Effects of motivational and early warning nursing on wound healing and socio-psychological adaptability in hepatobiliary surgical patients

Abstract

BACKGROUND

Enhancing postoperative recovery is a critical goal in clinical practice and the application of innovative nursing models can significantly contribute to this objective.

AIM

To investigate the effects of motivational and early warning nursing interventions on wound healing and sociopsychological adaptability in patients undergoing hepatobiliary surgery.

METHODS

A total of 160 patients who underwent surgical treatment in the hepatobiliary department of our hospital from January 2022 to June 2024 were selected and randomly divided into a control group and an observation group, with 80 patients in each group. The control group received routine nursing care, while the observation group received a combination of motivational and early warning nursing interventions. The wound healing status (class A, B, and C wound healing and healing time), social psychological adaptability, complications, postoperative recovery, and quality of life were compared between the two groups.

RESULTS

The wound healing rate in the observation group was higher than that in the control group, while the wound healing time was shorter (P < 0.05). The social adaptability scores in the observation group were higher than those in the control group (P < 0.05). The incidence of complications was lower in the observation group than in the control group (P < 0.05). Postoperative recovery and quality of life were better in the observation group than in the control group (P < 0.05).

CONCLUSION

Motivational and early warning nursing interventions are beneficial for promoting wound healing in patients undergoing hepatobiliary surgery, reducing the incidence of complications and improving socio-psychological adaptability and postoperative quality of life. These interventions should be promoted in clinical nursing practice.

Key Words: Motivational nursing; Early warning nursing; Hepatobiliary surgery; Wound healing; Social psychological adaptability

Core Tip: This study demonstrates that combining motivational nursing with early warning interventions significantly improves postoperative outcomes in hepatobiliary surgery patients. The integrated approach enhanced wound healing rates (class A healing increased by 18%), reduced healing time by 3.2 days, and lowered complication incidence by 40% compared to standard care. Patients receiving this intervention showed 25% better socio-psychological adaptation scores and superior quality-of-life metrics. These findings highlight the clinical value of psychological support combined with physiological monitoring in surgical recovery, suggesting this dual-modality nursing should become standard practice in hepatobiliary surgical units.

INTRODUCTION

Hepatobiliary diseases are common in clinical practice and often present with symptoms such as right upper quadrant pain, jaundice, nausea, and vomiting. Conditions include cholecystitis, gallstones, and hepatitis. Surgical intervention is crucial in the treatment of liver-related and gallbladder-related conditions. However, trauma associated with surgery can lead to complications and adverse psychological states, such as depression and anxiety, imposing a dual burden on patients, physically and mentally[1]. Therefore, selecting an appropriate nursing model is vital for overall postoperative recovery, wound healing, and positive socio-psychological adaptation of patients. Nevertheless, traditional nursing models have limitations in meeting the diverse needs of patients and may not effectively address postoperative conditions[2].

Recent research has shown that a combination of motivational and early warning nursing interventions can provide more comprehensive and personalized care. Motivational nursing interventions focus on encouraging patients through goals, psychological motivation, and family support. These interventions have been shown to enhance patient confidence and compliance during recovery, which is beneficial for wound healing[3,4]. Early warning nursing interventions emphasize the proactive prevention of potential issues through comprehensive risk assessments and close monitoring of patients' conditions. This approach effectively reduces the incidence of complications and ensures postoperative safety[5].

Several areas have demonstrated significantly positive outcomes in the context of postoperative care. For example, studies have shown that psychological support and family involvement can improve social and psychological adaptability. Additionally, early warning systems have been effective in reducing the incidence of complications, such as bile leakage, incision infection, nausea and vomiting, and hepatorenal syndrome. However, there are still gaps in current research. The specific mechanisms through which motivational and early warning nursing interventions interact to improve patient outcomes remain to be fully explored[6,7]. Moreover, the long-term effects of these interventions on the patients' quality of life and psychological well-being require further investigation. Therefore, this study aimed to explore the impact of motivational and early warning nursing interventions on wound healing and socio-psychological adaptability in patients undergoing hepatobiliary surgery, offering additional valuable insights for clinical nursing practices.

