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This study explored the impact of an interaction standard theory-based multi-care program on postpartum recovery, coping styles, psychological distress, and quality of life in women experiencing postpartum hemorrhage (PPH). A total of 110 women with PPH were randomized into a study group receiving the multi-care program or a control group receiving conventional nursing. Outcomes were assessed at baseline and 2 weeks post-intervention. The multi-care program significantly improved postpartum recovery, enhanced adaptive coping, reduced psychological distress, and improved quality of life compared to conventional care.
Postpartum hemorrhage (PPH) is a severe obstetric complication. While standard medical care addresses the physiological crisis, the psychosocial needs and coping mechanisms of women experiencing PPH may be inadequately addressed by conventional nursing. This prospective, randomized controlled trial aimed to evaluate an interaction standard theory-based multi-care program, integrating King's Theory of Goal Attainment and Satir's model, for women with PPH. Participants (n=110) admitted to Shijiazhuang Obstetrics and Gynecology Hospital from October 2023 to October 2024 were randomly assigned to the study group (n=55) receiving the multi-care program or the control group (n=55) receiving conventional nursing. The multi-care program included collective training for nursing staff, individualized patient data collection, collaborative care plan development, and specific interventions in hemorrhage care, psychological care (empathetic listening, Satir's communication stances, music therapy, guided imagery), cognitive intervention (education on PPH), dietary care, and rehabilitation training. Follow-up occurred at 1 and 2 weeks post-discharge. The study assessed changes in coping styles (SCSQ), psychological distress (HAMD, HAMA), quality of life (WHOQOL-BREF), postpartum recovery indicators (lochia duration, lactation onset, uterine involution, hospital stay), and nursing satisfaction. The study was designed and reported following CONSORT guidelines.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Interaction Standard Theory-Based Multi-Care Program Group | Experimental | Participants received conventional nursing care plus an interaction standard theory-based multi-care program. This program involved:
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| Conventional Nursing Intervention Group | Active Comparator | Participants received standard conventional nursing interventions as per the hospital's established protocol for postpartum hemorrhage management. This included careful examination of the soft birth canal and placenta, monitoring vital signs, administering oxygen therapy or blood transfusion if indicated, maintaining communication with the patient's family, and providing basic oral education regarding routine postpartum self-care. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Interaction Standard Theory-Based Multi-Care Program | Behavioral | A comprehensive nursing program based on King's Theory of Goal Attainment and Satir's model, focusing on structured nurse-patient communication, shared goal-setting, and multi-dimensional care addressing cognitive, psychological, behavioral, and dietary aspects. Delivered daily during hospitalization (30-45 min sessions) with post-discharge follow-up. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Coping Styles (Positive Coping) | Assessed using the Simplified Coping Style Questionnaire (SCSQ) positive coping subscale (0-36 points). Higher scores indicate more positive coping. | Baseline (1 day post-PPH event) and 2 weeks post-intervention. |
| Change in Coping Styles (Negative Coping) | Assessed using the Simplified Coping Style Questionnaire (SCSQ) negative coping subscale (0-24 points). Lower scores indicate less negative coping. | Baseline (1 day post-PPH event) and 2 weeks post-intervention. |
| Change in Depression Severity | Assessed using the Hamilton Depression Rating Scale (HAMD-17). Total score ranges, with scores >24 indicating severe depression, 18-24 moderate, 7-17 mild. Lower scores indicate less depression. | Baseline (1 day post-PPH event) and 2 weeks post-intervention (or 1 day before discharge if earlier). |
| Change in Anxiety Severity | Assessed using the Hamilton Anxiety Rating Scale (HAMA). Total score up to 56, with scores ≥29 severe anxiety, ≥21 definite, ≥14 mild, ≥7 possible. Lower scores indicate less anxiety. | Baseline (1 day post-PPH event) and 2 weeks post-intervention (or 1 day before discharge if earlier). |
| Change in Quality of Life | Assessed using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). Consists of 26 items across four dimensions (Environment, Physical, Psychological, Social Relations). Each item scored 0-5, higher total scores indicate better quality of life. | Baseline (1 day post-PPH event) and 2 weeks post-intervention. |
| Duration of Lochia |
| Measure | Description | Time Frame |
|---|---|---|
| Nursing Satisfaction Rate | Assessed using a locally adapted patient satisfaction questionnaire (15 items) focusing on nursing care. Levels: satisfied, neutral, dissatisfied. Rate calculated as (Number of satisfied + neutral patients) / Total number of patients × 100%. | At discharge (within 2 weeks post-intervention). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Na Li | Shijiazhuang Obstetrics and Gynecology Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shijiazhuang Obstetrics and Gynecology Hospital | Shijiazhuang | Hebei | 050000 | China |
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| ID | Term |
|---|---|
| D006473 | Postpartum Hemorrhage |
| ID | Term |
|---|---|
| D007744 | Obstetric Labor Complications |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
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| Conventional Nursing Intervention | Behavioral | Standard hospital protocol for postpartum hemorrhage management including physiological monitoring, emergency measures as needed, and basic postpartum care education. |
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Time in days from delivery until lochia cessation. |
| Assessed up to 2 weeks post-intervention. |
| Time for Uterus to Return to Pelvic Cavity (Uterine Involution) | Time in days from delivery for the uterus to involute to the pelvic cavity. | Assessed up to 2 weeks post-intervention. |
| Length of Hospitalization | Duration of hospital stay in days post-PPH event. | From enrollment until hospital discharge (up to approximately 1 week) |
| D011644 | Puerperal Disorders |
| D014592 | Uterine Hemorrhage |
| D006470 | Hemorrhage |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |