Analysis of the effect of health education model based on BCW theory in patients with acute retinal necrosis

2.2.1 Control group

Upon admission, each patient received routine nursing measures and health education, including routine dietary care, monitoring of vital signs during treatment, and medication instructions. In addition, the medical staff was set up to explain information, therapeutic schedule, prognosis, adverse effects, and precautions related to ARN to each patient and their family timely. Postoperatively, patients’ signs were monitored in real time to enhance risk assessment, prevent complications and manage underlying diseases; patients were instructed on medication use and informed of the importance of medication compliance; personalized diet plans were formulated according to patients’ conditions, with a diet rich in protein and vitamin; patients were urged to develop a good lifestyle habits, ensure adequate rest for the eyes, exercise reasonably, and avoid strenuous activities and heavy physical activities; patients were instructed on home self-care methods before discharge, and advised to come to the hospital for regular follow-up.

2.2.2 Observation group: a health education model based on BCW theory was given to the control group

Establishment of BCW Theory Intervention Team: An intervention team was established, consisting of an ophthalmic director, two ophthalmologists, two ophthalmology nurses, a nurse specialist, and a head nurse. The head nurse and nurse specialist were responsible for coordinating communication and developing a standardized training program, which included BCW theory, ophthalmology-related knowledge, how to implement the intervention program, and how to conduct quality control.

Development and implementation of a health education model based on the BCW theory for ophthalmic patients: BCW is centered on a model of competence, opportunity, and motivation to achieve healthy behaviors. Team members comb through and analyze patient data to develop a comprehensive care intervention based on the progress of ARN patients. The team established mutual assistance clusters, analyzed patient compliance rates and related influencing variables, and identified influencing elements of poor compliance, and then selected these aspects as the starting point for nursing services, and implementation of appropriate nursing interventions. These aspects interact to produce influential behaviors, such as competence, opportunity, and motivation, which in turn change bad habits.

(1) Motivation: Help patients generate motivation through motivation, education, persuasion, modeling, and compulsory.

Motivation function: Upon admission, the nurse specialist comprehensively assesses the patient’s condition, basic information, disease knowledge, mental status, and establish a health record. Warmly receive patients, leave a good first impression, establish good communication with patients, and enhance patients’ confidence in treating diseases.

Educational and persuasive function: In the case management room, one-on-one education is provided to patients. The nurse specialist explains ARN-related information such as eye structure, disease characteristics, prognosis, treatment options, surgical options, drug effects and side effects, eye self-care methods, and how to monitor and protect the contralateral eye to improve patients’ understanding of ARN and its prognosis, and reinforce the necessity for cognitive intervention.

Modeling function: Group support activities are carried out to guide recovering patients to share their experience in fighting with ARN, set goals with patients, and encourage others to build confidence in treatment.

Compulsory function: An integrated nurse-patient holistic care model is used. The nurse specialist establishes a healthy communication relationship with patients and their families, providing a relax atmosphere to enhance their cooperation and improve patients’ compliance behavior. Forced restriction of patient disengagement from the treatment plan during the visit, emergence of disengagement from follow-up, and provide immediate corrective guidance. During the nursing care progress, nurses should pay attention to protecting patients’ privacy, avoid talking about their conditions freely, and choose a private and quiet environment to explain their conditions and treatment to patients.

(2) Developing Competence: Helping patients develop competency through education, training, and realization.

Education function: Diverse forms of health education are used, such as face-to-face health education with graphics, voice and video health education to improve patients’ knowledge related to surgery and perioperative health. The nurse specialist provides health education through informational videos and video presentation of perioperative surgical knowledge, divided into preoperative, intraoperative, postoperative, postural care, and discharge education. Furthermore, patients can scan the WeChat code to watch the video repeatedly.

Training function: including intensive training and personalized training. Intensive training: intensive health education is placed before the patient’s scheduled surgical period. When surgery is necessary, appointment information letters were issued with printed text instructions and perioperative health education QR codes, which patients are instructed to scan to learn about perioperative surgical knowledge. Patients who need surgery are given focused health education and their questions are answered in a timely manner. Personalized training: Health education is provided throughout the perioperative surgical period, especially personalized postural care education for postoperative patients, and appropriate postural guidance is given according to vitreoretinal surgery method. A combination of on-site teaching and informal education is used to teach patients and their families the essentials of postoperative posture while guiding them to scan QR codes for learning.

Realization function: One-on-one private chat guidance via WeChat software to answer patients’ questions, introduce surgical procedures and precautions, and enhance self-care capabilities. The nurse specialist should concentrate on assessing the patient’s visual acuity, psychological status, illness awareness, and level of disease education. Improve the level of overall admission evaluation by patients and families and give individualized education. Education should focus on psychological guidance for ARN patients, vitreoretinal perioperative health education, and fall prevention safety instructions for patients with low vision.

