Am J Transl Res 2021;13(4):2939-2946

www.ajtr.org /ISSN:1943-8141/AJTR0126819

Original Article
Comfort nursing can alleviate pain and negative
emotion of patients after surgery for LVCFs
and improve their living ability
Hong Qian1*, Jingfen Zhou2*, Tingmin Huang1, Xingye Cao1, Chao Zhou1, Minjuan Yang1, Yan Chen3
1
Department of Orthopaedics, Affiliated Hospital of Jiangnan University, Wuxi 214125, Jiangsu Province, China;
2
Department of Hematology, Affiliated Hospital of Jiangnan University, Wuxi 214125, Jiangsu Province, China; 3De-
partment of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi 214125, Jiangsu Province, China. *Equal
contributors and co-first authors.
Received November 23, 2020; Accepted December 24, 2020; Epub April 15, 2021; Published April 30, 2021

Abstract: Objective: To determine the effect of comfort nursing in elderly patients with lumbar vertebral compression
fractures (LVCFs). Methods: A total of 194 elderly patients with LVCFs were enrolled, and assigned to two groups
based on different nursing intervention methods. Among them, 93 patients were given routine nursing intervention
as a control group (CON group), while the rest 101 patients were given comfort nursing as an intervention group (INT
group). The visual analog scale (VAS) was adopted to evaluate patients’ pain and Japanese Orthopaedic Association
score (JOA) to evaluate their dysfunction. In addition, Barthel score was used to evaluate patients’ self-care ability,
and the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were adopted to score their anxiety and
depression. Moreover, the compliance and nursing satisfaction of the two groups were investigated. Results: After
nursing, t VAS, SAS, and SDS scores of both groups declined significantly, and these scores of the INT group declined
more notably. After nursing, the JOA and Barthel scores of the two groups increased greatly, and both scores of the
INT group were significantly higher than those of the CON group. Additionally, the INT group consumed significantly
less analgesic drugs and experienced significantly shorter hospital stay than the CON group. Moreover, according to
the survey on nursing compliance and nursing satisfaction, the INT group showed significantly higher nursing com-
pliance and nursing satisfaction than the CON group. Conclusion: For elderly patients with LVCFs, comfort nursing
can effectively relieve their postoperative pain and negative emotion and improve their daily living ability.

Keywords: Comfort nursing, elderly patients, lumbar vertebral compression fractures, postoperative pain, negative
emotion, living ability

Introduction percutaneous vertebroplasty, but after such

operations, patients often suffer severe pain,
Lumbar vertebral compression fracture (LVCF), which not only delays their postoperative recov-
referred to as fracture of lumbar vertebra, is ery, but also increases their psychological bur-
a common disease of spinal fracture in the den [4]. In addition, the elderly have poor physi-
elderly [1]. The elderly are often accompanied cal basic ability and decline of various body
by osteoporosis, which increases their bone functions, and usually suffer from complica-
fragility, so daily muscle tension and direct vio- tions of various degrees, such as diabetes and
lent trauma can give rise to lumbar vertebral hypertension, so their tolerance to surgery is
compression fractures (LVCFs) [2]. Due to the poor, which also hinders their recovery after
special injury part, LVCFs are mainly manifest- surgery [5]. Therefore, it is of great significance
ed as subcutaneous ecchymosis and waist to take effective nursing intervention for
pain, which seriously compromises the daily liv- patients with LVCFs after surgery.
ing ability and physical and mental health of
patients [3]. In clinical practice, the disease is Nowadays, as the society advances, the clinical
primarily treated by surgical operations such as practice calls for increasingly specialized nurs-
 Nursing care of elderly patients with lumbar compression fracture

