Research on the Influence Value of Narrative Nursing Intervention on

Ischemic Stroke Patients' Negative Emotions and Quality of Life

based on Telemedicine

Jinfeng Huang

1,* a

, Li Zhang

, Dongxue Han

, Yuehui Jia

and Yang Liu

Department of Neurology, The Second Affiliated Hospital of Qiqihar Medical University,

Qiqihar, Heilongjiang,161006, China

Pharmacy Intravenous Admixture Services,The Second Affiliated Hospital of Qiqihar Medical University,

Qiqihar, Heilongjiang,161006, China

School of Public Health, Qiqihar Medical University,Qiqihar, Heilongjiang,161006,China

Department of Ultrasound, The Second Affiliated Hospital of QiqiharMedical University,

Qiqihar,Heilongjiang,161006, China

Keywords: Narrative Nursing, Telemedicine, Ischemic Stroke, Negative Emotion, Quality of Life.

Abstract: [Objective] To explore the value of telemedicine-based narrative nursing intervention on daily living ability

and emotion regulation in patients with acute stroke.[Method] A total of 70 patients with acute ischemic

cerebral infarction were randomly divided into two groups: the control group, the routine nursing group, and

the experimental group, the remote narrative nursing intervention group. The patients in the routine nursing

group were given simple daily life nursing guidance after discharge, and the patients in the remote narrative

nursing intervention group were given remote narrative nursing intervention after discharge. [Results] The

scores of daily living ability of the patients in the telenarrative nursing group were better than those in the

routine nursing group, and the improvement of the caregiver stress index was greater than that in the routine

nursing group (P<0.05). [Conclusion] The narrative nursing intervention of telemedicine can help improve

the daily living ability of ischemic stroke patients, relieve the pressure of caregivers, and improve the negative

emotions of ischemic stroke patients.

1 INTRODUCTION

Telemedicine is outlined as “distant health services

and activities through medical information and

communication technology.” Diagnosis and

treatment of distant patients, providing patient care,

medical education, and drug monitoring across time

and space constraints Management and other medical

services. The International Council of Nurses (ICN)

defines telenursing as the application of telemedicine

technology for nursing care and to guide nursing

practice. Tele-nursing is accompanied by tele-

medicine. For some chronic diseases, such as

medication monitoring of patients with hypertension,

comprehensive management of diabetic patients,

https://orcid.org/0000-0001-6234-1669

https://orcid.org/0000-0003-4095-8152

https://orcid.org/0000-0001-9303-8830

wound dressing change and comprehensive

assessment of patients with pressure ulcers, tele-

nursing can be used as a continuation of these chronic

diseases. Nursing, through telephone, video, Internet

and other electronic devices, establish remote

intervention based on home care to improve the

symptoms of chronic disease patients, effectively

improve the quality of intervention, and improve the

satisfaction of patients and their families. Especially

suitable for stroke patients, the patient's ability to take

care of themselves in daily life is seriously affected,

and it is difficult to take care of themselves in life.

Daily nursing intervention plays an important role in

the recovery of patients' functions. However, due to

limited medical resources, many patients with

ischemic cerebral infarction go home to continue

https://orcid.org/0000-0002-0098-5941

https://orcid.org/0000-0001-6454-1429

Huang, J., Zhang, L., Han, D., Jia, Y. and Liu, Y.

Research on the Inﬂuence Value of Narrative Nursing Intervention on Ischemic Stroke Patients’ Negative Emotions and Quality of Life based on Telemedicine.

DOI: 10.5220/0011233900003444

In Proceedings of the 2nd Conference on Artiﬁcial Intelligence and Healthcare (CAIH 2021), pages 175-180

ISBN: 978-989-758-594-4

175

rehabilitation treatment and pressure ulcer care after

discharge. Therefore, during the recovery process, the

caregivers feel overwhelmed due to factors such as

the patient's inability to take care of themselves with

hemiplegia and the complex and diverse

rehabilitation methods. This not only affects the

quality of care, but also decreases the caregiver's

health and quality of life. At this time, nursing

intervention and guidance are needed. We use remote

video and WeChat group narrative nursing

intervention to intervene in patients' negative

emotions and daily nursing guidance, and explore the

effect of telemedicine narrative nursing intervention

on the daily living ability, ease and care of patients

with ischemic stroke. effects of stress and improving

negative emotions in ischemic stroke patients.

