Effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures

Convenience sampling was used to select 122 patients with lower limb fractures admitted to a Grade A hospital in Fujian province from September 2021 to March 2022. A historical control group (61 cases) comprised patients admitted from September to November 2021, while an intervention group (61 cases) included patients admitted from December 2021 to March 2022. Inclusion criteria: ages 18–75, CT-diagnosed lower limb fractures requiring surgery, WeChat users, and voluntary participation. Exclusion criteria: concomitant cranio-cerebral injury, impaired consciousness, mental disorders, lower limb venous inflammation, inability to cooperate, or early withdrawal from the study.

For robust statistical power, we calculated the sample size using Gpower 3.1 software. With d = 0.5 (moderate effect size), 1-β = 0.80 (statistical power), and α = 0.05 (significance level), a minimum of 128 participants (64 in each group, 1:1 ratio) was required. We distributed 128 questionnaires, collected 122 (95% response rate), and excluded six participants lost to follow-up. Self-administered questionnaires gathered demographic and medical data. All data were collected anonymously and securely to ensure confidentiality.

The control group (61 cases) received traditional patient education, while the intervention group (61 cases) received a concise patient education video. Control group patients were admitted from September to November 2021, and intervention group patients were admitted from December 2021 to March 2022.

In the control group, traditional patient education involved oral and paper-based instruction conducted at admission, the day before surgery, the day of surgery, the day after surgery, and the day before discharge. It included addressing patient queries and demonstrating exercises. Questionnaires were filled out one day before discharge, based on electronic health records and provider confirmation.In the intervention group, patients watched department-produced health videos alongside their regular education. The specific process was as follows: (1) The head nurse organized the production of a concise health education video. A nursing forum was created on the department’s official WeChat account, where patient education content was customized based on patient characteristics, medical staff experience, and existing literature (2). The nursing team created concise 1–3 min videos filmed in familiar hospital locations, enhancing clinical understanding. The videos covered perioperative care for lower extremity fracture patients, including admission instructions, ward setup, appointments, billing, specimen collection, sputum management, blood drawing precautions, pre and postoperative care, limb exercises, pain management, instrument usage, and discharge guidance, totaling 14 videos (3). Implementation method: Nurses were trained to guide patients and families in using WeChat. A registered nurse scheduled patient log-ins at admission, before surgery, post-surgery, and pre-discharge [8]. Attending nurses addressed questions, enhanced education quality, and promoted independent learning. An on-site questionnaire was completed before patient discharge, verified by electronic health records and discharge time (4).

In the feedback phase, registered nurses collected input from patients and families to enhance the short-form video health education and nursing care experience.

Perioperative health education knowledge was assessed using the “Health Education Knowledge Awareness Questionnaire,“ which included 9 items covering various aspects of health education. Scores ranged from 1 (poor) to 5 (excellent), with a total score of ≥ 32 points indicating acceptable knowledge. Cronbach’s alpha coefficient for the experience scale was 0.943 in this study.Newcastle Satisfaction with Nursing Scale (NSNS) developed by THOMAS [8] and others [9], measures patient satisfaction with nursing services during hospital stays using 19 items scored on a 5-level Likert scale. Higher scores reflect increased satisfaction with perioperative nursing care. The Cronbach’s alpha coefficient for experience scale was 0.967, and the correlation between items was 0.53–0.82. In this study, the Cronbach’s alpha coefficient for experience scale was measured to be 0.932.

We implemented quality control measures to maintain data accuracy, objectivity, and authenticity. Personnel underwent standardized training, ensuring proficiency in procedures and experimental processes. Surveys were conducted in quiet environments, and assistance was provided for those with reading difficulties. Completed questionnaires were carefully reviewed for accuracy before data analysis.2.7Statistical methods.

There was no significant difference between the two groups in age, gender, medical payment method, educational level, fracture site, etc. (P > 0.05). For details, see Table 1.

The health education knowledge score in the intervention group was 95.1%, higher than 82.0% in the control group (P < 0.05). There were significant differences between the two groups across five items specifically: hospital environment and precautions, precautions before and after examination or operation, rehabilitation knowledge of disease, methods of promoting rehabilitation, and overall health education (P < 0.05). There were no significant differences (P > 0.05) between the two groups in terms of treatment and nursing precautions, medication guidance, dietary guidance, and post-discharge rehabilitation precautions. See Tables 2 and 3 for details.

The satisfaction score of the intervention group (80.902 ± 7.016) was higher than that of the control group (78.131 ± 8.213), and the difference was statistically significant (P < 0.05). There were significant differences between the two groups across six items specifically: time nurses spent on patient, nurses’ work ability, the amount of disease and treatment information provided, nurse put relatives’ mind at rest, the type of disease and treatment information provided, and the nurses’ awareness of patients’ needs (P < 0.05). There were no significant differences (P > 0.05) between the two groups across thirteen items, including nurse’s availability, the nurse’s knowledge about the patient’s care, how quickly nurses responded to patient, nurses’ treatment of you as an individual, how often nurses checked on a patient, nurse helpfulness, how nurses explained things to patient, nurses’ manner while doing their work, respectful attitude towards patients in the nursing process, nurses listened to patients’ worries, freedom nurses gave patient in the ward, the willingness to respond to patient requests, and the level of privacy nurses gave patient. See Tables 4 and 5 for details.