(3) Provide opportunities: Patients are provided with access to gain relevant knowledge and support through the reconstructing, limitation, and realization of functions in the environment. At the same time, these create opportunities for sharing and arrange for patients with better post-operative outcomes to enhance communication, improve their understanding of the disease and increase their confidence in treatment.

Environment reconstruction function: Reconstructing a good atmosphere by participating in patient clubs, peer support groups, and WeChat communication. To help patients comprehend the significance of positive emotions in improving treatment outcomes and the adverse effects of negative emotions on their treatment. ARN is characterized by rapid onset, progression, and devastation, and patients with ARN are prone to fear, anxiety, depression, stress, and other negative emotions, which can affect their compliance and clinical outcomes. Therefore, according to their characteristics, nurses are required to create a quiet environment, listen carefully, and guide patients to vent negative emotions to relieve psychological pressure. In addition, patients are encouraged to participate in social activities and develop more friends to maintain a cheerful mood.

Restriction function: Nurses instruct patients on the proper use of eyedrops, application precautions, and the management of drug adverse effects. Furthermore, nurses trained the patients to master the correct use method of eye drops through explanation and demonstration. Avoid the spout of eyedrops or ointment contact with eyes, tears, and mucous membranes. Instruments that come into direct contact with the patient’s eyes should be disinfected and sterilized before reuse. Before and after interaction with patients, nurses are required to wash their hands and put on gloves. During lacrimal flushing, gloves, medical masks, and protective glasses should be worn to maintain eye hygiene and avoid eye infections, given that the patient’s body fluids or flushing solution may contact the operator’s face.

Realization function: Out-of-hospital telephone follow-ups and outpatient follow-ups are available. When patients are discharged from the hospital, nursing staff should clearly inform the time and place of review, postoperative precautions, and help patients establish postoperative contact. After 2 hours of discharge, nurses should make a return visit to check if the patient has returned to his or her residence, if it is safe, and if there are any discomfort symptoms. Additionally, nurses should pay attention to postoperative visual acuity, intraocular pressure, postoperative medication, and body position compliance. During follow up, regular observation of symptoms in the affected eye, inflammation condition, and extent of lesions will aid in the early detection of disease complications. Moreover, patients need to strengthen the observation and protection of the lateral eye. Patients with low vision should be promptly matched with low vision centers for vision training. Patients should be advised to pay attention to safety hazards in daily life and place objects in a fixed location to prevent accidents such as falls, crushing, and burns and need to be accompanied by family members when going out.

2.2.3 Observation indicators

Sense of disease uncertainty: The Mishel Uncertainty in Illness Scale (MUIS) was used, and the scale includes four dimensions of uncertainty, complexity, lack of information, and unpredictability, with lower scores indicating that patients have less uncertainty about the disease [6].

SAS/SDS scores: Psychological conditions were assessed by the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) [7, 8], which consisted of 20 items on a 4-point scale from 1 to 4, with a total score of 20–80 points. The cut-off value in SAS and SDS are 50 and 53 points, respectively. In SAS, a score of ≥50 points indicates the presence of anxiety symptoms, and in SDS, a score of ≥53 points reveals the presence of depressive symptoms, with higher scores meaning more severe symptoms.

Compliance behavior and Disease awareness [9]: Treatment compliance was rated on a 4-point scale of 1 to 4, with 1 point indicating non-compliance, 2 points indicating partial compliance, 3 points indicating basic compliance, and 4 points indicating full compliance. Disease awareness was measured by a questionnaire, which was self-administered by our hospital. The disease awareness questionnaire assesses disease knowledge, treatment methods, postoperative precautions, and self-management measures, with scores ranging from 0 to 100 points, and higher scores indicating higher awareness of diseases.

Care satisfaction: Based on the literature review, a nursing satisfaction questionnaire was designed ranging from 0 to 100 points, with <69 being dissatisfied, 70–79 being less satisfied, 80–89 being satisfied, and ≥90 being very satisfied. Satisfaction = (less satisfied + satisfied + very satisfied)/total number of cases × 100%.

2.2.4 Statistical analysis

All data were statistically analyzed using SPSS 26.0 (IBM Corporation, Armonk, NY, USA). Measurement data were described by x̄ ± s, and the data such as disease uncertainty scores and SAS/SDS scores were determined by Student’s t-test. The count data were reported as frequency and n (%) and the comparison between groups was carried out by χ² test. p < 0.05 (2-tailed) was regarded as statistically significant.