ing [6]. Ordinary nursing mode is difficult to severe organ disease, coagulation dysfunction,
meet the needs of patients, so it is imperative cognitive dysfunction, or malignant tumor.
to carry out more clinical targeted nursing inter-
vention for patients [7]. Comfort nursing is a Grouping and nursing methods
patient-centered nursing mode, under which
corresponding nursing intervention schemes A total of 194 elderly patients with LVCFs were
are formulated for patients according to their enrolled, and assigned to two groups based
diseases, and targeted comfort nursing is on different nursing intervention methods. Am-
taken for the good of patients’ physical and ong them, 93 patients were given routine nurs-
mental health to promote their recovery [8]. ing intervention as a control group (CON group),
One study by Hou et al. [9] surveyed nurse while the rest 101 were given comfort nursing
practitioners and hospitalized patients in terms as an INT group. Routine nursing methods:
of their knowledge and attitude about comfort During nursing, the nursing staff were arranged
nursing, and the highest and lowest scores of to make regular rounds of the wards to closely
knowledge about comfort nursing were found monitor each patient’s vital signs, and timely
contact the attending doctor to deal with any
in intensive care units and the oncology de-
abnormal situation. Additionally, the staff were
partment, respectively. As the results show,
required to maintain the environmental sanita-
nurses in different departments and for differ-
tion of the wards, so they made effects to avoid
ent diseases have different understanding on
dust on the desktops, keep the sheets clean
comfort nursing, and achieve different applica-
and tidy, regularly ventilate the wards and keep
tion effects of it. One study by Krinsky et al. [10]
their humidity and temperature proper. Comfort
holds the opinion that the theory of comfort
nursing was as follows: Psychological inter-
nursing has great benefits for patients with
vention: The nursing staff were required to pay
heart diseases. Although the clinical applica-
attention to the emotional changes of each
tion of comfort nursing has been widely re-
patient after his/her admission, communicate
ported [11, 12], the application of comfort
with the patient in time and provide psycholo-
nursing in elderly patients with LVCFs after sur-
gical counseling to eliminate negative psycho-
gery is rarely studied, and whether it can pro-
logical effects on the patient, and establish a
mote the rehabilitation of patients is still under
good nurse-patient relationship. Additionally,
investigation.
the staff were arranged to popularize health-
In this study, we intervened with elderly patients related knowledge about the disease to the
with LVCFs through comfort nursing to deter- patients, including correct treatment of pos-
mine the effect of this nursing mode in such toperative pain symptoms and postoperative
patients. precautions, to improve the patients’ cognitive
level of disease and reduce their psychological
Materials and methods burden. Moreover, the staff were required to
create a favorable postoperative recovery envi-
General materials ronment for patients to benefit their recovery.
Diet nursing: The nursing staff were required to
A total of 194 elderly patients with LVCFs who strengthen the guidance of diet nursing for
underwent surgery in Affiliated Hospital of Jiang- the patients after their admission, so that the
nan University from January 2018 to November patients can keep correct eating habits. The
2019 were selected. The inclusion criteria of nursing staff were also required to instruct the
the study: Patients meeting the diagnostic cri- patients in eating light foods, including liquid
teria of LVCFs according to imaging examina- and crude fiber foods, and firmly avoiding spicy,
tion [13], patients who signed informed con- cold, or greasy foods and other irritating foods.
sent forms after understanding the study, pa- In daily life, the patients were required to eat
tients ≥60 years old, and those with detailed more fruits and vegetables, and sesame paste
general clinical data. This study was approved foods, which would help promote their gastro-
by the ethics committee of our hospital. The intestinal peristalsis. During eating, patients
exclusion criteria of the study: Patients with were told to eat several small meals slowly and
contraindications to surgery on LVCFs, and drink more warm water. Posture nursing: The
those with comorbid cardiovascular diseases, nursing staff were required to ask each patient