The results of this study demonstrated that short-form health education videos were beneficial toward the improvement of perioperative health knowledge in patients with lower extremity injuries. This was particularly attributed to five aspects, including hospital environment and precautions, precautions before and after inspection or operation, knowledge of disease rehabilitation, methods of promoting disease rehabilitation, and overall health education. Comparison between the control and intervention groups revealed that the scores of the intervention group were significantly higher than those of the control group. These were particularly attributed to the section “hospital environment and precautions”. One of the reasons for this difference may be that most of the patients enrolled suffered from great pain due to the fractures caused by external factors when they were first admitted to the hospital. It is plausible that the pain focus on admission perturbed their ability to concentrate on the nurses’ admission education. Patients often required bed rest after admission and were unfamiliar with the surroundings environment, due to the inability to get out of bed and move around. However, the patients in the intervention group had access to the short-form videos, allowing them to learn about the department environment and other precautions despite hinderances to receiving conventional education on admission. This hypothesis is consistent with the findings of other reports [10, 11], who suggested that patients’ awareness of the ward environment was greatly improved after receiving video education. The item “precautions before and after examination or operation” may operate under a similar phenomenon, whereby routine, oral education may be incompletely absorbed due to patient anxiety, which tends to be higher when the patient is unfamiliar with the process. Indeed, patients repeatedly asked the nurses about the precautions and the experiences of the people around them. Similarly, postoperative patients are often distracted due to postoperative pain, which can limit their ability to absorb oral education. By providing short-form video health education, patients can intuitively understand the procedure ahead of the surgery, reducing perioperative anxiety and circumventing the absorption of pertinent information at inopportune times. This hypothesis is similar to some previous reports [12‐14]. Oliveira AP similarly found that the application of preoperative video resources can more effectively preserve the patients’ retention of the content, supporting the findings of this study [15]. Regarding the item “disease rehabilitation knowledge”, conventional education methods are generally conducted by medical staff to guide patients in rehabilitation exercise at a specified time point. By the end of the education, patients often forget steps and require guided re-training, especially for lengthy rehabilitation processes. In this study, the intervention group was able to review the processes autonomously via the short-form videos, accessing a preview of the rehabilitative process and reviewing the experience repeatedly if needed. This is consistent with the point of view which evaluated the application of video education in patients after orthopedic surgery. For the item “methods of promoting disease recovery”, it is plausible that compared with the conventional educational method, the novelty of short-form video health education increases interest and engagement. This hypothesis is consistent with the research results, wherein three-dimensional and multi-form nursing and health education increased patient buy-in. In this study, there was no significant difference between groups on the items “treatment and nursing precautions”, “medication guidance”, “dietary guidance”, or “rehabilitation and discharge precautions”. The reasons for this may be that these basic nursing measures are routine in the daily care of patients, and nurses implement this conventional oral education with such regularity that presentation of this education in short-form video may not be perceived as any different by the patient. Due to the lack of pre- and post-intervention comparisons in this study, the data was not able to be evaluated according to change in baseline health knowledge between the control group and the observation group using different health education methods. As such, the research design can be further improved in the future.

As can be seen from Tables 4 and 5, the Newcastle satisfaction with nursing score of the intervention group was higher than that of the control group. This was specifically reflected in the degree of satisfaction with the time spent by nurses, how capable nurses were at their job, the amount of disease and treatment information provided, nurses ability to put relatives’ mind at rest, the type of disease and treatment information provided, and nurses’ awareness of patient needs. Patients with lower extremity fractures tend to be bedridden for long periods of time. Capitalizing on this scenario, short-form health education videos can be leveraged to assist patients and their families with meaningful, semi-autonomous learning opportunities with patient-centered control of time and frequency access. This may help reduce patients’ anxiety and minimize obstruction to learning due to distractions (e.g. pain, anxiety, etc.). Additionally, familiarity with the clinical environment via frequent access to digital health education can circumvent anxiety related to unfamiliar environments, a chronic limitation of lower extremity patients with limited mobility. Finally, addition of short form health education videos and access to a nursing-led social media forum increase the patients’ perception of the nurses’ work ability and recognition of medical staff. This is similar to the findings of Wang’s and others who have evaluated the application of video health education [16, 17]. In the control group, traditional oral and paper-based materials for health education may be perceived as being of “lower effort” by the patients, which may translate into their perception of their clinical care experience in general. One limitation of this methodology is that a large fraction of patients with lower extremity fractures are elderly, and thus less likely to engage with digital forms of health education. However, these same patients are more likely to forget the content of conventional oral education, experience high anxiety/feel overwhelmed, and report lower satisfaction with nursing care. The results of this study indicate that efforts to diversify patient health education have promising outcomes, reiterating the need to champion conventional and novel methods for wide patient audiences of all ages. These findings are supported by previous research studies demonstrating improved patient satisfaction in light of video-centric patient health education [18, 19].

During the implementation process, it was found that different patients have different needs. Some patients want more in-depth knowledge or have specific questions, while the production of videos mainly focuses on common problems and exercise methods. Additionally, patients’ acceptance of new types of education methods varies greatly. Using short form-videos for health education in the digital age requires continuous exploration of more suitable methods for patients.

This study is a quasi-experimental study, which belongs to a prospective study where intervention precedes effect, and the causal relationship is highly credible with feasibility and practicality. It is commonly used in clinical nursing research, but lacks randomized grouping or a control group, making it difficult to fully attribute the effects to the intervention, resulting in lower credibility compared to experimental studies. In this study, the baseline surveys for the control group and intervention group were consistent. The surgical doctors and nursing staff in the department all met the same standards, ensuring stability and reducing bias due to the lack of random controls. At the same time, considering the comparison between the two groups during the same period, providing video education to the intervention group only may cause interference and produce a halo effect due to video sharing. Additionally, it may affect the mental health of the control group and their family members, causing psychological imbalance, etc. To circumvent these, the two groups were not investigated in parallel.