Topic is Orem’s Self Care Deficit Theory
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Computational and Mathematical Methods in Medicine
Volume 2022, Article ID 4133812, 9 pages
https://doi.org/10.1155/2022/4133812
Research Article
Effects of Comprehensive Nursing Based on Orem’s Self-Care
Theory on Symptom Improvement and Pregnancy Outcome in
Patients with Antiphospholipid Syndrome: A Retrospective
Cohort Study
Meng Bi, Lingyuan Meng, and Liying Bai
Obstetrics Department of Beijing Chaoyang Hospital, Capital Medical University 100020, China
Correspondence should be addressed to Liying Bai; 18409092@masu.edu.cn
Received 28 February 2022; Revised 11 April 2022; Accepted 25 April 2022; Published 19 May 2022
Academic Editor: Min Tang
Copyright © 2022 Meng Bi et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective. A retrospective cohort study was conducted to explore the effects of comprehensive nursing based on Orem’s self-care
theory on symptom improvement and pregnancy outcomes in patients with antiphospholipid syndrome (APS). Methods. Sixty
patients with antiphospholipid antibody syndrome treated in our hospital from February 2019 to April 2021 were enrolled.
The control group received comprehensive nursing, while the study group received comprehensive nursing based on Orem’s
self-care theory. Nursing satisfaction, self-nursing ability, anxiety score, social support status, pregnancy outcome, and the
score of life quality were compared between the two groups. Results. First of all, we compared the nursing satisfaction, the
study group was very satisfied in 23 cases, satisfactory in 5 cases, general in 2 cases, the satisfaction rate was 100.00%. While in
the control group, 11 cases were very satisfied, 10 cases were satisfied, 4 cases were general, and 5 cases were dissatisfied, the
satisfaction rate was 83.33%. The nursing satisfaction in the study group was higher compared to the control group (P < 0:05).
Secondly, the self-concept, sense of self-care responsibility, self-nursing skills, health knowledge, and total score of the study
group were higher compared to the control group (P < 0:05). After intervention, the anxiety scores of the two groups
decreased. Compared between the two groups, the anxiety scores of the study group before intervention and 1 week, 2 weeks, 3
weeks, and 4 weeks after intervention were lower compared to the control group (P < 0:05). The comparison of social support
showed that the scores of objective support, subjective support, utilization of support, and total score of social support in the
study group were higher compared to the control group (P < 0:05). The number of abortions in the control group was lower
compared to the control group, and the number of full-term deliveries was higher compared to the control group (P < 0:05).
Finally, we compared the scores of life quality. After nursing, the scores of life quality of the two groups increased. Of note, the
scores of physiological function, psychological function, social function, and health self-cognition in the study group were
lower compared to the control group (P < 0:05). Conclusion. Comprehensive nursing for patients with APS based on Orem’s
self-care theory can effectively improve clinical symptoms and pregnancy outcome and play a positive role in facilitating
patients’ nursing satisfaction and self-nursing ability, which can also effectively strengthen mental health and social support,
this nursing model is worth popularizing in clinic.
1. Introduction
Antiphospholipid syndrome (APS) is a noninflammatory
autoimmune disease characterized by persistent high titer
positive antiphospholipid antibodies (APL) [1]. The most
common clinical manifestations are arterial or venous
thrombosis and/or recurrent bad pregnancy. The common
APL that are significant for the diagnosis of APS are anticardiolipin antibodies (ACL), anti-β 2-glycoprotein I (β-2GPI)
antibodies, and lupus anticoagulant (LA) antibodies. APS is
more common in young women of childbearing age.
Women account for about 70% of APS patients, and the
incidence is the highest during pregnancy [2]. Some studies
have indicated that APL is a risk factor for thrombosis. If the
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three antibodies (ACL, LA, anti-β 2-GP I antibody) in
patients with APS are all positive, the risk of thrombosis
increases [3]. Recurrent abortion refers to the abortion that
occurs more than 2 times with the same partner and occurs
before 20 weeks of pregnancy, which is an important reason
of female infertility. The most common obstetrical complication of APS is abnormal pregnancy, most of which are
recurrent abortion, and about 80% of the patients are early
pregnancy (before 12 weeks of pregnancy) abortion [4].
