Humanistic and graded psychological nursing care for patients undergoing endoscopic submucosal dissection of gastrointestinal tumors

Abstract

BACKGROUND

Endoscopic submucosal dissection (ESD) has become a widely accepted, minimally invasive treatment for gastrointestinal submucosal tumors. It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’ physical activity in patients, reduce postoperative complications, and improve their postoperative quality of life.

AIM

To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.

METHODS

A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023. Patients were allocated into groups based on the nursing care they received: The control group, which received routine care (n = 90), and the observation group, which was subjected to humanistic nursing care in combination with graded psychological support (n = 90). Patient anxiety and depression were assessed using the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Quality of life was evaluated using the short-form 36 health survey, and additional indications such as time to first food intake, surgery duration, length of hospital stay, nursing satisfaction, and adverse reactions were also recorded. Data was analyzed using SPSS22.0, with t-tests employed for continuous variables and χ² tests for categorical data.

RESULTS

Patients in the observation group experienced significantly shorter times to first postoperative meal, surgery, and hospital stay compared to the control group. After the intervention, the SAS score of the observation group was 43.17 ± 5.68, and the SDS score was 41.57 ± 6.52, both significantly lower than those of the control group, with SAS score of 52.38 ± 5.21 and SDS score of 51.23 ± 8.25. In addition, the observation group scored significantly higher in daily living, physical function, psychological well-being, and social functioning (80.01 ± 6.39, 83.59 ± 6.89, 81.69 ± 5.34, and 85.23 ± 6.05, respectively). Moreover, the observation group also exhibited higher satisfaction and self-efficacy scores and a lower incidence of adverse reactions compared to the control group (P < 0.05).

CONCLUSION

For patients undergoing ESD for gastrointestinal submucosal tumors, humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal, surgery, and hospital stay, effectively alleviates anxiety and depression, improves quality of life and nursing satisfaction, and mitigate the incidence of adverse reactions.

Key Words: Humanistic nursing care; Minimally invasive treatment; Graded psychological nursing care; Gastrointestinal submucosal tumor; Endoscopic submucosal dissection

Core Tip: Gastrointestinal submucosal tumors are a prevalent condition affecting the digestive system. Endoscopic submucosal dissection efficaciously attenuates the risk of residual or recurrent tumors. The implementation of humanistic care and graded psychological support has shown to dramatically improve the quality of care and the recovery rate in postoperative patients. These approaches can ameliorate negative emotions and boost the overall quality of life. However, research on the effects of humanistic nursing care and graded psychological nursing in patients undergoing gastrointestinal submucosal tumors post-surgery is not fully. Here elucidated, we analyzed data from 180 patients who underwent endoscopic submucosal dissection for gastrointestinal submucosal tumors, focusing on their postoperative emotion state, quality of life, and complications. The results suggest that combining humanistic nursing care with graded psychological nursing care significantly alleviates postoperative negative emotions, shortens hospital stay, lowers complication rates, and improves quality of life scores.

INTRODUCTION

Gastrointestinal submucosal tumors are a prevalent ailment affecting the digestive system[1]. Lumps or tumors typically develop beneath the gastrointestinal mucosa and are generally benign, though malignant cases can occur[2]. Patients with these tumors, especially early-stage cancer, often show no obvious signs, making the early diagnosis very difficult. When diagnosed, patients usually experienced symptoms such as indigestion, abdominal pain, and even gastrointestinal bleeding[3]. Therefore, it is crucial to establish timely diagnosis and treatment for these patients. Endoscopic examination and tissue biopsy are currently the gold standard for assessing these tumors, and treatment options may include surgical removal, radiotherapy, and chemotherapy, or other methods depending on the case[4]. Proper intervention can significantly enhance patients’ survival rates and quality of life, making prompt medical attention essential for those experiencing related symptoms. With the rapid advancement of endoscopic technology, endoscopic submucosal dissection (ESD) has recently become a widely accepted therapeutic option for gastrointestinal cancer[5]. ESD is an endoscopically guided, minimally invasive and local surgical resection technique. The treatment promotes faster recovery, improves the en bloc resection rate and reduces the risk of recurrence[6]. However, patients experience a series of psychological and physiological stress during the perioperative period, leading to the reduced efficacy of treatment, low quality of life, and adversely affecting prognosis[7]. Hence, it is essential to enhance perioperative clinical care for these patients[8].