The rest of this article is organized as follows. The

second section introduces the research objects and

methods in detail. The experimental results and

discussion will be discussed in Section 3. Finally,

conclusions are drawn in Section 4.

2 OBJECTS AND METHODS:

2.1 Research Object

A total of 60 patients with cerebral infarction and

recovered from cerebral infarction admitted to our

hospital from January 2020 to December 2021 were

selected as the research subjects. Case inclusion

criteria: ① In line with the diagnosis and treatment

guidelines formulated by the Neurology and

Cerebrovascular Disease Group of the Chinese

Medical Association in 2014, transcranial CT or MR

workers diagnosed with ischemic stroke; ② patients

with clear consciousness and stable vital signs; ③

SDS score ≥ 53 points or SAS score ≥ 50 points;

patients with barrier-free communication and no

aphasia; ④ voluntary participation in this study, and

signed the informed consent. According to the

random number table method, they were divided into

30 cases in the control group and 30 cases in the

experimental group. Among them, there were 13

male patients and 17 female patients in the

experimental group, aged 43-88 years, with an

average age of (54.55±11.56) years; the shortest

course of disease was 4 months and the longest was

32 months, with an average of (12.46±1.42) months.

In the control group, there were 16 male patients and

14 female patients, aged 40-87 years, with an average

age of (54.32±11.72) years; the shortest course of

disease was 3 months, and the longest was 30 months,

with an average of (12.22±1.32) months. There was

no statistical difference in basic data between the two

groups (P>0.05). See Table 1 for details.

2.2 Methods

2.2.1 Preparation Before Discharge

Each patient shall have a tele-nursing registration

form, including basic information such as the

patient's address, electrical work, contact information

of the primary caregiver, email address, and

telephone number. Before arranging hospital

discharge, evaluate pressure ulcers, medication,

nutrition and other nursing issues, communicate with

family members, formulate a tele-nursing plan

reasonably, and inform the value of tele-nursing.

2.2.2 Remote Narrative Nursing

Intervention Methods

The patients in the control group were given routine

discharge nursing guidance and regular follow-up

after discharge. In addition to routine nursing care,

patients in the remote nursing group underwent home

rehabilitation exercises and pressure ulcer nursing

treatment for the first 3 months, and guided,

supervised, and adjusted nursing plans through

DingTalk video software and WeChat group

conversations. Regular video follow-up was

conducted once a month. In the last 3 months, only

routine nursing intervention was performed, and

regular follow-up visits were made.

2.2.3 The Implementation Process and

Team Composition of Telemedicine

Narrative Nursing

The members of this study consisted of 1 deputy chief

physician majoring in neurology, 1 trainee in

residency majoring in neurology, and 5 nurses who

had been engaged in clinical nursing work in

neurology for more than 5 years. Stroke patients may

suffer from depression and anxiety due to hemiplegia.

Some patients cannot accept the inconvenience

caused by limb hemiplegia and cannot adapt in a short

period of time. DingTalk and WeChat video

conversations and telephone guidance are used. One

video conversation per month is used to understand

the changes of the patient's condition and nursing

needs, formulate a feasible rehabilitation plan

according to the actual situation of the individual, and

provide remote nursing guidance and intervention.

First, nursing staff conduct interactive activities such

as guidance and consultation through remote video

CAIH 2021 - Conference on Artiﬁcial Intelligence and Healthcare

176

sessions, which play the role of guiding, supervising,

and adjusting nursing and rehabilitation programs.

The main module of narrative nursing intervention is

to provide video playback and web browsing

functions, including stroke-related videos, dietary

guidance, medication instructions, and self-

management related health education materials. In

addition, by sharing videos or experiences of patients

and caregivers who have been more satisfied with

their previous recovery, patients can increase their

confidence in recovery. Improve the patient's ability

to bear disability, overcome the inconvenience

caused by the disease in life and work, and establish

a positive life goal.

2.2.4 Home Visit

On the 20th of every month, we have a follow-up

visit. face-to-face communication with patients and

their caregivers, life guidance and employment

training for patients, assessment of family

environment, self-health management ability,

psychology, and rehabilitation guidance and health

education. Through close communication, patients

and their caregivers are willing to express their true

thoughts and difficulties they face. Nursing staff

provide nursing guidance by formulating targeted

nursing diagnosis and nursing measures.