According to the literature, the probability of pregnancy loss
in APS patients is from 23.8% to 52.3%, and recurrent abortion and fetal death are the most common in uterus; about
5%-20% of recurrent abortion patients have persistent antiphospholipid antibody positive; if there is no clinical intervention, up to 90% of antiphospholipid antibody positive
patients can have unsuccessful pregnancy again [5]. Therefore, strengthening the understanding of pregnancy complicated with APS is conducive to better clinical intervention,
reduce the incidence of thrombosis and pregnancy complications, and improve the pregnancy outcome of patients [6].
Orem’s self-care theory was originally put forward by
Dorothea Orem, an American nursing theorist [7]. Selfcare is an individual’s self-care behavior and activities to
meet the maintenance of their own life, health function,
growth, development, and happiness, which is realized by
meeting the existing self-care needs [8]. In recent years,
there have been more investigations and applications on
self-care behavior, which have developed rapidly, mainly
focused on chronic diseases such as chronic obstructive pulmonary disease, asthma, heart failure, diabetes, hypertension, and hemiplegia [9]. The results indicate that after
self-nursing intervention, patients can master the relevant
knowledge of the disease, correctly understand the disease
and self-worth, and adapt to various changes caused by illness [9]. Active participation in the treatment and rehabilitation of the disease can enhance the quality of life of patients.
Orem’s self-care theory emphasizes the individual’s self-care
ability, which is consistent with the nursing concept of
“patient-centered” holistic nursing [10]. Its purpose is to
strengthen personal health and the physical coping skills of
the body and has gradually become the main means of
chronic diseases management [11]. Comprehensive nursing
is a nursing model that integrates psychological nursing, diet
intervention, health education, and other nursing methods.
This nursing strategy pays more attention to the comprehensiveness and integrity of nursing methods, while the
comprehensive nursing based on Orem’s self-care theory is
guided by Orem’s self-care theory and carries out comprehensive nursing according to Orem’s self-care theory, which
can take targeted nursing intervention measures for patients
more effectively [12].
APS has a serious impact on people’s lives and health
[13]. In order to promote the life quality of patients with
APS, it is imperative to facilitate the self-care ability of
patients with APS. In line with the current requirements of
high-quality nursing services, patients’ self-care ability has
been improved in order to return more time to nurses, and
nurses can more efficiently spend their time on patients
who really need it. Meanwhile, with the innovation and
Computational and Mathematical Methods in Medicine
progress of medical technology in recent years, the number
of patients with APS is also increasing, in order to
strengthen the life quality of patients after discharge and
reduce the burden of society and families. It is also very valuable to promote the self-care ability of patients [13, 14]. In
the process of self-nursing intervention, the most important
thing is to completely change the mind that patients are
dependent on medical staff and their families, make them
consciously realize the importance and significance of selfcare ability, and constantly mobilize patients’ enthusiasm
and sense of participation; make patients from simple passive treatment and nursing to actively participate in treatment and nursing activities, gradually assume the
responsibility of self-care [13]. In the past, routine nursing
was adopted for patients with APS, but the nursing effect
was not satisfactory. Based on this, this study focuses on
the effect of comprehensive nursing based on Orem’s selfcare theory on the improvement of symptoms and pregnancy outcome of patients with APS. The results are
reported as follows.
2. Patients and Methods
2.1. General Information. Sixty patients with APS treated in
our hospital from February 2019 to April 2021 were
enrolled. The control group received routine nursing, and
the study group received comprehensive nursing based on
Orem’s self-care theory. In the control group, the age was
21-44 years old, the average age was 32:94 ± 3:63 years old.
In the study group, the age was 20-45 years old, the average
age was 32:931 ± 3:66 years old. There was no statistical significance in the general data of the two groups. This study
was permitted by the Medical Ethics Association of our hospital and all patients noticed informed consent.
Inclusion criteria are as follows: (1) age ≥ 18 years old;
(2) no cognitive, language and intellectual impairment, basic
reading and writing ability; and (3) consent to follow-up for
6 months and be able to accept and answer telephone
followers.
