The Effect of Nurse-Led Structured Patient Education on Anxiety and Quality of Life in Patients Undergoing Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial
The Effect of Nurse-Led Structured Patient Education on Anxiety and Quality of Life in Patients Undergoing Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial
Urolithiasis is a significant health problem characterized by the formation of stones in urinary system organs such as the kidneys, ureters, and bladder, and its prevalence is increasing worldwide. It is reported that its prevalence varies between 1% and 20% due to geographical, diet-related, genetic, and climatic factors, and it shows a recurrence rate of approximately 50%. Urolithiasis is the third most common pathology in urology after urinary tract infections and prostate diseases and is closely related to multiple factors such as the increase in the prevalence of metabolic syndrome, dietary habits, inadequate fluid intake, physical inactivity, obesity, and climate change. This situation increases the clinical burden of the disease, leading to a decrease in the quality of life of individuals and the development of various physical and psychological problems during the treatment process.
Extracorporeal shock wave lithotripsy (ESWL) is a widely used non-invasive method in the treatment of urolithiasis. ESWL uses shock waves to break kidney stones into smaller pieces, which are then passed through the urinary tract. Current urolithiasis guidelines emphasize that treatment selection should be individualized, taking into account the stone's size and location, as well as its density and the patient's anatomical conditions. According to guidelines published by the European Association of Urology and the American Urological Association, ESWL or retrograde intrarenal surgery (RIRS) are among the primary treatment options for kidney stones smaller than 20 mm, while percutaneous nephrolithotomy (PCNL) is recommended for kidney stones 20 mm and larger. In addition, it recommends ESWL as the first-line treatment for lower calyx stones smaller than 10 mm, provided that the appropriate stone composition and anatomical conditions are met. The current literature shows that ESWL has complication rates similar to or lower than those of ureteroscopic lithotripsy (URSL), RIRS, and PCNL and offers shorter hospital stays. However, uncertainties regarding the patient experience, including treatment success and the need for retreatment, remain.
Although ESWL is generally considered a safe and effective method, uncertainties regarding the procedure and insufficient information can cause increased anxiety in patients.Increased anxiety levels can heighten pain perception, thereby increasing the need for analgesics and negatively affecting treatment compliance. Furthermore, complications such as pain, hematuria, nausea and vomiting, and infection that may occur in the post-procedure period can lead to a decrease in patients' quality of life and repeated visits to healthcare facilities.
The role of nurses in the pre- and post-procedure care of patients undergoing ESWL treatment extends beyond technical care to include improving the patient's experience through patient education and psychosocial support. Nurses make significant contributions by identifying potential contraindications to ESWL, planning appropriate patient preparation, and enhancing procedure safety through comprehensive pre-procedure assessments. In addition, patient education led by nurses plays a critical role in increasing patients' knowledge and awareness of lifestyle adjustments and preventive approaches to reduce the recurrence of urolithiasis.
A review of the current literature reveals a limited number of studies that jointly evaluate the effect of structured patient education led by nurses on key psychosocial outcomes, such as anxiety levels and quality of life, in patients undergoing ESWL treatment. This situation underscores the need for interventional studies to assess the comprehensive effects of these educational interventions on patient-centered outcomes.
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