2.2.5 Evaluation Indicators

Nursing patients in the experimental group and the

control group were followed up at the 3rd month and

6th month after discharge to collect data. Self-rating

anxiety scale (SAS) and self-rating depression scale

were used. The table (self-rating depression scale

SDS) was used to evaluate anxiety and depression in

the 3rd and 6th months after discharge. SAS includes

a total of 20 items, and each item is scored from 1 to

4 points. The higher the score, the more severe the

anxiety symptoms; the SDS includes 20 items, each

of which corresponds to a symptom of depression.

The more severe the depressive symptoms. Quality of

life assessment: The MOS item short from health

survey (SF-36) was used to assess the quality of life

on the day of discharge. The SF-36 scale assesses

patients' quality of life from both physical and

psychological aspects. The higher the score, the better

the quality of life.

2.2.6 Statistical Methods

ssps19.0 statistical software package was used for

data entry, normal data were expressed as mean ±

standard deviation (X ± s), and %, t and x 2 test,

P<0.05 was considered statistically significant.

2.3 Results

2.3.1 Comparison of Patients' Scores at 3

and 6 Months after Discharge (SAS)

and (SDS)

The patients in the control nursing group and the

experimental nursing group were evaluated by the

self-rating anxiety scale (SAS) and the self-rating

depression scale (SDS) after the 3rd month and the

6th month after discharge, respectively.) scores, there

was a statistically significant difference between the

two groups (P<0.05) table 1.

Table 1: Comparison of SAS and SDS scores at 3 and 6 months after discharge between the two groups (x±s).

Time Group

umber

of cases

SAS SDS

3months after

discharge

Test group

Control group

T value

P value

55.53±5.31

57.23±5.35

－4.256

0.000

53.42±5.43

53.36±5.46

0.034

0.000

6months out of

hospital

Test group

Control group

T value

P value

45.35±4.23*

48.13±4.46*

－4.277

0.000

48.56±4.21*

45.33±4.43*

2.253

0.000

2.3.2 Comparison of Quality of Life Scores

between the Two Groups of Patients

After the telemedicine narrative nursing intervention,

the physical and psychological quality of life scores

of the observation objects in the experimental group

were significantly higher than those in the control

group, and there was a statistically significant

difference between the two groups (P<0.05). As

shown in table 2.

Research on the Inﬂuence Value of Narrative Nursing Intervention on Ischemic Stroke Patients’ Negative Emotions and Quality of Life

based on Telemedicine

177

Table 2: Comparison of quality of life scores between the two groups [points, x±s].

Fractional

dimension

Control group (n=30) Experimental group

(

n=30

)

t P

Physical

ect

Physiological

function

72.1±19.37 85.36±12.40

-7.930

＜0.001

physiological

function

61..40±37.21 72.51±34.70

-8.020

＜0.001

body pain

70.10±19.76 82.10±14.35

-7.525

＜0.001

general health

56.23±14.20 69.55±20.32

-12.531

＜0.001

psychologic

al as

ect

Energy

63.40±16.07 74.45±15.01

-4.601

＜0.001

Social function

76.65±23.78 83.75±14.27

-3.017

0.004

Emotional

69.40±40.39 75.56±33.49

-4.301

＜0.001

Function

64.31±16.25 74.90±17.86

-7.616

＜0.001

2.3.3 Comparing Medical Compliance

The medical compliance in the experimental group

was higher than that in the control group (P<0.05) and

the difference was statistically significant Table3.

Table 3: Comparison of medical compliance between the two groups [n(%)].

Grou

n Full com

liance Partial com

liance Non-com

liance Com

liance

Research group 30 28（93.33） 2（6.67） 0（0.00） 30（100.00）

Control group 30

22（73.33） 4（13.33） 4（13.33） 26（86.67）



- 14.398 2.464 14.282 14.282

P - 0.000 0.216 0.000 0.000

3 DISCUSSION

3.1 Telemedicine Combined with

Narrative Nursing Intervention

Can Help Improve the Negative

Emotions of Ischemic Stroke

Patients and Rekindle Their Hope

in Life

With the acceleration of the aging process of the

global population, the incidence of ischemic stroke

patients is relatively high. Stroke has become the

main cause of disability and death in my country. The

survivors have different degrees of emotional

disorders. Significant negative impact on quality and

clinical care. Anxiety and depression are produced,

and severe patients also have a sense of stigma. In this

study, based on the Internet, narrative therapy as a

means, through remote narrative nursing

intervention, the results showed that the self-rating

anxiety scale (SAS) and self-rating depression scale

(SDS) of stroke patients in the experimental group

were the third Monthly and 6th month evaluation,

comparing the scores of the experimental group at 3

months and 6 months, the scale scores gradually

decreased, indicating that the therapeutic intervention

time of narrative nursing was long, and the patient's

anxiety and depression were gradually alleviated.

Months later, the scores of the experimental group

(SAS) and self-rating depression scale (SDS) were

significantly lower than those of the control group (P

< 0.05), indicating that Cheng medical treatment

combined with narrative nursing intervention can

help the anxiety and depression of ischemic stroke

patients Emotional outcomes have a positive effect.

Thereby reducing the occurrence of anxiety and

depression. Wang Hongying et al reported that

psychological intervention is beneficial to patients'

negative emotion regulation, helps patients to

understand themselves correctly, and actively

cooperate to promote their own early recovery, which

is consistent with the conclusions of this study.

3.2 Telemedicine-based Narrative

Nursing Interventions Help

Patients Improve Their Quality of

Life and Reduce the Burden at

Home

Through remote narrative nursing intervention, the

scores of quality of life in the experimental group,

such as physical function, physical pain, general

health, energy, social function, emotional function,

CAIH 2021 - Conference on Artiﬁcial Intelligence and Healthcare

178

and mental health, were higher than those in the

control group (P<0.05). It has been affected in all

aspects of economy, physiology, psychology and

society, with a decline in income, aggravation of

economic burden, loss of hope in life, and a negative

impact on the quality of life. It also develops remote

nursing intervention, actively provides nursing

services to patients through electro-active follow-up,

timely assesses nursing problems after patients are

discharged from the hospital, and urges patients to

perform rehabilitation exercises through QQ

messages, videos and other communication methods,

which is helpful for reducing physical pain and

improving mental health. It reduces the burden on the

patient, improves life confidence, solves the

difficulties and problems encountered by patients in

different rehabilitation stages, reduces the distress

and psychological pressure of patients facing

complex nursing problems, helps to promote the early

recovery of stroke patients, and reduces the risk of

complications. to prevent recurrence of stroke.

3.3 Nursing Intervention based on

Telemedicine Can Improve Patient

Compliance and Help Patients

Standardize Treatment

Organize a distance education class once a month to

provide professional home care health education for

patients and caregivers, which can improve the

awareness and attention of patients and caregivers to

relevant knowledge; nurses will visit home every

month to confirm the prevention measures. The

implementation of the situation, improve the

compliance of patients with home health behavior,

effectively avoid the occurrence of pressure ulcer

injury, thereby improving the standardized treatment

of patients. Telenarrative nursing intervention to urge

patients and caregivers to adhere to correct exercise

and self-management of healthy behaviors during

home rehabilitation.

4 CONCLUSIONS

Based on telemedicine technology, narrative nursing

intervention, DingTalk, group sharing, video and

other means are used to provide specialized and

individualized nursing treatment plans and

psychological counseling for ischemic stroke

patients, which is of great help in reducing ischemic

stroke patients’ anxiety and anxiety. Depression and

negative emotions have a direct therapeutic effect,

providing similar patients and their families with

vivid, easy-to-understand and emulated experience

and treatment templates; increasing patient

compliance and improving patients' quality of life.

There are still shortcomings in this study. Since there

are many factors that affect the negative emotions of

ischemic stroke patients, how to further improve the

psychological state and quality of life of ischemic

stroke patients still needs to be confirmed by a large

sample study involving multiple centers.

ACKNOWLEDGMENTS

Fund Project: Qiqihar City Science and Technology

Plan Innovation Incentive Project: A study on the

impact of narrative nursing on negative emotions and

self-care ability in patients with ischemic stroke. (No.

CSFGG-2021331)

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