Effects of standardized health education pathway on patients undergoing endobronchial ultrasound‐guided transbronchial needle aspiration

To explore the application and effect of standardized health education pathway in patients undergoing EBUS‐TNBA.

mediastinal lymphadenopathy; and (d) diagnosis of mediastinal tumors. 2 Due to its strong irritation to the trachea, patients often have obvious discomfort, resulting in patients' anxiety, tension (or even fear) and resistance, as well as behavioral changes, and thus in the failure to well coordinate with the examination. Some researchers 3 reported that the targeted medical knowledge and health education can reduce patient anxiety, shorten hospital stay, improve the success rate of bronchoscopy, reduce the incidence of complications, improve patients' satisfaction and trust. Thus, it is fundamental to be aware of the implementation of standardized health education on tracheoscopy.
Since the concept of clinical nursing pathway was introduced into China, it has been applied to the health education of patients and has achieved good results. 4  Exclusion criteria: severe cardiopulmonary disease and coagulation dysfunction. This study was approved by the hospital ethics committee (Ethical number: 2018350). All patients signed the informed consent forms prior to the examination.

| Control group
Patients in the control group received routine health education, which was list on a sheet, mainly including the endoscopy notice from nurses for preexamination preparations such as fasting, completing electrocardiogram and coagulation tests on time, and checking instructions of the drugs needed for the morning of the examination day; remindings from the ward nurses the night before examination about fasting in the next morning; and the explanations from endoscopy nurses about diet, self-observation and the time to obtain the report after examination.

| Study group
We established the standardized health education pathway form for patients undergoing EBUS-TBNA (Table 1), and carried out the standardized health education according to the form strictly.  Standardized health education pathway on Table 1.

| Study outcome measures
Self-rating anxiety scale (SAS)

Success rate of first intubation attempt
The endoscopy nurses observed and recorded the successful intubation of the patients, and recorded whether the intubation was successful at the first attempt. The success rate of first intubation attempt in the study (control) group was calculated as the case number of successful intubation patients at the first attempt/the number of patients in the study (control) group.

Patient satisfaction
The self-prepared patient satisfaction questionnaire was used to investigate patient satisfaction. The questionnaire contained totally 12 items, and was sent out to the patients by endoscopy nurses when they received the examination report after the examination. It was filled and given back to the nurses on the spot.
Patient satisfaction was regarded as "unsatisfactory" if the patient was not satisfied with any one of the 12 items, while the evaluation of being "satisfied" and "basically satisfied" was considered "satisfactory."

| Statistics methods
The data were statistically analyzed by SPSS20.0 software. Counting data were expressed by frequency and percentage, and the difference between the two groups was compared by χ 2 test. While the measurement data were described by mean ± SD, and the difference between the two groups was compared by two-tail t test. The difference was statistically significant when P < .05. Wilcoxon rank sum test was used if the sample data were not normally distributed.

| RESULTS
A total of 101 patients were enrolled in this study, including 51 cases in the study group and 50 in the control group.  Table 2).
The anxiety levels of patients in the two groups were compared using Wilcoxon rank sum test since they were not normally distributed. As shown in Table 3, SAS score of the study group was significantly lower than that of the control group (P < .001).
The heart rate and oxygen saturation recovery time of patients in the two groups were compared using Wilcoxon rank sum test since they were not normally distributed. As shown in Table 3, recovery time of heart rate and blood oxygen saturation in the study group were significantly lower than those in the control group (P < .001).The success rate of first intubation attempt between the two groups was tested by χ 2 test, and the difference of the success rate between the two groups was compared. As shown in Table 4, success rate of first intubation attempt in the study group was significantly higher than that in the control group (P = .007).The satisfaction of patients in the two groups was tested by χ 2 test, and the difference between the two groups was compared. As shown in Table 4, patient satisfaction of the study group was significantly higher than that of the control group (P = .013). theory, which result in statistically significant difference. The SAS scores of the recovery time of heart rate and oxygen saturation in the study group were observably lower than those in the control group (P < .05, see Table 3), while the success rate of first intubation attempt and the satisfaction rate of the patients in the study group were remarkably higher (P < .05, see Table 4).

| DISCUSSIONS
Consistent with the research of other scholars, 12-14 Zhong 12 using the clinical nursing path table improved the patients' cooperation degree and cognitive level. The measuring of two groups at admission, 30 min before surgery and 24 h after surgery was compared, which showed that their psychological status was more stable.
In comparison with the control group using systematic education, Wang 13 found the experimental group had better outcome on anesthesia effect, intraoperative coordination, and higher success rate of