Impact of Neuman model-guided stepped care on elderly gastric cancer patients’ postop recovery

Abstract

BACKGROUND

Owing to age-related physiological declines, elderly patients undergoing radical gastrectomy (RG) often experience physical and psychological challenges. Hence, appropriate nursing strategies need to be identified for optimizing patient outcomes.

AIM

To evaluate the effects of the Neuman Systems Model-guided stepped care intervention (NGSC) model on postoperative physical and psychological recovery in elderly patients with gastric cancer who underwent RG.

METHODS

In total, 80 elderly patients (≥ 65 years old) who underwent RG at the Shanxi Fenyang Hospital between January 2023 and June 2024 were included and randomly divided as follows: Control group (n = 40, those receiving conventional stepped care intervention); observation group (n = 40, those receiving NGSC). Postoperative recovery indices, anxiety/depression scores (Self-Rating Anxiety Scale/Self-Rating Depression Scale), quality of life (36-item short form health survey), and adverse event rates were compared between the groups.

RESULTS

Compared with the control group, the observation group presented significantly shorter recovery times for first bowel sounds, ambulation, flatus, oral intake, catheter removal, and hospitalization (all P < 0.05). Notably, in the observation group, Self-Rating Anxiety Scale/Self-Rating Depression Scale scores and the adverse event rate were significantly lower (all P < 0.05), whereas 36-item short form health survey scores were higher (P < 0.05), compared with those in the control group.

CONCLUSION

Overall, the findings of this study show that the proposed NGSC model accelerates postoperative recovery, alleviates psychological distress, improves quality of life, and reduces complications in elderly patients with gastric cancer who underwent RG, presenting potential for clinical application.

Keywords: Gastric cancer; Neuman Systems Model; Stepped care intervention; Elderly radical gastrectomy; Physical and psychological status; Postoperative recovery

Core Tip: This study innovatively applied the Neuman Systems Model to stepped care interventions during postoperative recovery for elderly gastric cancer patients. By systematically assessing patients’ stressors and hierarchically activating the physiological-psychological defense mechanisms, the Neuman Systems Model-guided approach could significantly accelerate functional recovery (32% reduction in bowel sound recovery time, 24% shorter hospitalization) and reduce anxiety/depression rates by 41%. Concurrently, it showed improvement in the quality of life scores (36-item short form health survey increased by 18.6 points), thereby establishing a theoretically driven practical paradigm for perioperative management in cases of geriatric oncology.