2940 Am J Transl Res 2021;13(4):2939-2946

 Nursing care of elderly patients with lumbar compression fracture

to take a rest by lying on his/her back, with score of 15 points was given to a person who
affected limb padded, under the premise of can complete the item independently, a score
ensuring that the patient’ spine was in a hori- of 10 points to a person who can complete the
zontal position. The patient was asked to keep item with help, a score of 5 points to a person
gentle movements while lying on side or turning who can complete the item with great help, and
over to avoid pain caused by improper body a score of 0 point to a person who can com-
position and to ensure the comfort body posi- plete the item by relying entirely on others for
tion. Guidance and nursing after surgery: The help. Higher scores indicate stronger self-care
staff were arranged to instruct each patient ability. Additionally, we adopted the self-rating
to transfer pain through abdominal breathing. anxiety scale (SAS) and self-rating depression
During the transfer process, the patient’s abdo- scale (SDS) to evaluate the anxiety and depres-
men expanded outward after inhalation, and sion of patients [17]. Each scale covered 20
contracted inward to the maximum extent. The items, and each item was given 0-4 points.
patient was required to take such breathing Higher SAS and SDS scores indicate more seri-
ous anxiety and depression, respectively. We
according to the actual situation for once a day
compared the compliance of the two groups
and no more than 15 min each time. The staff
according to the Health and responsiveness of
were arranged to massage the patient’s abdo-
health systems [18]. For the purpose of evalu-
men when appropriate. The patient was mas-
ating patients’ compliance, we scored patients
saged, with his/her navel as the center, for no in their cooperation with nurses in dressing
more than 30 minutes. During the massage, change, physical examination, regular work and
the staff were required to observe whether the rest, strict compliance with doctor’s advice,
patient has bowel sounds and observe his/her active exercise and rehabilitation. A higher
exhaust status after the massage. score indicates better compliance. Moreover,
we surveyed the nursing satisfaction of each
Observation indexes
patient before his/her discharge [19]. The nurs-
ing satisfaction has a full score of 100 points,
We adopted the visual analog scale (VAS) to
with a score >90 points for high satisfaction, a
evaluate the pain of each patient before sur-
score between 60 and 90 points for satisfac-
gery and at 3 d after surgery [14]. A mov-
tion, and a score <60 for dissatisfaction.
able 10-cm scale was adopted, which was Nursing satisfaction = (The number of patients
divided into 10 scales. The scale of 0 point indi- highly satisfied with nursing + that of patients
cated painless, and a scale closer to the scale satisfied with it) × 100%. We also counted the
of 10 points indicated unbearable and severe usage amount of analgesic drugs and hospital
pain. We adopted the Japanese Orthopaedic stay of patients in the two groups.
Association (JOA) score to evaluate the patients
[15], which covered low back pain, leg pain and Statistical analyses
tingling, gait, Lasegue’s sign, sensory distur-
bance, decreased muscle strength, limited Enumeration data, expressed as [n (%)], were
daily activities and bladder function. A lower compared between groups using the chi-square
score indicates more obvious dysfunction. We test. Measurement data, expressed as (mean ±
also adopted the Barthel score for the evalua- SD), were compared between groups using the
tion of patients [16], which covered 10 items. t test, and within groups before and after nurs-
Among the 10 items, eating, dressing, defecat- ing using the paired t test. IBM SPSS 26.0 was
ing, peeing, toilet use, and going up and down adopted for statistical analyses of data, and
stairs were all given 10 points. A score of 10 GraphPad Prism 6.0 for drawing of correspond-
points was given to a person who can complete ing figures.
the item independently, a score of 5 points to a Results
person who can complete the item with help,
and a score of 0 point to a person who can General materials
complete the item with great help of others or
by relying entirely on others for help. Bath and The comparison of clinical data between the
grooming were both given 5 points in full. In INT and CON groups showed that there was no
addition, transferring bed and chair and walk- significant difference between them in general
ing on flat ground were both given 15 in full. A clinical data such as sex, age, injury cause,

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 Nursing care of elderly patients with lumbar compression fracture

Table 1. Clinical data of the control group and the intervention group
Item The control group (n=93) The intervention group (n=101) t/χ2 P-value
Sex 2.538 0.111
Female 40 (43.01) 60 (54.46)
Male 53 (56.99) 41 (45.54)
Age (Y) 67.6±3.5 68.1±3.7 0.945 0.336
Cause of injury 1.328 0.515
Injury for traffic accident 29 (31.18) 25 (24.75)
Injury for falling 53 (56.99) 60 (59.41)
Trauma from foreign objects 11 (11.83) 16 (15.84)
Time from injury to admission (h) 11.4±3.2 11.9±3.9 0.971 0.333
Education level 0.972 0.808
With university diploma 38 (40.86) 37 (36.63)
With senior diploma 41 (44.09) 51 (50.50)
With junior diploma 11 (11.83) 11 (10.89)
With primary school diploma 3 (3.23) 2 (1.98)
Coronary heart disease 0.208 0.648
Yes 10 (10.75) 13 (12.87)
No 83 (89.25) 88 (87.13)
Hypertension 0.236 0.627
Yes 23 (24.73) 22 (21.78)
No 70 (75.27) 79 (78.22)
Diabetes mellitus 0.077 0.781
Yes 9 (9.68) 11 (10.89)
No 84 (90.32) 90 (89.11)

education level and complications (all P>0.05)

(Table 1).

VAS scores of the two groups before and after

nursing

We adopted VAS scores to evaluate the pain of

the two groups, finding that before nursing,
there was no notable difference between the
two groups in VAS score (P>0.05), while after
nursing, the VAS scores of both groups decre-
ased significantly (P<0.001), and the decrease
in the INT group was more significant (P<0.001)
(Figure 1).

