Effects of three-dimensional quality assessment nursing intervention on efficacy and disease management of patients undergoing esophageal cancer surgery

Abstract

BACKGROUND

Esophageal cancer is one of the most common malignant tumors. The three-dimensional quality structure model is a quality assessment theory that includes three dimensions: Structure, process, and results.

AIM

To investigate the effects of nursing interventions with three-dimensional quality assessment on the efficacy and disease management ability of patients undergoing esophageal cancer surgery.

METHODS

In this prospective study, the control group received routine nursing, and the intervention group additionally received a three-dimensional quality assessment intervention based on the above routine care. Self-efficacy and patient disease management abilities were evaluated using the General Self-Efficacy Scale (GSES) and Exercise of Self-Care Agency scale, respectively. IBM SPSS Statistics for Windows, version 17.0, was used for the data processing.

RESULTS

This study recruited 112 patients who were assigned to the control and experimental groups (n = 56 per group). Before the intervention, there was no significant difference in GSES scores between the two groups (P > 0.05). After the intervention, the GSES scores of both groups increased, with the experimental group showing higher values (P < 0.05). At the time of discharge and three months after discharge, the scores for positive attitudes, self-stress reduction, and total score of health promotion in the experimental group were higher than those in the control group (P < 0.05).

CONCLUSION

The implementation of a three-dimensional quality structure model for postoperative patients with esophageal cancer can effectively improve their self-management ability and self-efficacy of postoperative patients.

Key Words: Esophageal cancer; Three-dimensional quality structure model; Self-efficacy; Disease management ability

Core Tip: Esophageal cancer diagnosis and surgery can lead to anxiety, fear, worry, despair, and other negative emotions. These negative emotions result in long-term negative coping, consequently reducing the patients’ physical function and quality of life. The three-dimensional quality structure nursing evaluation model can improve the postoperative self-efficacy and disease self-management ability of patients with esophageal cancer, enabling them to better deal with the stress caused by the disease and maintain a better psychological status and, ultimately, a higher quality of life.

INTRODUCTION

Esophageal cancer is one of the most common malignant tumors-its incidence rate is among the top ten malignant tumors[1,2]. Developing countries such as China have a high incidence of esophageal cancer, particularly in men and rural populations[3]. Patients with stage I, II, and partial stage III (T3N1M0 and partial T4N1M0) esophageal cancers are mainly treated with surgery[4]. Difficulties in eating and swallowing, postoperative digestive tract status, pain, fatigue, and other systemic symptoms can cause pain in patients with esophageal cancer. The diagnosis and operation of esophageal cancer tend to bring patients anxiety, fear, worry, despair, and other negative emotions, which in turn elicit long-term negative coping, resulting in diminished physical function and quality of life[5,6]. Therefore, the psychological status of postoperative patients with esophageal cancer and its possible influence on the quality of life merit investigation.

As an important measure of nursing quality, nursing quality evaluation objectively evaluates the quality level of clinical nursing work through the quantitative measurement of nursing quality and becomes an important means of quality control[7,8]. The nursing profession faces the following urgent challenges: Formulating a scientific and effective nursing quality evaluation system, improving the fine management of nursing quality, and providing high-quality services for patients[9,10]. One promising approach is the three-dimensional quality structure model, which is a quality assessment theory that includes three dimensions: Structure, process, and results[11]. The structural dimension is the requirement of the organization, the process dimension is the combination of factors that constitute practice, and the result dimension reflects the final outcome-the measurement of the effectiveness of the structure and process design. This model, first proposed in the 1960s, provides a scientific theoretical basis for the systematic evaluation of medical care quality and has been widely used by nurses in nursing quality evaluation systems[12].

Specifically, the three-dimensional quality structure model includes three dimensions: Structure, process, and result quality. Structural components refer to the environment in which medical care is provided, including the settings, operational factors, and organizational characteristics required for medical care. Process quality pertains to the specific course of action undertaken to provide healthcare. The outcome quality dimension is the result of providing healthcare, which is the result of the structure and process. The structure, process, and results complement each other and play a positive incentive role. A good structure can result in a good process, which increases the possibility of obtaining good results. These three aspects and their relationships determine healthcare quality. Therefore, the three-dimensional quality structure models have become the basis for nursing quality assessment.

Self-efficacy refers to an individual’s ability to deal with endogenous and exogenous emergencies[13]. For patients with esophageal cancer, self-efficacy refers to the belief in the ability to overcome challenges associated with the diagnosis and treatment of the cancer[14]. Self-efficacy emphasizes a patient’s belief in their ability to cope with stress and confidence in their ability to deal with stress and maintain physical and mental health. Cancer patients with high self-efficacy can better deal with the stress caused by the disease, maintain a better psychological status, and ultimately have a higher quality of life[15].