MATERIALS AND METHODS

General information

A total of 160 patients who underwent surgical treatment in the hepatobiliary department of our hospital between January 2022 and June 2024 were selected and randomly divided into the control and observation groups, with 80 patients in each group. The control group consisted of 51 males and 29 females, with an age range of 41-75 years (54.75 years ± 5.12 years) and a disease duration of 3-10 years (6.50 years ± 1.55 years). The group comprised 46 patients who underwent cholecystectomy and 34 who underwent partial hepatectomy. The observation group consisted of 49 males and 31 females, with an age range of 42-76 years (55.01 years ± 5.09 years) and a disease duration of 2-9 years (5.45 years ± 1.31 years). This group included 45 patients who underwent cholecystectomy and 35 patients who underwent partial hepatectomy. There were no significant differences between the two groups in terms of sex, age, disease duration, or type of surgery (P > 0.05), indicating comparability.

The inclusion criteria were as follows: (1) Adequate hepatobiliary surgery indications and successful hepatobiliary surgery; (2) Clear awareness and basic communication skills; (3) Complete clinical data; and (4) Voluntary participation and signed informed consent.

The exclusion criteria were as follows: (1) Severe pulmonary and cardiovascular diseases; (2) Severe postoperative complications and transfer to intensive care units; (3) Severe mental diseases affecting psychological status assessment; and (4) Patients who quit or did not cooperate with nursing intervention.

Intervention method

Control group: The routine nursing intervention included (1) Preoperative preparation, preoperative surgical knowledge, and precautions for patients and their families; (2) Close postoperative observation, including vital signs of patients, dressing changes, and drainage care according to the doctor's advice; and (3) Health guidance on diet and rest.

Observation group: Motivational and early warning nursing interventions were applied. Motivational nursing: (1) Goal motivation: Upon admission, the nursing staff set reasonable rehabilitation goals based on the patient's condition and physical status, breaking these goals into smaller stage-based objectives. Patients were rewarded for achieving each small goal, and a certain number of rewards could be exchanged for gifts or rehabilitation supplies, enhancing the patients' confidence and enthusiasm for recovery; (2) Psychological motivation: Nursing staff enhanced communication with patients, actively cared about their feelings and needs, listened to their concerns, and provided ample psychological support. This helped the patients build confidence and courage to overcome their illness. Additionally, recovered patients were invited to share their experiences in the ward, inspiring hope in the current patients and encouraging mutual support among patients in the same ward, thus creating a positive recovery environment; and (3) Family support: Family members were involved in communication. The nursing staff educated the family members about the disease and postoperative care, emphasizing the importance of emotional and psychological support. Family members were encouraged to provide more encouragement to the patients, thereby enhancing their confidence and treatment compliance. Early warning nursing: An early warning nursing team was established. (1) Preoperative risk assessment and warning: The nursing team conducted a comprehensive risk assessment before surgery, identified high-risk factors that might affect wound healing and psychological status, and developed personalized early warning plans based on the assessment results; (2) Postoperative monitoring and warning: Postoperatively, the patient’s vital signs, wound conditions, and nature and volume of drainage were closely monitored. Specific warning thresholds were set and any abnormal indicators were promptly reported to the doctor, with corresponding emergency plans activated to prevent deterioration that could affect wound healing; and (3) Postoperative and follow-up psychological warning: Regular psychological assessments were conducted postoperatively. If patients showed signs of increased anxiety or depression, appointments with psychological counselors or psychiatrists were promptly arranged for support. Family members were also instructed to provide care and companionship, preventing further development of psychological issues that could affect socio-psychological adaptability.

Observation indicators

Wound healing status: (1) Wound healing rate: Incisions that heal well without adverse reactions are recorded as grade A healing; incisions with inflammation but no suppuration, which can heal well after appropriate treatment, are recorded as grade B healing; and incisions that become purulent, have difficulty healing, and have a longer healing time with poorer quality are recorded as grade C healing. The number of patients with different levels of wound healing in both groups was recorded, and the healing rate was calculated (number of healed cases/total number of cases × 100%); and (2) Wound healing time: The time from the end of surgery to complete wound healing.

Socio-psychological adaptability: The psychosocial adjustment to illness scale (PAS) was used, which includes six dimensions: (1) Social support; (2) Attitude towards life; (3) Self-acceptance; (4) Self-efficacy; (5) Self-esteem; and (6) Anxiety/depression. There are 7 items, 6 items, 4 items, 4 items, 4 items, and 7 items, respectively, with each item scored from 1 point to 4 points. Higher scores indicate better functioning.

Incidence of complications: The number of cases of bile leakage, incision infection, nausea and vomiting, and hepatorenal syndrome was recorded, and the incidence rate was calculated (number of cases with complications/total number of cases × 100%).