Traditionally, perioperative care involves key aspects such as preoperative preparation, anesthesia management, dietary adjustments, oral hygiene. Nevertheless, these conventional approaches have certain limitations. They emphasizes the management of disease progression and clinical symptoms while often neglecting essential elements like patient communication, targeted health education, and psychological support, which lead to suboptimal outcomes[9]. Humanistic nursing care, a patient-centered approach, aims to ensure that patients are not only physically comfortable, but also psychologically, socially, and spiritually at ease. This method is particularly effective in alleviating negative emotions and enhancing the quality of life, especially for patients with mental health disorders[10]. On the other hand, graded psychological nursing adapts its interventions to the beliefs and attitudes of the patient using various techniques, including psychological and technological tools. Unlike general psychological nursing care, which lacks specificity, graded psychological nursing is formulated based on the patient’s varying psychological condition. This targeted method improves the recovery after surgery[11]. Studies suggest that both humanistic and graded psychological nursing care can alleviate anxiety and depression, and enhance self-efficacy in patients[12]. Despite studies that explore these two nursing models independently, comprehensive research that assesses their combined effects is relatively limited, making it challenging to fully evaluate their synergistic potential[12]. By integrating insights from psychology, sociology, and nursing, a more integrated nursing model could better meet the physiological and psychological needs of patients. In this study, we conducted a retrospective analysis of the clinical data from 180 patients with gastrointestinal submucosal tumors who underwent ESD surgery in our hospital from March 2021 to February 2023. The study aimed to investigate the effectiveness of combining humanistic nursing care with graded psychological support in the surgical treatment of these patients.

MATERIALS AND METHODS

General data

From March 2021 to February 2023, we retrospectively analyzed clinical data from 180 patients with gastrointestinal submucosal tumors who underwent ESD surgery at our hospital. Patients were divided into two groups based on the different nursing methods provided: The observation group (n = 90) received humanistic nursing care combined with graded psychological support, while the control group (n = 90) received routine care. Inclusion criteria for the study were: (1) A histopathological diagnosis of gastrointestinal submucosal tumors; (2) Treatment with ESD; (3) First-time and single tumor; and (4) The ability to communicate effectively. Exclusion criteria were: (1) Concomitant malignant tumors; (2) Cardiopulmonary insufficiency; (3) Mental disorders; and (4) Incomplete or missing data. In the control group, there were 56 males and 34 females, aged between 30 to 61 years, with a mean age of 50.16 ± 3.52 years. As for the observation group, there were 55 males and 35 females, aged between 32 to 63 years, with a mean age of 51.20 ± 3.37 years. Baseline data between the two groups showed no significant differences.

Nursing methods

The control cohort received routine nursing care as implemented in the department. Upon admission, patients were informed about general and relevant precautions. They cooperated with doctors to complete all procedures, with their vital signs and surgical incisions closely monitored. Preventive measures were discussed to patients and their families, emphasizing the importance of regular cleaning and disinfection to maintain a hygienic environment. Patients and their families’ questions were patiently answered. Additionally, patients were advised to maintain optimal environmental temperature conditions, including appropriate temperature, humidity, and ventilation. In terms of diet, they were suggested to follow a low-salt, low-fat regimen, increase their intake of protein, vitamins, and other nutrients as needed, and avoid cold stimuli and spicy foods. On the basis of the control group, the observation cohort received humanistic nursing care combined with graded psychological nursing interventions. The specific measures were as follows.

Daily care: Nurses focused on maximizing patients’ comfort and ensuring they felt respected. Some patients experienced severe depression and negative emotions, sometimes even leading to suicidal tendencies. Therefore, the management of the hospital room and the security of the medical staff are important. The hospital should remain clean and neat.

Daily activities: An open activity room was set up to address patient concerns and improve their social skills. Nurses engaged patients in conversation to understand their health status, offering support through active listening and encouragement.

Psychological counseling: One-on-one counseling was provided to address anxiety and depression, which helps establish positive coping mechanisms for patients, mobilize their subjective initiative and confidence, and maintain a calm mindset.

Vocational rehabilitation training: Patients were encouraged to participate in activities, for example, under the premise of ensuring safety, patients were encouraged to assist medical staff in maintaining order and cleanliness in the cafeteria and participate in simulated shopping games to improve manual skills and lay the foundation for reintegrating into society.

Psychological grading: Upon admission, patients were assessed using the Hospital Anxiety and Depression Scale to determine the level of psychological care required. The specific approaches are as follows: (1) Emotional relaxation: Help patients relax through warm language and appropriate physical contact (such as gently patting their shoulders), creating a comfortable nursing environment; (2) Environmental management: Pay attention to the ward environment, minimize noise and disturbances to avoid affecting patients’ emotions and cooperation with treatment; (3) Patient answers: Respond to patients’ inquiries with patience, enhancing their sense of security; (4) Health guidance: Provide health education in a suitable way based on patients’ receptive ability, elaborating on surgical treatment plans and possible complications, preventive measures, and treatment methods; and (5) Emotional counseling: Assist patients in alleviating negative emotions and eliminating concerns about surgical outcomes and urination function.

