Application of a nursing care bundle combined with a clinical nursing pathway in liver transplantation and its impact on patient self-management: a randomized controlled trial

This study aimed to explore the effects of a nursing care bundle combined with a clinical nursing pathway on self-management ability, postoperative biochemical markers, medication adherence, psychological status, and quality of life among liver transplant recipients. This study was a single-center, prospective, randomized controlled trial. A total of 103 patients who underwent liver transplantation were initially screened. Three individuals were excluded due to severe postoperative complications ( n = 1), incomplete medical records ( n = 1), or inability to adhere to follow-up procedures ( n = 1). The remaining 100 patients completed follow-up and were randomly assigned in a 1:1 ratio to either the control group ( n = 50) or the intervention group ( n = 50) using a random number table. The control group received routine perioperative nursing care and standard follow-up after discharge. The intervention group received a structured nursing care bundle integrated with a clinical nursing pathway under the enhanced recovery after surgery (ERAS) framework. Primary outcome included self-management ability [assessed using the Chinese version of the Exercise of Self-Care Agency Scale (ESCA)]. Secondary outcomes included postoperative biochemical indicators at 1 and 6 months after discharge [including fasting blood glucose (FBG), 2-hour postprandial blood glucose (2 h-PBG), alanine aminotransferase (ALT), serum creatinine (SCr), total bilirubin (TBil), blood urea nitrogen (BUN), and therapeutic drug concentrations], medication adherence [assessed by the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)], psychological status [measured by the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS)], and quality of life (evaluated using the GQOLI-74 questionnaire). At both 1 and 6 months following discharge, patients in the intervention group demonstrated better biochemical outcomes, including lower FBG, 2 h-PBG, ALT, SCr, TBil, and BUN levels, as well as more stable drug concentrations compared with the control group ( P < 0.05). Furthermore, ESCA scores, BAASIS scores, and GQOLI-74 scores were all higher in the intervention group than in the control group ( P < 0.05). SDS and SAS scores were reduced in the intervention group relative to the control group ( P < 0.05). The integration of a nursing care bundle with a clinical nursing pathway has a positive effect on improving self-management ability and medication adherence, optimizing postoperative biochemical indicators, alleviating negative emotions, and enhancing quality of life in liver transplant patients.