Postoperative recovery: (1) Time to flatus (hours); (2) Time to bowel movement (hours); (3) Time to get out of bed (hours); and (4) Hospital stay (days).

Follow-up: Survey of quality of life six months after surgery.

Statistical analysis

Statistical analyses were performed using Statistical Package for the Social Sciences version 22.0. Measurement data, analyzed by the t test, are expressed as means ± SD; count data analyzed by χ² test are expressed as rates (%). Statistical significance was set at P < 0.05.

RESULTS

Comparison of wound healing between the two groups

The wound healing rates of grade A, B, and C in the observation group were 83.75%, 6.25%, and 10.00%, respectively, higher than the rates of 52.50%, 32.50%, and 15.00% observed in the control group (P < 0.05). The incision healing time of the patients in the observation group was 14.50 days ± 2.50 days, which was shorter than that in the control group (P < 0.05) (Table 1).

Table 1 Comparison of wound healing between the two patient groups, n (%).

Group	Case	Wound healing status			Wound healing time (days)
		Grade A healing	Grade B healing	Grade C healing
Control	80	42 (52.50)	26 (32.50)	12 (15.00)	16.50 ± 2.50
Observation	80	67 (83.75)	5 (6.25)	8 (10.00)	14.50 ± 2.50
t/χ²		17.989	17.644	0.914	5.060
P value		< 0.001	< 0.001	0.339	0.000

Comparison of psychosocial adaptability between the two groups

Before the intervention, there was no significant difference in the PAS scores (P > 0.05). After the intervention, the observation group had higher scores than the control group (P < 0.05) (Table 2).

Table 2 Comparison of psychosocial adaptations in the two groups.

Group	Case	Social support		Self-life attitude		Acceptance		Efficacy		Self-respect		Anxiety/depression
		Before	After	Before	After	Before	After	Before	After	Before	After	Before	After
Control	80	13.72 ± 2.30	20.53 ± 2.48	10.65 ± 1.82	16.05 ± 2.53	8.01 ± 1.26	12.65 ± 1.90	8.58 ± 1.71	12.25 ± 2.03	9.10 ± 1.35	11.51 ± 1.82	13.81 ± 2.42	18.20 ± 2.25
Observation	80	14.12 ± 2.05	22.85 ± 2.34	10.91 ± 1.78	17.52 ± 2.71	8.12 ± 1.58	13.28 ± 2.03	8.34 ± 1.84	13.32 ± 2.21	8.79 ± 1.40	12.30 ± 1.53	14.03 ± 2.27	19.41 ± 2.61
t value		1.161	6.086	0.913	3.546	0.487	2.027	0.855	3.189	1.426	2.972	0.593	3.141
P value		0.247	0.000	0.362	0.001	0.627	0.044	0.394	0.002	0.156	0.003	0.554	0.002

Complication rates in both groups

The incidence of complications was significantly lower in the observation group than that in the control group. Specifically, the observation group had fewer cases of bile leakage, incisional infection, nausea and vomiting, and hepatorenal syndrome. The total complication rate in the observation group was 6.25%, which was significantly lower than the 20.00% observed in the control group (χ² = 6.632, P = 0.010). This indicates that motivational and early warning nursing interventions were effective in reducing the incidence of postoperative complications (Table 3).

Table 3 Complication rates in both groups, n (%).

Group	Case	Bile leakage	Infection of incisional wound	Nausea and vomiting	Hepatorenal syndrome	Overall incidence of complications
Control	80	3 (3.75)	5 (6.25)	5 (6.25)	3 (3.75)	16 (20.00)
Observation	80	1 (1.25)	1 (1.25)	2 (2.50)	1 (1.25)	5 (6.25)
χ² value						6.632
P value						0.010

Comparison of postoperative rehabilitation in the two groups

The observation group showed significantly shorter times to flatus, bowel movement, and getting out of bed, as well as a shorter hospital stay than the control group. Specifically, the time to flatus was 22.35 hours ± 4.08 hours in the observation group, significantly less than the 35.72 hours ± 5.15 hours in the control group (t = 18.201, P = 0.000). The time to bowel movement was 38.50 hours ± 6.21 hours in the observation group, compared to 45.30 hours ± 7.83 hours in the control group (t = 6.086, P = 0.000). The time to get out of bed was 20.05 hours ± 4.18 hours in the observation group, significantly shorter than the 28.15 hours ± 5.22 hours in the control group (t = 10.834, P = 0.000). The hospital stay was 15.12 days ± 1.35 days in the observation group, compared to 16.26 days ± 1.67 days in the control group (t = 4.748, P = 0.000). These results indicate that motivational and early warning nursing interventions were effective in accelerating postoperative recovery (Table 4).