Disease management ability can be understood as the cognitive and behavioral ways that individuals adopt in the face of stressful events, which are adapted to their personal habits and psychology[16,17]. The different disease management abilities of patients after esophageal cancer surgery directly determine the degree of stress response. Positive coping styles can help patients adapt to the disease, reduce their level of disease stress response, and maintain better physical and mental states, thereby improving their quality of life.

To date, no study has evaluated the effects of nursing interventions using a three-dimensional quality assessment on the efficacy and disease management ability of patients undergoing esophageal cancer surgery. Therefore, our main purpose was to investigate the effect of nursing interventions with three-dimensional quality assessment on the efficacy and disease management abilities of patients undergoing esophageal cancer surgery.

MATERIALS AND METHODS

This prospective study was approved by the Ethics Committee of Huai'an First People’s Hospital, China. All patients signed an informed consent form before participating in the study.

Patient recruitment and selection criteria

We set the following inclusion criteria: Diagnosis of esophageal cancer; days 2-7 after surgery for esophageal cancer; clear consciousness; basic communication skills (i.e., listening, speaking, reading, and writing); ability to communicate normally; ability to read and understand oneself; no mental illness; no history of participation in psychological treatment programs; and volunteering to cooperate with this study. As for the exclusion criteria, we set the following: Complications related to heart, brain, and other important organ diseases; severe cognitive impairment; and inability to cooperate with the researchers.

Study design

This study had a prospective design. The participants were patients with esophageal cancer admitted in 2020 to December 30, 2023. The control group received routine nursing care, mainly including information about precautions before and during surgery, nursing problems that may occur after surgery and measures to handle them, close observation of the patient’s condition, medication nursing, diet nursing, and health knowledge education. The intervention group also underwent a three-dimensional quality assessment intervention on the basis of the above routine care.

Self-efficacy

The General Self-Efficacy Scale (GSES) was used before and after the intervention. The ten-item scale measures the self-confidence of patients facing difficulties and setbacks. Each item was evaluated on a scale of 1-4, where 1 = completely incorrect and 4 = completely correct. Out of a total score of 40, a score of 1-10 indicated low self-confidence. A score of 11-20 indicates low self-confidence and a small amount of time indicates a lack of confidence. A score of 21-30 indicates high self-confidence. A score of 31-40 indicates a high level of self-confidence and the ability to put one’s shortcomings into perspective.

Patient disease management ability

We assessed self-management ability before and after the nursing intervention using the Exercise of Self-Care Agency (ESCA) scale, which has four dimensions: Self-concept, self-care responsibility, self-care skills, and health knowledge. Each of the 43 items is rated on a five-point Likert scale (0-4 points) for a total score range of 0-172 points. Higher scores indicate stronger self-care ability.

Statistical analysis

We used IBM SPSS Statistics for Windows (version 17.0) for the data processing. Count data were represented by frequency values and χ² test. Measurement data were represented by mean ± SD values and t-test. P < 0.05 was considered statistically significant.

RESULTS

Patient characteristics

We included 112 patients (56 in the control group and 56 in the experimental group). All the patients successfully completed the experiment without any adverse reactions. Patient characteristics are outlined in Table 1. No significant differences were found between the control and experimental groups in terms of the characteristics.

Table 1 Patient characteristics (n = 112).

Variables	Control group	Experiment group
Sample size	56	56
Male	46	53
Age (years)	44.7 ± 7.7	48.7 ± 7.7
Duration of illness (years)	7.3 ± 2.3	8.1 ± 3.2
Surgical approach
Thoracic laparoscopy	56	47
Thoracotomy	44	53
Metastasis
No	97	96
Yes	3	4
Neoplasm staging
I phase	65	68
II phase	24	27
III phase	11	5

Self-efficacy

Before the intervention, the two groups showed no significant differences in GSES scores (P > 0.05). After the intervention, the GSES scores of both groups increased, with the experimental group scoring higher than the control group (P < 0.05) (Table 2).

Table 2 Comparison of General Self-Efficacy Scale scores before and after intervention between the two groups.

Group	Sample size	GSES score		t value	P value
		Pre-intervention	Post-intervention
Control group	56	11.79 ± 2.36	19.45 ± 3.28	14.684	< 0.001
Experiment group	56	12.03 ± 2.32	24.65 ± 3.74	22.211	< 0.001
t value		0.562	8.097
P value		0.575	< 0.001

GSES: General Self-Efficacy Scale.