Exclusion criteria are as follows: patients with SLE,
hematopathy, heart disease, genetic disease, hyperthyroidism, hypothyroidism, and other diseases that can lead to
abortion or thrombosis and incomplete data were excluded.
2.2. Treatment Methods. The control group received comprehensive nursing, issued disease guidance manuals to
patients on the day of admission, evaluated admission,
patiently carried out health education for patients, explained
to patients matters needing attention in disease-related selfmanagement, and gave individualized nursing guidance.
Education is mainly carried out through health education.
Compared to the control group, the study group carried
out comprehensive nursing based on Orem’s self-care theory. The specific measures are as follows: (1) complete compensation system: at this stage, patients are unable to take
care of themselves and have a low level of self-care ability.
Due to adverse pregnancy outcomes, patients have no time
to take care of themselves at this time the use of complete
compensation system to compensate for patients’ lack of
Computational and Mathematical Methods in Medicine
self-care. Meanwhile, the patients are in a negative mood
and need to be comforted by others. To relieve the patients’
emotions, nurses should strengthen their communication
with patients, understand the types of music they like, and
choose relaxing and decompression music according to their
wishes, such as “brook chanting” and “sea reverie.” Guide
patients to follow the music rhythm for progressive muscle
relaxation. Tighten the hands, forearms, upper arms, forehead, cheeks, nose, lower jaw, shoulder and neck, chest
and back, abdomen, thighs, calves, and feet in turn, and relax
after holding for (5-7) seconds. And 30 min/times, once a
day; (2) partial compensation system: at this stage, the level
of patients’ self-care ability is moderate, some of them need
nurses to provide nursing care, and both nurses and patients
play a certain role in satisfying self-care. Then, nurses provide partial compensatory care to mobilize patient initiative.
Next, nurses should be considerate and care for patients,
enumerate cure cases, encourage patients to speak for themselves, and encourage family members to accompany and
care, so as to establish the belief that patients can restore
their health. In addition, nurses should also enhance image
guidance on the basis of the original music relaxation training, that is, under the background music, they should
instruct patients to carry out progressive muscle relaxation
while imagining a happy life experience under the guidance
of instructions; (3) support-education system: at this stage,
the level of self-care ability of patients is at a high level,
which belongs to the type of mild dependence. Patients have
the ability to implement or learn some necessary self-care
methods, but they must consult a nurse and complete it
under the guidance and education: (1) provide psychological
care to family members and seek emotional support from
family members. Improve communication with the patient’s
family and inform them that venting anger is a normal psychological process for the patient. In addition, they should
also explain the simple psychological nursing knowledge
(such as listening, persuasion, comfort, and appropriate
physical contact). Encourage family members to visit and
accompany; (2) to guide the patients to vent their emotions
reasonably. Patients are encouraged to vent their anger by
writing diaries, pouring out your feelings, listening to music,
sports, and other ways. In addition, nurses should care and
understand patients and analyze irrational concepts in view
of patients in order to correct their misunderstandings.
2.3. Observation Index
2.3.1. Satisfaction. After consulting the literature and expert
discussion, we designed patients’ follow-up satisfaction, a
total of 10 items, and recorded patients’ satisfaction with
follow-up management mode, health education, medical
and nursing service, appointment registration process, and
so on [14]. It is divided into four dimensions: very satisfied,
satisfied, general, and dissatisfied. Satisfaction rate = very
satisfaction rate + satisfaction rate + general rate.
2.3.2. Self-Care Ability. Self-care ability scale (ESCA): the
scale was designed according to Orem’s self-care theory
[15]. Invented by Kearny and Fleisher in 1979, it is used to
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investigate the patients’ self-care ability. There are 4 dimensions and 43 items: self-concept, sense of self-care responsibility, self-care skills, and health knowledge [16]. The score
of each item of the scale was 0-4, of which 11 were reverse
scores, with a total score of 172. According to the total score
of the scale and the score of each item, the self-nursing ability was divided into three levels: 66%
of total score was high level, and the higher the score was.
