, dilatancy, anticoagulation, and prevention of thrombosis. The patient’s blood pressure, temperature, pulse, respiration and other changes were closely observed. The patients should eat little meals, high protein, easy to digest, high fiber content, and light and low salt semi-liquid food. Strenuous exercise and pressure on the pelvic and abdominal cavity are prohibited. At the same time, examination of the pelvic and abdominal cavity is prohibited to avoid ovarian rupture or ovarian torsion. Patients with pleural effusion or ascites need assistance to adjust their posture to the semi-decubitus or decubitus position in order to improve their dyspnea. The bed needs to be kept clean and dry, and nursing person should guide the patients to take the right recumbent position, and move slowly when turning up, frequently turn over during bed rest. Patients need to be given proper massage to prevent blood clots forming, told the daily activity in patients with attention at the same time, and given comfort, told the appointment time.

The intervention group was given IMB mode guidance for 4 weeks on the basis of the normal control, which means nursing intervention was carried out from three aspects of information, motivation and behavioral skills. The first two weeks of intervention were information and motivation intervention, and the second two weeks were behavioral skills intervention (Table 1). Establishment of IMB intervention team: the team was composed of a multidisciplinary team, including 1 physician with psychological background, 2 nursing supervisors, 1 attending physician and 2 nursing graduate students. The psychologist is responsible for evaluating the intervention plan and training team members to ensure the effect of the intervention. The nurse in charge is responsible for the synchronous implementation of the intervention program. The attending physician is responsible for the adjustment of the patient’s treatment plan and risk control, and the graduate student is responsible for the coordination and communication and the evaluation of indicators.

2.4 Observation Indicators

Evaluation was performed before intervention and 4 weeks after intervention. The evaluation included: (1) Self-efficacy: Self-efficacy scale [10] was used for evaluation, which mainly included 4 dimensions of patients’ daily life, health behavior, medication situation and medical compliance behavior. The highest score of each dimension was 10 points. The total score of self-efficacy was equal to the sum of the scores of all dimensions, and the higher the score, the higher the self-efficacy. (2) Anxiety and depression states: Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to evaluate the psychological states of patients in the two groups [11], among which SAS score 50–59 was classified as mild anxiety, 60–69 as moderate anxiety, and $\ge$70 as severe anxiety. SDS depression score $<$53 indicates normal, 53–62 indicates mild depression, 63–72 indicates moderate depression, and $>$72 indicates major depression. The lower the score, the better the mental state. (3) Quality of life: Quality of life Scale Summary table (QOL-BREF) [12] was used to evaluate the quality of life of patients in the two groups. The scale included 24 items in physiological field, psychological field, social relationship field and environmental field, and each item was scored according to the scale of 1–5. The higher the score, the better the quality of life of patients. The changes of self-efficacy, anxiety, depression (SAS, SDS) and quality of life (QOL-BREF) in two groups were observed before intervention and 4 weeks after intervention.

2.5 Statistical analysis

Using SPSS software (version 25.0, SPSS, Inc., Chicago, IL, USA), measurement data of normal distribution were expressed as mean $\pm$ standard deviation ($\overline{x}$$\pm$s), and comparison between groups was performed by t test. The test level $\alpha$ = 0.05, and p $<$ 0.05 was considered statistically significant.

3.1 Comparison of self-efficacy scores between the two groups

Before intervention, there was no significant difference in self-efficacy score between the two groups (all p $>$ 0.05). As shown in Table 2, after 4 weeks of intervention, the scores of both groups were increased, and the self-efficacy and scores of all dimensions in the intervention group were significantly higher than those in the normal control, with statistical significance (all p $<$ 0.05).

3.2 Comparison of SAS and SDS scores between two groups

As shown in Table 3, before intervention, there was no significant difference in SAS and SDS scores between 2 groups (all p $>$ 0.05). After 4 weeks of intervention, the scores of both groups were decreased, and the scores of SAS and SDS in the intervention group were significantly lower than those in the normal control, with statistical significance (all p $<$ 0.05).

3.3 Comparison of QOL-BREF scores between 2 groups

There was no statistical significance in QOL-BREF score between two groups before intervention (all p $>$ 0.05). After 4 weeks of intervention, the scores of both groups were increased, and the QOL-BREF scores and scores of all dimensions in the intervention group were significantly higher than those in the normal control, with statistical significance (all p $<$ 0.05). These results were shown in Table 4.