Enhancing Health Outcomes through Nurse-Led Education in Patients Undergoing Extracorporeal Shock Wave Lithotripsy

Nephrolithiasis is a common and increasingly prevalent urological condition marked by the formation of mineral deposits in the kidneys, often causing severe pain and urinary complications (1). It is the third most frequent urological disease globally (2) and is particularly widespread in Pakistan, where it accounts for up to 70% of urological admissions in rural areas (3). The rising incidence has been linked to dietary habits, sedentary lifestyles, and environmental factors, with calcium oxalate stones being the most common and highly recurrent type (4).

Extracorporeal Shock Wave Lithotripsy (ESWL) is widely used as a non‑invasive and effective treatment for small to moderate kidney stones, offering rapid recovery and fewer complications compared to surgical methods (5). However, ESWL is not without risks: complications such as pain, hematuria, infection, and residual fragments are frequently reported (6,7). Recurrence is common, particularly when patients do not adhere to key lifestyle modifications, such as proper hydration, dietary control, and regular follow-up (8). These challenges contribute to a reduced quality of life among affected individuals (9).

Given these concerns, patient education has become a critical strategy to improve outcomes and prevent recurrence after ESWL. Nurses, due to their continuous patient contact and holistic role, are well-positioned to provide structured, evidence-based education (10). Nurse‑led interventions have shown success in improving adherence and self-management in various chronic conditions (11), yet evidence on their impact specifically in ESWL patients—especially in low-resource settings—is limited (12). Therefore, this study aims to evaluate the effectiveness of a nurse-led education program on awareness, preventive practices, and overall health outcomes in patients undergoing ESWL.

A quasi-experimental single-group study was conducted over five months (July 2025 to November 2025) at the Urology OPD of Mayo Hospital and Lahore General Hospital, Lahore, to evaluate the effectiveness of a nurse-led educational intervention on health outcomes among patients undergoing Extracorporeal Shock Wave Lithotripsy (ESWL). A purposive sample of 40 patients aged 20–50 years with clinically diagnosed renal stones and scheduled for ESWL was selected according to predefined inclusion and exclusion criteria. The independent variable was the nurse-led education intervention, while the dependent variables were health outcomes, including pain, complications, quality of life, and patients’ knowledge. Data were collected using validated and reliable tools: a demographic questionnaire; a 15-item Knowledge Assessment Questionnaire adopted from Abdel Wahab et al. (2021) (27); the ESWL Health Outcomes Assessment Tool comprising the Numerical Pain Rating Scale (NRS-11) (16), the Modified Clavien System for complications (16), and the RAND SF-36 for quality of life (16). The study followed three phases: pre-intervention assessment after informed consent; a structured six-session nurse-led educational program delivered in small groups covering ESWL procedure, preparation, post-procedure care, lifestyle modification, and quality-of-life enhancement; and a post-intervention assessment conducted one month after the sessions. Validity was ensured through expert review (CVI 0.88–0.95), and reliability was confirmed through a pilot study (Cronbach’s alpha 0.79–0.90). Ethical approval was obtained from the Research Ethics Committee of The University of Lahore, and participants’ confidentiality, autonomy, voluntary participation, and anonymity were fully maintained throughout the study. Data were analyzed using SPSS version 25. The non-parametric Wilcoxon sign rank test was applied. A significance level of p < 0.05 was considered statistically significant.

Demographic Characteristics of Participants

Table 4.1

Demographic Characteristics of Participants (n=40)

Table 4.1 presents the demographic characteristics of the study participants. The majority of respondents (35%) were aged between 31–35 years, while 25% were 20–25 years old. More than half of the participants (57.5%) were male. Regarding education, 37.5% had primary-level education, and 35% had secondary-level education. Most participants (52.5%) resided in urban areas, and 55% were married. In terms of occupation, 52.5% were unemployed, 45% were laborers, and only 2.5% were government employees.

Knowledge of Participants

Table 4.2

Comparison of knowledge of participants regarding Extracorporeal Shock Wave Lithotripsy pre and post intervention (n=40)

             Table 4.2 shows a significant increase in participants’ knowledge after the intervention. The median score improved from 16.7 before the intervention to 40.0 after it. The change was statistically significant (p < 0.001).

Extracorporeal Shock Wave Lithotripsy Health Outcomes

Table 4.3

Comparison of pain that participants experience during Extracorporeal Shock Wave Lithotripsy pre and post intervention (n=40)

Table 4.3 shows that participants experienced a reduction in pain after the intervention. The median pain score decreased from 3.5 before the intervention to 3.0 after it, and this change was statistically significant (p = 0.021).

Table 4.4

Comparison of quality of life of participants undergoing Extracorporeal Shock Wave Lithotripsy pre and post intervention (n=40)

Table 4.4 shows an improvement in participants’ quality of life after the intervention. The median score increased from 53.9 before the intervention to 61.4 after it, and this difference was statistically significant (p = 0.021).

Table 4.5

Comparison of complications regarding Extracorporeal Shock Wave Lithotripsy pre and post intervention (n=40)

Table 4.5 shows a reduction in complications after the intervention. The median complication score decreased from 12.5 before the intervention to 12.0 after it, with the change being statistically significant (p = 0.021).

This study demonstrated that a nurse-led educational intervention significantly enhanced patients’ knowledge regarding Extracorporeal Shock Wave Lithotripsy (ESWL). Post-intervention knowledge scores increased markedly, reflecting the effectiveness of structured, patient-centered education. These findings are consistent with prior research showing that nurse-led education improves understanding of ESWL procedures, pre- and post-care instructions, and preventive measures, thereby promoting adherence and reducing complications (13,14,25). The improvement is likely due to interactive, clear, and focused teaching strategies that facilitate retention and comprehension.

The intervention also significantly improved health outcomes. Median pain scores decreased from 3.5 to 3.0 (p = 0.021), indicating reduced procedural discomfort, aligning with evidence that pre-procedure education mitigates anxiety and enhances pain tolerance (15,17,26). Participants’ quality of life improved, reflecting better self-care, adherence to preventive measures, and reduced post-procedural anxiety, consistent with previous studies (18,19,20). Post-ESWL complications declined notably, suggesting that structured guidance on hydration, medication adherence, activity modification, and early symptom recognition contributes to safer recovery (21,22,23).

Overall, these findings confirm that nurse-led educational interventions exert a multidimensional impact by improving knowledge, reducing pain and complications, and enhancing quality of life. This underscores the critical role of nurses in delivering evidence-based, patient-centered education to optimize clinical outcomes in ESWL care (23,24,28).

The findings of this study demonstrated that the nurse-led educational intervention had a significant positive impact on patients undergoing Extracorporeal Shock Wave Lithotripsy (ESWL). Demographically, most participants were middle-aged, male, with primary to secondary education levels, and moderate to hard occupational effort, representing a diverse socioeconomic background. Following the intervention, participants showed a marked improvement in knowledge regarding ESWL. In terms of health outcomes, there was a statistically significant reduction in pain intensity (p = 0.021). The quality of life scores also improved significantly (p = 0.021).

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