2.3.3. Self-Rating Anxiety Scale (SAS). Compiled by Zung in
1971, it was used to evaluate the subjective feelings of anxiety
patients. There were 20 questions, containing 4 reverse
scores [16]. The answers were divided into 4 grades and
the positive scores were 1, 2, 3, and 4, respectively. The
reverse score is 4, 3, 2, and 1, respectively. The total scores
for the 20 themes were added together to obtain the total
score. In the scale cooperation group, 1158 Chinese normal
subjects were studied. The results indicated that the average
gross score was 29:78 ± 10:07, and the normal upper limit of
the total gross score was 40 points.
2.3.4. Social Support Rating Scale (SSRS). Compiled by Xiao
Shuiyuan in 1986 and tested by a large sample of people in
the community, it is proved to have good reliability and
validity, and it is widely employed in the field of psychosomatic medicine in China [17]. The scale includes three
dimensions: objective support (3 items), subjective support
(4 items), and utilization of social support (3 items). There
are 10 items in the scale, only 1 item is enrolled for each item
of item 1-4 and item 8-10, and items 1, 2, 3, and 4 are
enrolled, and the scores are 1, 2, 3, and 4, respectively. Article 5 is divided into items A, B, C, D, and E5, score 0-4 for
each item from zero to full support; Articles 6 and 7, if you
answer “there is no source”, score 0. If you answer “the following sources,” you will get a few points from several
sources. The total score is the sum of 10 items. The total
score ranges from 12 points to 66 points, the higher the
score, the higher the social support, lower than 33 points
as low social support, 33 to 45 points as average social support, and higher than 45 points as high social support.
2.3.5. Pregnancy Outcome. The pregnancy outcomes of the
two groups were calculated. Containing: miscarriage, stillbirth, premature delivery, and full-term delivery.
2.3.6. Life Quality Scale. The scale of life quality consists of
four subscales, containing physical, psychological, social,
and health self-awareness with a total of 29 items. Cronbach’s α coefficient of the scale is 0.79 to 0.91. The scale
was scored by 1-5 grades. The lower the score, the higher
the satisfaction.
2.4. Statistical Analysis. The obtained data were analyzed by
using SPSS Statistics 22.0 software. The measurement data
were tested by normality test and variance homogeneity test.
The normal distribution was presented by mean ± standard
deviation (x ± s), compared with t-test, the nonnormal distribution was presented by median and quartile M
(Q1 ~ Q3), and the rank sum test was employed for
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comparison. Counting data line chi-square test. The above
test, P < 0:05 indicates that the difference is statistically
significant.
3. Results
3.1. Comparison of Nursing Satisfaction. First of all, we compared the nursing satisfaction. The study group was very satisfied in 23 cases, satisfactory in 5 cases, and general in 2
cases, and the satisfaction rate was 100%. The control group
was very satisfied in 11 cases, satisfactory in 10 cases, general
in 4 cases, and dissatisfied in 5 cases. The satisfaction rate
was 83.33%. The nursing satisfaction in the study group
was higher compared to the control group (P < 0:05). All
the data results are indicated in Figure 1.
3.2. Comparison of Self-Nursing Ability Score. Secondly, we
compared the score of self-nursing ability. The self-concept,
sense of self-care responsibility, self-nursing skills, health
knowledge, and total score of the study group were higher
compared to the control group (P 0:05). The anxiety
scores of the study group before intervention, 1 week, 2
weeks, 3 weeks, and 4 weeks after intervention were lower
compared to the control group (P < 0:05). The results of all
the data are indicated in Table 2.
3.4. Comparison of Social Support. Then, we compared the
status of social support. The study group objective support,
subjective support, support utilization, and the total score
of social support were higher compared to the control group
(P < 0:05). All the data results are indicated in Table 3.
3.5. Comparison of Pregnancy Outcome. There were 5 cases
of abortion, 2 cases of stillbirth, 2 cases of premature delivery, and 21 cases of full-term delivery in the study group,
while 7 cases of abortion, 2 cases of stillbirth, 10 cases of premature delivery, and 11 cases of full-term delivery in the
control group. The number of abortions in the study group
was lower compared to the control group, and the number
of full-term deliveries in the study group was higher compared to the control group (P 0:05). The scores of physiological function, psychological function, social function, and health selfcognition in the study group were lower compared to the
control group (P < 0:05). All the data results are indicated
in Table 4.