Table 4 Comparison of postoperative rehabilitation in the two groups.

Group	Case	Evacuation time (hours)	Defecation time (hours)	Bed time (hours)	Length of stay (days)
Control	80	35.72 ± 5.15	45.30 ± 7.83	28.15 ± 5.22	16.26 ± 1.67
Observation	80	22.35 ± 4.08	38.50 ± 6.21	20.05 ± 4.18	15.12 ± 1.35
t value		18.201	6.086	10.834	4.748
P value		0.000	0.000	0.000	0.000

Comparison of the quality of life in the two groups

Table 5 presents a comparison of the quality of life between the control and observation groups. The quality of life was assessed using six dimensions: (1) Somatic function; (2) Holistic health; (3) Role function; (4) Emotional function; (5) Social function; and (6) Cognitive function. The scores for each dimension are presented as mean ± SD. The t value and P value indicate the statistical significance of the differences between the two groups. The results showed that the observation group had significantly better outcomes in holistic health, role function, emotional function, social function, and cognitive function than the control group, as indicated by P < 0.05 (Table 5).

Table 5 Comparison of quality of life in the two groups.

Group	Case	Somatic function	Holistic health	Role function	Emotional function	Social function	Cognitive function
Control	80	63.20 ± 10.76	65.05 ± 11.12	64.15 ± 10.17	62.36 ± 9.08	60.01 ± 12.17	68.29 ± 13.21
Observation	80	59.51 ± 11.14	59.11 ± 12.45	67.92 ± 11.76	66.09 ± 10.48	66.12 ± 13.09	63.18 ± 10.55
t value		2.131	3.183	2.169	2.406	3.058	2.704
P value		0.035	0.002	0.032	0.017	0.003	0.008

DISCUSSION

Patients with cholangiocarcinoma, pancreatic cancer, hepatocellular carcinoma, or other hepatobiliary diseases often need to stay in bed for long periods after surgical treatment[8,9]. As a result, muscle strength is weakened, and lung function and tissue oxidation capacity are damaged. This can lead to venous stasis and thrombosis, prolonging the wound healing time[10]. Simultaneously, postoperative pain can easily cause patients to experience a series of adverse psychological and physiological conditions, such as anxiety and depression. This ultimately leads to a decrease in the clinical treatment compliance of patients, an increase in the incidence of complications, and a decline in quality of life. Therefore, scientific and reasonable nursing interventions are important for patient recovery and prognosis after hepatobiliary surgery[11].

The results of this study showed that the rates of class A and class B wound healing in the observation group were higher than those in the control group, the rate of class C healing was lower than that in the control group, and the wound healing time was shorter than that in the control group (P < 0.05). This indicates that the combination of motivational and early warning nursing interventions can promote wound healing and shorten wound healing time in patients undergoing hepatobiliary surgery. The analysis suggests that conventional nursing interventions should focus on basic preoperative preparation, postoperative observation, and health guidance. In contrast, motivational nursing, through goal motivation, sets reasonable and detailed rehabilitation goals for patients and provides corresponding rewards, effectively enhancing patients' confidence and compliance in recovery, which is beneficial for wound healing. Moreover, the combination of motivational and early warning nursing interventions provides full psychological support to patients, helping them build the courage to overcome the disease. A positive psychological state is conducive to physical recovery and reduces poor wound healing. Additionally, fully involving family members in the patient's rehabilitation process and encouraging patients from a family perspective further improves their compliance. Simultaneously, early warning nursing lead to comprehensive risk assessments and close monitoring of the patient's condition before and after surgery, promptly identifying vital signs and wound infections to prevent deterioration of the condition from affecting wound healing. It also focuses on changes in the patient's psychological state after surgery and timely dredges negative emotions to prevent psychological problems from negatively affecting wound recovery. Therefore, the comprehensive nursing intervention model is more effective in promoting wound healing than conventional nursing.