The specific measures include: (1) Monitor emotional changes: During communication, pay attention to observing changes in the patient’s emotions and adjust the communication approach accordingly. Appropriately lengthen communication time with patients to make them feel the care of medical staff and enhance their sense of being cared for; (2) Share success stories: Introduce recent successful surgery cases to boost the patient’s confidence in the surgical procedure; (3) Emphasize the importance of positive emotions: Inform patients about the importance of managing positive emotions to enhance treatment outcomes; and (4) Involve family members: Encourage family members to participate in the care process and strengthen communication with them to enhance the patient’s sense of support.

Observation of indicators

We compared the emotional status, complications, quality of life improvement, nursing satisfaction, and self-efficacy between the two groups of patients before and 3 months after the nursing intervention. The data collected from both cohorts were analyzed.

Self-rating anxiety scale: Self-rating anxiety scale (SAS) was developed by Zung et al[13] in 1971, which is a widely tool for assessing anxiety levels. It consists of 20 test items that measure anxiety symptoms, which are evaluated over weekly intervals. The scoring system includes 4 levels: (1) Standard scores of 50 or below are considered within the normal range; (2) Scores between 50 and 59 suggest mild anxiety; (3) 60 to 69 indicate moderate anxiety; and (4) Scores above 70 reflect severe anxiety symptoms. Higher scores represent greater severity of anxiety.

Self-rating depression scale: Self-rating depression scale (SDS) was employed to evaluate participants’ depression states and severity[14]. This scale was filled out based on the patient’s feelings over the past week. The SDS comprises 20 items across 4 dimensions: Psychotic emotional symptoms, physical disorders, psychomotor disorders, and depressive psychological disorders. It is a simple and suitable for individuals from various backgrounds, professions, cultures, and ages, including both those without mental health issues and psychiatric patients. Lower scores denote better conditions. The scoring criteria for SDS are as follows: Scores < 53 indicate no depression; scores 53-62 suggest mild depression; scores 63-72 reflect moderate depression; scores > 72 indicate severe depression.

Quality of life scale: The short-form 36 health survey was utilized to evaluate the quality of life[15]. This survey covers four aspects: Daily life, physical function, mental health, and social function. Each aspect is scored on a scale from 0 and 100. Higher scores denote a better quality of life for the patient.

Nursing satisfaction survey: Questionnaires were adopted to assess the satisfaction level of the two cohorts of patients with their nursing care. The satisfaction was categorized into three different evaluation criteria: Dissatisfied, satisfied, and very satisfied. The maximum score on the survey was 100 points, with the range for being very satisfied standing between 85 and 100 points, satisfied between 60 and 84 points, and less than 60 points indicating dissatisfaction. The total satisfaction rate was calculated as (very satisfied + satisfied)/n × 100%.

Analysis of self-efficacy: The general self-efficacy scale, developed by Luszczynska et al[16]. Jerusalem, is a psychological measurement scale that consists of 10 items. Each item is scored from 1 (completely incorrect) to 4 (completely correct). Higher scores denote stronger self-efficacy.

Statistical analysis

Here, statistical analysis was implemented using SPSS 22.0 software. For the measurement data of nursing satisfaction and quality of life in the two groups of patients, a t-test was adopted. For the enumeration data, a χ² test was employed. P < 0.05 was considered statistically significant.

RESULTS

Comparison of postoperative first meal time, surgery duration, and length of hospital stay between the two groups

The postoperative first meal time 1.81 ± 0.43 days, surgery duration 68.35 ± 10.31 hours, and length of hospital stay 8.65 ± 1.03 days within the observation cohort were all less than those in the control group 2.45 ± 0.32 days, 77.51 ± 10.58 hours, 12.37 ± 1.12 days, respectively, with P < 0.05 (Table 1).

Table 1 Comparison of postoperative first meal time, surgery duration, and length of hospital stay between the two groups (mean ± SD).

Group	n	First postoperative meal time (day)	Surgery duration (hour)	Length of hospital stay (day)
Control group	90	2.45 ± 0.32	77.51 ± 10.58	12.37 ± 1.12
Observation group	90	1.81 ± 0.43	68.35 ± 10.31	8.65 ± 1.03
t value		6.839	5.216	6.856
P value		0.017	0.020	0.018

Comparison of SAS and SDS scores preceding and following nursing care in both groups

Prior to nursing care, there was no significant difference in SAS scores (61.35 ± 6.12 vs 61.29 ± 7.06) and SDS scores (60.10 ± 3.21 vs 60.22 ± 4.52) between the two groups, respectively. Subsequent to nursing care, the SAS scores (43.17 ± 5.68) and SDS scores (41.57 ± 6.52) within the observation group were significantly lower than those within the control group (SAS: 52.38 ± 5.21, SDS: 51.23 ± 8.25) (Table 2).