4. Discussion
The effect of APS on abortion has been paid attention to by
obstetricians and gynecologists [18]. Women of childbearing
age with this will have an increased risk of recurrent abor-
Computational and Mathematical Methods in Medicine
tion or other obstetrical complications. APL include ACL
and LAs, which can cause placental vascular thrombosis,
placental infarction, and placental dysfunction [19]. Other
studies have suggested that it may inhibit trophoblast cell
erosion and differentiation and lead to early abortion [20].
Anticoagulant therapy, glucocorticoid, and immunotherapy
have been widely employed in clinic for recurrent abortion
caused by APS, and aspirin has become a routine treatment.
According to the revised standard of Sapporo in 2006, the
laboratory standard of APS is that medium and high titers
of IgG or IgM ACL or LAs or β 2GPI antibodies were found
in at least 2 or more examinations at intervals of 6 weeks. In
addition to laboratory diagnosis, clinical diagnosis is also
very important. Many obstetrical complications related to
APS have been proposed in the newly revised diagnostic criteria of APS. However, the diagnosis and treatment of APS
are still controversial. The understanding of the etiology
and pathogenesis of APS is still limited. APS is now widely
considered to be a coagulation disorder, so heparin or aspirin is often applied for anticoagulation. However, recent
studies on the animal model of APS suggest that the etiology
of obstetrical complications caused by APS is mainly mediated by inflammation, not thrombosis. The study suggests
that anti-inflammatory therapy should be employed in the
treatment of APS. Meanwhile, these studies have also discussed that the potential mechanism of recurrent miscarriage as possibly being muscle damage caused by APL
expression. Heparin can inhibit this pathogenic factor and
is effective in the treatment of APS obstetrical diseases [21].
APL are a series of autoimmune antibodies, the existence
of which is related to thrombosis and recurrent abortion
[22]. Regardless of the titer of anticardiolipin antibody,
anticardiolipin antibody can bind to phospholipids on
plasma proteins, such as prothrombin, β-2GPI, and Vannexin, and become a risk factor for thrombosis in patients
with systemic lupus erythematosus or recurrent abortion
[23]. These antibodies are more common and have higher
titers in patients with primary APS and systemic lupus erythematosus than in patients with recurrent abortion. APL
IgG or IgM, anti-β 2GPI antibodies, anti-PT antibodies,
and anti-V annexin antibodies accounted for 100%, 80%,
60%, and 24% of primary APS patients, respectively, compared with 66% of recurrent abortion patients whose above
antibodies were negative, of which ACL IgG or IgM, anti-β
2GPI antibodies, anti-PT antibodies, and anti-V annexin
antibodies accounted for 6%, 6%, 16%, and 17%, respectively
[23]. Thrombosis and thrombocytopenia are common in
patients with SLE and primary APS, but rare in patients with
recurrent abortion. One study indicated that the APL of
pregnant women with a history of recurrent abortion was
higher compared to normal pregnant women [24]. The
detections of ACL and anionic phospholipid antibodies in
320 patients with recurrent abortion indicated that antibody
titers have reached moderate levels, some of which are even
at high levels, while others are negative. When these patients
were treated with heparin or aspirin, 64% responded to
treatment and could have a normal pregnancy. Obstetrical
APS is defined as the complications of pregnancy, such as
recurrent abortion, stillbirth, preterm delivery, severe
Computational and Mathematical Methods in Medicine
5
40
30
20
10
0
Common
Control group
Research group
Figure 1: Comparison of patient satisfaction between two groups. The green bar represents the control group and the yellow bar represents
the research group.
Table 1: Comparison of self-nursing ability scores between the two groups [x ± s, Points].
N
Self-concept
Sense of responsibility for self-care
Self-nursing skills
Health knowledge level
Total score
C group
30
14:31 ± 3:16
15:66 ± 3:31
17:59 ± 3:12
23:28 ± 2:21
70:85 ± 2:14
R group
30
18:93 ± 6:42
17:49 ± 1:56
20:58 ± 2:12
30:68 ± 3:31
85:81 ± 1:23
Group
t
3.530
2.739
4.341
10.183
33.196
P
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