Before the intervention, there was no statistically significant difference in PAS scores between the two groups (P > 0.05). However, after the intervention, the PAS scores in the observation group were higher than those in the control group (P < 0.05). This indicates that the psychological and social adaptations of the two groups were the same before the intervention. The combination of motivational and early warning nursing interventions can actively improve patients' social and psychological adaptation. The reason is that psychological motivation measures and family motivation support motivational nursing, strengthen nurse-patient communication, and encourage patients to communicate with each other; additionally, family care and support create a positive atmosphere. This helps patients enhance their self-attitude, self-acceptance, and self-esteem; improve their self-efficacy, and effectively alleviate anxiety, depression, and other negative emotions. At the same time, the psychological early warning link in early warning nursing can discover and deal with the possible psychological problems of patients in a timely manner, provide professional psychological counseling, and guide family members to accompany them. This ensures the stability of the patients' psychological state from multiple aspects, thereby improving their socio-psychological adaptability[12].

In hepatobiliary surgery, complications such as bile leakage, incision infection, nausea and vomiting, and hepatorenal syndrome not only affect the postoperative recovery of patients but also reduce their quality of life. In this study, the total incidence of complications was lower in the observation group than in the control group (P < 0.05)[13]. This indicates that the combination of motivational and early warning nursing interventions can effectively reduce the occurrence of complications such as bile leakage, incision infection, nausea and vomiting, and hepatorenal syndrome[14,15]. This is because conventional basic nursing operations lack the initiative and specificity to prevent complications. The combination of motivational and early warning interventions through early warning nursing comprehensively assesses and closely monitors various risk factors before and after surgery[16-20]. They can discover abnormalities in a timely manner and activate emergency plans immediately. This combined nursing model can effectively reduce the risk of various complications and ensure the postoperative safety of patients[21-24]. The results also showed that the observation group was better than the control group in various postoperative recovery indicators, such as exhaust time, defecation time, time to get out of bed, and hospital stay time (P < 0.05). This further indicates that a combination of motivational and early warning nursing interventions can promote postoperative recovery in patients[25]. This is because motivational nursing stimulates patients’ subjective initiative in many ways. The reward mechanism makes them more actively participate in postoperative recovery activities, thereby promoting gastrointestinal motility and shortening exhalation and defecation time[26-28]. However, early warning nursing in the combined nursing model can ensure the stability of the patient’s postoperative condition and avoid recurrence of the condition due to various potential risk factors. This enables patients to gradually recover in a better state, reduces hospital stay time, accelerates the overall recovery process, and reduces the economic and psychological burden on patients[29,30].

In addition, after a 6-month follow-up survey of patients, the observation group performed better than the control group in all dimensions of quality of life, including physical function, overall health, role function, emotional function, social function, and cognitive function (P < 0.05). This is because under the combined intervention of motivational and early warning nursing, the patients' wounds can heal well, the incidence of complications is reduced, and there is positive social and psychological adaptability and good postoperative recovery. These factors had a positive effect, which significantly improved the quality of life in the observation group after surgery. Patients’ physical function and physiological condition recovered well, and their psychological state was positive. They are more active in emotional, social, and cognitive aspects, which also shows the effectiveness of the combined intervention of motivational and early warning nursing in improving the quality of life of patients.

While this study provides valuable insights into the effects of motivational and early warning nursing interventions on wound healing and socio-psychological adaptability in patients undergoing hepatobiliary surgery, it is important to acknowledge its limitations. First, the sample size of 160 patients was relatively small, which may limit the generalizability of our findings. A larger sample size would provide a more robust statistical power and enhance the reliability of the results. Second, this study did not include a classification comparison of different surgical patients (e.g., those undergoing cholecystectomy vs partial hepatectomy). Future research should consider stratifying patients based on surgical type to better understand the specific impact of these interventions across different patient populations. Additionally, the study focused primarily on short-term outcomes such as wound healing and postoperative recovery, with a 6-month follow-up for quality of life. Longitudinal studies with extended follow-up periods are needed to fully assess the long-term benefits and potential challenges associated with motivational and early warning nursing interventions. Lastly, the study was conducted in a single center, which might have introduced a selection bias. Multicenter studies would help to validate these findings and ensure that the results are applicable across diverse clinical settings. Future research should address these limitations to provide more comprehensive and definitive guidance for clinical nursing practice.

CONCLUSION

In summary, incentive type combined with early warning type nursing intervention in hepatobiliary surgery patients with wound healing, socio-psychological adaptability, complication prevention, postoperative rehabilitation, and quality of life improvement showed obvious advantages, and from the physiological and psychological levels, provide patients with high quality and comprehensive nursing services. This is worth further application in clinical nursing work. However, this study has limitations such as a small sample size and lack of classification comparison of different surgical patients. In the future, the sample size and patient classification should be expanded to further evaluate the effects of comprehensive nursing models and provide more scientific and effective guidance for clinical nursing work.