JOA scores of the two groups before and after

nursing

We adopted JOA score to evaluate the dysfunc-

tion of the two groups, finding that before nurs-
ing, there was no significant difference between
Figure 1. Comparison of VAS scores between the the two groups in JOA score (P>0.05), while
control group and the intervention group before and after nursing, the JOA scores of both groups
after nursing. After nursing, the VAS scores of both
groups decreased notably, and the decrease in the increased significantly (P<0.001), but the JOA
intervention group was more significant. Note: *** in- score of the INT group was notably higher
dicates P<0.001. (P<0.001) (Figure 2).

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 Nursing care of elderly patients with lumbar compression fracture

Figure 2. Comparison of JOA score between the con- Figure 3. Comparison of Barthel score between the
trol group and the intervention group before and control group and the intervention group before
after nursing. After nursing, the JOA scores of both and after nursing. After nursing, the Barthel scores
groups increased notably, while the JOA score of the of both groups increased notably, while the Barthel
intervention group was notably higher than that of score of the intervention group was notably higher
the control group. Note: *** indicates P<0.001. than that of the control group. Note: *** indicates
P<0.001.

Barthel score of the two groups before and

after nursing time of the two groups, the INT group con-
sumed less analgesic drugs and experienced
We adopted Barthel score to evaluate the shorter hospital stay than the CON group (Table
self-living ability of the two groups before and 2).
after nursing, finding that there was no signifi-
cant difference between the two groups in Nursing compliance of the two groups
Barthel score (P<0.001), while after nursing,
the Barthel scores of both groups increased According to the observation of the nursing
notably (P<0.001), but the Barthel score of the compliance of the two groups, the INT group
INT group was notably higher (P<0.001) (Figure showed notably higher nursing compliance
3). than the control group (97.03% vs. 89.25%)
(Table 3).
Anxiety and depression scores of the two
groups before and after nursing Nursing satisfaction of the two groups

We adopted SAS and SDS scores to eva- We evaluated the nursing satisfaction of the
luate the anxiety and depression of the two two groups before their discharge and found
groups, finding that before nursing, there was that the nursing satisfaction of the INT group
no significant difference between the two gr- was notably higher than that of the CON group
oups in SAS and SDS scores (both P>0.05), (94.06% vs. 83.87%) (Table 4).
while after nursing, the SAS and SDS scores
of both groups decreased notably (both P< Discussion
0.001), but the decrease in the INT group was
more significant (P<0.001) (Figure 4). LVCFs show a high incidence among the elderly
in clinical practice. Patients with mild LVCFs
Usage amount of analgesic drugs after sur- suffer dyskinesia and local pain, and those
gery and discharge time of the two groups with severe LVCFs suffer spasm of the back
muscles and even loss of daily activity ability,
According to the observation of usage amount so LVCFs are extremely harmful [20]. The elder-
of analgesic drugs after surgery and discharge ly with LVCFs face a high risk during surgery,