Patient disease management ability

At the time of discharge and three months after discharge, the scores for positive attitudes, self-stress reduction, and overall health promotion were higher in the experimental group than in the control group (P < 0.05), as shown in Table 3.

Table 3 Comparison of disease management ability and health behavior between the two groups.

Group	Sample size	ESCA scale
		Pre-intervention	Post-intervention
Control group	45	88.53 ± 8.15	110.37 ± 9.67a
Experiment group	45	88.62 ± 8.52	132.45 ± 10.23a
t value		0.051	10.522
P value		0.959	< 0.001

^aP < 0.05 pre-intervention vs post-intervention.

ESCA: Exercise of Self-Care Agency.

DISCUSSION

In the implementation of nursing, the nursing staff should not only carry out the medical advice of the healthcare team but also pay attention to the health education and psychological state of patients and their families[18]. Nurses should understand the patients’ families, economic status, life experiences, social relations, and existing psychological problems. In the nursing process, nurses should formulate intervention goals and plans, communicate as much as possible to ease concerns, be patient, gentle, and skilled, and attach importance to personalized interventions. Nurses should cooperate and communicate with family members to improve their daily nursing skills through mutual communication. Nurses should also offer timely feedback to patients and family members regarding the effects of surgery[19,20].

Self-management involves the use of one’s own health knowledge reserve, with the help of inner strength, to change one’s risky behaviors to promote disease recovery[21]. The preoperative self-management ability of patients undergoing esophageal cancer surgery has been reported to be at a low to middle level and needs to be improved[22]. Clinical observations show that most patients undergoing esophageal cancer surgery are older adults who tend to lack effective cognition, reflecting the influence of memory and educational level on the disease and operation. Health education has not dramatically improved the ability to receive information. Indeed, the educational effect is not apparent.

We adopted a three-dimensional quality assessment of nursing, multilevel supervision, and patient feedback to ensure that health education and emotional relief provided by nurses to patients were implemented in the field. The application of feedback health education by responsible nurses plays an important role in transmitting postoperative rehabilitation knowledge to patients, thereby improving their cognitive levels, promoting the establishment of rehabilitation beliefs, and correcting risky behaviors. These are expected to promote the functional recovery of patients and change patients’ misunderstandings by focusing on early activity intervention and dietary guidance in accordance with the educational path of patients after esophageal cancer surgery[23].

To a certain extent, the physical function and fatigue symptoms of postoperative patients can be improved, and the lifestyle habits of postoperative patients with esophageal cancer can be changed. The stress of surgery can easily cause various discomforts and have a negative emotional impact on patients. Early dietary habits and behavioral intervention guidance can effectively reduce postoperative nausea and vomiting. Responsible nurses conduct targeted psychological counseling to teach patients to relieve negative emotions, thereby improving cognitive function. When a surgical incision is made, and a drainage tube is placed, patients experience varying degrees of pain. Early pain management helps patients participate in disease management, improves compliance, promotes drainage tube removal and incision repair, and relieves postoperative pain and discomfort to a certain extent. Through health education, patients’ families also participate in receiving relevant information, which can promote positive changes in patients’ health behaviors and improve patients’ self-management ability and quality of life[24,25].

Our results showed that the disease management ability and self-efficacy scores of the experimental group after the nursing intervention were higher than those of the control group (P < 0.05). Compared with conventional nursing, the use of three-dimensional quality evaluation of nursing can improve the quality of nursing from multiple dimensions and, at the same time, improve the disease management ability and psychological state of patients with esophageal cancer after surgery. Through cognitive and psychological interventions, patients can effectively improve their understanding of their disease, alleviate negative emotions, establish treatment self-confidence, and improve self-efficacy. A good sense of self-efficacy is conducive to the rapid improvement of a patient’s disease status. In the implementation stage, the individual needs and cognition of patients were assessed, and health guidance was provided to help patients change their misconceptions and compensate for cognitive deficiencies. Simultaneously, the concept is externalized into behavior, and patients are encouraged to cooperate actively in various nursing operations. In addition, by reflecting on their experiences and lessons, nursing staff can clarify the difficult problems existing in the implementation of patient care, analyze the root causes, and flexibly adjust measures to solve them. Thus, the nursing staff can ensure closed-loop management of the nursing process, effectively solve problems, improve the knowledge and behavior of patients from multiple aspects, enhance the disease management ability, and thus accelerate the recovery of gastrointestinal function, leading to early getting out of bed and discharge of the patient.

CONCLUSION

The implementation of a three-dimensional quality structure model for postoperative patients with esophageal cancer can effectively improve their self-management ability and self-efficacy of postoperative patients. Thus, a three-dimensional quality evaluation of nursing is feasible and worthy of clinical promotion.