Table 2 Comparison of self-rating anxiety scale and self-rating depression scale scores between the two groups (points, mean ± SD).

Group	n	SAS				SDS
		Before nursing	After nursing	t value	P value	Before nursing	After nursing	t value	P value
Control group	90	61.35 ± 6.12	52.38 ± 5.21	5.386	0.023	60.10 ± 3.21	51.23 ± 8.25	6.287	0.024
Observation group	90	61.29 ± 7.06	43.17 ± 5.68	6.821	0.019	60.22 ± 4.52	41.57 ± 6.52	8.125	0.018
t value		0.239	8.352			0.315	6.583
P value		0.512	0.021			0.423	0.010

SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Comparison of quality of life preceding and following nursing care in the two groups

Before the nursing care, there was no significant difference in the quality of life between the control group and the observation group. However, following the nursing care, both groups showed the improvements in their quality of life compared to pre-intervention levels. When compared to pre-nursing care levels, the observation group displayed significantly greater improvement in quality of life compared to the control group (Table 3).

Table 3 Comparison of quality of life between the two groups before and after nursing care (mean ± SD).

Item	Stage	Control group (n = 90)	Observation group (n = 90)	t value	P value
Daily life	Before nursing	67.35 ± 5.12	67.58 ± 5.07	0.436	0.128
	After nursing	73.10 ± 3.26	80.01 ± 6.39	5.327	0.021
	t value	6.037	5.865
	P value	0.021	0.020
Physiological function	Before nursing	70.34 ± 5.36	70.82 ± 5.51	0.351	0.258
	After nursing	76.11 ± 6.25	83.59 ± 6.89	5.187	0.020
	t value	5.109	8.357
	P value	0.022	0.018
Psychology	Before nursing	68.35 ± 4.27	68.59 ± 4.35	0.517	0.365
	After nursing	74.51 ± 5.16	81.69 ± 5.34	5.639	0.025
	t value	6.235	7.512
	P value	0.023	0.020
Social function	Before nursing	68.31 ± 5.68	68.16 ± 5.37	0.411	0.327
	After nursing	77.65 ± 6.13	85.23 ± 6.05	6.132	0.021
	t value	5.361	7.155
	P value	0.021	0.018

Nursing satisfaction in the two groups

Nursing satisfaction was categorized as very satisfied, satisfied, and dissatisfied. The results showed that the nursing satisfaction score in the observation cohort (94.44%) was significantly higher than that in the control cohort (86.67%) (Table 4).

Table 4 Comparison of nursing satisfaction between the two groups, n (%).

Group	n	Very satisfied	Satisfied	Dissatisfied	Overall satisfaction
Control group	90	45 (50.00)	33 (36.67)	12 (13.33)	78 (86.67)
Observation group	90	54 (60.00)	31 (34.44)	5 (5.56)	85 (94.44)
χ2					6.851
P value					0.021

Comparison of the incidence of adverse reactions

The total incidence of adverse reactions within the control group (11.10%) was significantly higher than that in the observation group (5.55%) (Table 5).

Table 5 Comparison of the incidence of adverse reactions, n (%).

Group	n	Abdominal pain	Bleeding	Bore a hole	Total incidence rate
Control group	90	4 (4.44)	4 (4.44)	2 (2.22)	10 (11.10)
Observation group	90	3 (3.33)	2 (2.22)	0 (0)	5 (5.55)
χ2					9.357
P value					0.019

Self-efficacy scores in the two groups

Prior to nursing intervention, there was no significant difference in self-efficacy scores between the two groups. However, after the nursing intervention, both groups exhibited a notable improvement in their self-efficacy scores. Moreover, the observation cohort displayed significantly higher self-efficacy scores compared to the control group (Table 6).

Table 6 Analysis of self-efficacy scores in the two groups (mean ± SD).