2943 Am J Transl Res 2021;13(4):2939-2946

 Nursing care of elderly patients with lumbar compression fracture

which suggested that com-

fort nursing can accelerate
the postoperative rehabilita-
tion of patients and improve
their daily living ability. In one
study, Olsson and other team
members carried out nursing
intervention within an integr-
ated care pathway for patients
with hip fractures, and found
that such intervention can pro-
mote the recovery of patients
and avoid them from deviat-
Figure 4. Comparison of SAS and SDS scores between the control group and ing from the nursing plan [25].
the intervention group before and after nursing. After nursing, the SAS (A) In our research, patients sh-
and SDS (B) scores of both groups decreased notably, and the decrease in owed notably higher compli-
the intervention group was more significant than that in the control group.
ance after comfort nursing.
Note: ***
indicates P<0.001.
Therefore, with a correspond-
ing nursing scheme, the pa-
and they will suffer from obvious postoperative tients can be effectively intervened. It may be
pain [21]. In order to ensure that postoperative due to the fact that comfort nursing is an ef-
rehabilitation of patients, it is imperative to fective, individualized, innovative nursing mode
carry out reasonable nursing intervention for [26]. Through nursing intervention in various
patients. aspects, we can help patients reach a positive
state in society, physiology and psychology and
In one report by Hertz et al. [22], there are greatly reduce their unhappiness, thus promot-
approximate 9 million cases of fragile fractures ing their physical recovery. Neuman and other
in the elderly every year, and there is a great team members have reported that the survival
need for nursing care for patients with fragile and prognosis of patients with hip fracture are
fractures worldwide, so it is necessary to not poor, especially elderly patients and those with
only build a nursing mode to prevent fractures, various complications and advanced cognitive
but also provide an effective nursing mode to impairment, so appropriate nursing plans sh-
promote the recovery of patients with fragile ould be provided for these individuals [27].
fractures. Comfort nursing is a nursing mode Some of the elderly cases enrolled were accom-
with targeted nursing schemes developed for panied by some complications. After comfort
patients according to their symptoms [23]. Due nursing, they can get discharge earlier and
to the influence of LVCFs, most of patients with spend less money. We surveyed the nursing
the disease will have severe back pain, so their satisfaction of the two groups at their dis-
physiological and self-care abilities decline, charge, finding that patients were generally sat-
and they will inevitably suffer some bad emo- isfied with the comfort nursing mode, which
tions such as tension, anxiety and irritability was helpful to popularize and apply it in clinical
[24]. In view of these phenomena, we carried practice.
out psychological intervention, health-related
Our study has confirmed the application pros-
knowledge propaganda and posture nursing for pect of comfort nursing intervention in elderly
patients. As a result, after comfort nursing, the patients with LVCFs. However, the study still
VAS score of patients decreased more notably, has some limitations. For example, we have not
and they consumed less usage amount of anal- carried out nursing intervention guidance for
gesic drugs and got greatly lower SAS and SDS patients after discharge, and the application
scores. The results imply that comfort nursing prospect of comfort nursing in other diseases
can effectively control the pain of patients, is still to be studied. These limitations need to
reduce their postoperative stress reaction and be addressed in future research.
improve their physical and mental health. In
addition, the JOA score of patients interven- To sum up, for elderly patients with LVCFs, com-
ed by comfort nursing increased significantly, fort nursing can effectively relieve their postop-

2944 Am J Transl Res 2021;13(4):2939-2946

 Nursing care of elderly patients with lumbar compression fracture

Table 2. Comparison of usage amount of analgesic drugs after surgery and discharge time between
the two groups
The control group (n=93) The intervention group (n=101) t P-value
Usage amount of analgesic drugs 29.45±5.14 23.71±4.26 8.494 <0.001
Hospital stay 7.46±1.86 6.13±1.56 5.411 <0.001

Table 3. Comparison of nursing compliance between the two groups fractures in south korea:
a nationwide population-
The control The intervention based study. Asian Spine
Nursing compliance χ 2
P-value
group (n=93) group (n=101) J 2020; 14: 220-228.
Complete compliance 42 (45.16) 46 (45.54) - - [4] Yuan L, Bai J, Geng C,
Partial compliance 41 (44.09) 52 (51.49) - - Han G, Xu W, Zhang Z,
Non-compliance 10 (10.75) 3 (2.97) - - Luo H and Zhu X. Com-
parison of targeted per-
Overall compliance rate (%) 89.25 97.03 4.690 0.030
cutaneous vertebroplas-
ty and traditional percu-
taneous vertebroplasty
Table 4. Comparison of nursing satisfaction between the two groups for the treatment of os-
The control The intervention teoporotic vertebral com-
Nursing satisfaction χ 2
P-value pression fractures in the
group (n=93) group (n=101)
High satisfaction 31 (33.33) 65 (64.36) - - elderly. J Orthop Surg
Res 2020; 15: 359.
Satisfaction 47 (50.54) 30 (29.70) - -
[5] Zhang HX, Shen Y, Chen
Dissatisfaction 15 (16.13) 6 (5.94) - - J, Zhang L and Lin W.
Treatment satisfaction 83.87 94.06 5.207 0.022 Risk factors of pulmo-
nary complications after
minimally invasive sur-
erative pain and negative emotion and improve gery for elderly patients with vertebral com-
their daily living ability. pression fractures. Ther Clin Risk Manag
2020; 16: 7-15.
Disclosure of conflict of interest [6] Mitrea N, Ancuta C, Malloy P and Mosoiu D.
Developing, promoting, and sustaining pallia-
None. tive care across central Eastern Europe: edu-
cating nurses to be leaders is a critical first
Address correspondence to: Yan Chen, Department step. J Hosp Palliat Nurs 2019; 21: 510-517.
of Nephrology, Affiliated Hospital of Jiangnan Uni- [7] Booth S, Silvester S and Todd C. Breathless-
versity, 1000 Hefeng Road, Wuxi 214125, Jiangsu ness in cancer and chronic obstructive pulmo-
Province, China. Tel: +86-15301517312; E-mail: nary disease: using a qualitative approach to
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chenyan20202020@126.com
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