	Control group (n = 90)	Observation group (n = 90)	t value	P value
Before nursing	22.43 ± 2.42	23.02 ± 2.37	1.652	0.100
After nursing	25.53 ± 2.98	29.23 ± 3.12	8.136	< 0.001

DISCUSSION

Gastrointestinal submucosal tumors originate from the muscularis mucosa, submucosa, and muscularis propria, and they are often asymptomatic[17,18]. Due to a low incidence, obscure symptoms, and poor prognosis, early diagnosis has been a hot topic of research[19]. With the technology development, ESD has brought significant advancements in managing these tumors[20]. Endoscopic surgery has advantages such as minimal invasiveness, short operation time, and low cost, making it an increasingly preferred method with promising clinical outcomes[21]. Patients are diagnosed via endoscopy examination and subjected to proper surgical treatment. However, surgical interventions can induce side effects, making the clinical nursing necessary for these patients[22]. Routine nursing interventions often fail to address the patients’ individual needs and psychological support, which may lead to overlooked negative emotions and unmet care expectations[23]. This study aims to improve the nursing experience by employing patient-centered care through scientific and standardized procedures. By adopting humanistic nursing and graded psychological nursing interventions, we aim to provide high-quality and personalized nursing services that alleviate patients’ psychological burdens to some extent, motivate better cooperation during treatment, and ultimately boost their overall quality of life.

The study found that patients in the observation group had shorter postoperative food initiation times, reduced surgical durations, and shorter hospital stays compared to the control cohort. The total incidence of adverse reactions was significantly lower within the observation group (5.50%) than in the control group (11.10%), suggesting that integrated nursing care effectively improved perioperative clinical outcomes and promoted faster recovery. Moreover, after nursing intervention, the observation cohort displayed significantly lower SAS and SDS scores compared to the control group, along with higher levels of nursing satisfaction and self-efficacy. These results confirm that the observation group exhibited greater improvements in alleviating anxiety and depressive, as well as enhanced satisfaction with care. It is well recognized that while most cancer survivors are able to adapt well to life after cancer, some experience persistent negative emotions, such as cancer-related fears, post-traumatic stress, anxiety, or depression[24-27]. Traditional nursing helps reduce stress, but often falls short in fully addressing these psychological issues, especially due to gaps in doctor-patient communication[28]. Therefore, seeking novel nursing methods is essential for the recovery of cancer patient’s post-surgery. Humanistic nursing care employs a patient-centered approach that prioritizes individual personalities, quality of life, and psychological needs[29], which has been extensively studied in alleviating negative emotions in patients with various diseases and enhancing their quality of life[10,12,30]. Psychological nursing procedures apply the bio-psycho-social medical model to the patient’s treatment process, positively influencing the mental state of patients during treatment[31]. It helps patients manage the emotional and physical pain associated with cancer and its treatments, enabling them to face challenges with greater resilience[32]. Graded psychological nursing care is a more scientific method of psychological nursing, where nursing measures are taken according to the patient’s grading levels to ensure that care is more targeted and effective[33]. In our study, the integration of humanistic nursing and graded psychological nursing care methods contributes to fostering better nurse-patient relationships, improving the quality of life of patients. Hence, the combined nursing method can attenuate the occurrence of postoperative adverse emotions and complications, improve patient quality of life, and ensure nursing effects.

Research on the effects of humanized care and graded psychological care is becoming increasingly prevalent both domestically and internationally. For example, Gao et al[34] and Lu et al[35] found that humanistic care based on the Carolina care model significantly improves the rehabilitation for patients with ovarian cancer and non-small cell lung cancer patients, alleviates physical and mental stress responses, and effectively enhances nursing satisfaction and quality of life. Additionally, Tauber et al[36] found that psychological interventions can effectively reduce cancer patients’ fear of recurrence. In breast cancer studies, studies show that personalized and graded psychological interventions significantly reduce negative emotions, enhance positive emotions, and improve quality of life. These interventions have demonstrated such approach could be suggested for broader clinical application[37,38]. While these findings were consistent with our research to some extent, they differ in their emphasis. Most prior studies focused mainly on changes in patients’ emotional states, often overlooking the comparative analyses of clinical outcomes such as the time to first postoperative feeding, duration of surgery, and length of hospital stay. Our study not only explores the synergistic effects of humanized care and graded psychological care on the positive emotional impact for cancer patients but also reveals a deeper understanding of their effects on clinical efficacy, which is the novel and significant aspect of our research.

CONCLUSION

In summary, the combined application of humanistic nursing care and graded psychological support dramatically boosts nursing satisfaction and quality of life for patients undergoing ESD treatment for gastrointestinal submucosal tumors. It enhances patient quality of life and nursing satisfaction while reduces the incidence of adverse reactions. We not only address patient perioperative experiences but also highlights the significant clinical outcomes of this nursing model for patients undergoing ESD treatment for gastrointestinal submucosal tumors, providing new strategies for their care. Nevertheless, the sample size was small, and each patient’s mental state varied. Further studies should be done to expand the sample size form different patient groups to help refine nursing practices.