Effect of CICARE and humanistic care on resilience and pain after colon polypectomy

Abstract

BACKGROUND

Colon polypectomy under endoscopic ultrasound is a common procedure, yet postoperative pain and psychological distress often impair recovery and reduce resilience. Traditional care focuses on physiological monitoring, neglecting psychosocial support. Based on positive psychology and patient-centered communication principles, we hypothesize that combining the Connect, Introduce, Communicate, Ask, Respond, Exit (CICARE) communication model with humanistic care will significantly enhance psychological resilience, alleviate pain, and improve postoperative outcomes in these patients.

AIM

To investigate the effects of CICARE combined with humanistic care on post-polypectomy resilience and pain.

METHODS

In this prospective randomized controlled trial, 98 patients undergoing ultrasound-guided colon polypectomy were randomized into observation group (CICARE plus humanistic care) and control group (routine care plus standard humanistic support), 49 each. Psychological resilience, anxiety, depression, and pain were assessed using the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Numerical Rating Scale. The t tests or rank-sum tests were used for comparison.

RESULTS

After surgery, the observation group showed significantly higher Connor-Davidson Resilience Scale scores than the control group across resilience (42.92 ± 3.35 vs 36.37 ± 3.58), strength (26.86 ± 2.92 vs 24.61 ± 2.98), optimism (9.63 ± 1.30 vs 8.80 ± 1.15), and total score (80.31 ± 4.30 vs 73.84 ± 3.29). Anxiety and depression scores were lower (7.53 ± 1.12 vs 8.16 ± 0.87; 6.55 ± 1.16 vs 8.22 ± 1.30). Severe pain incidence was reduced (4.09% vs 10.21%). The observation group also had shorter first defecation (1.46 ± 0.34 days), first oral intake (0.53 ± 0.07 days), hospital stay (2.06 ± 0.84 days), higher self-management ability (168.18 ± 8.41), and better quality of life (5.53 ± 0.98), all P < 0.05.

CONCLUSION

Combining CICARE with humanistic care after colon polypectomy improves psychological resilience, alleviates anxiety, depression and pain, and enhances postoperative recovery, self-management and quality of life.

Key Words: Colonic polyps; Endoscopic ultrasound; Connect-introduce-communicate-ask-respond-end communication model; Humanistic care; Psychological resilience; Pain

Core Tip: The Connect, Introduce, Communicate, Ask, Respond, Exit (CICARE) communication model combined with humanistic care significantly improves postoperative outcomes in patients undergoing endoscopic ultrasound-guided colon polypectomy. This integrated approach enhances psychological resilience, alleviates anxiety and depression, reduces pain intensity, and promotes self-management ability. By systematically addressing patients’ cognitive and emotional needs through structured, empathetic communication, this nursing strategy accelerates physical recovery and improves quality of life, providing an evidence-based framework for patient-centered postoperative care.

INTRODUCTION

Colonic polyps are a common benign lesion of the digestive system worldwide. If not treated in time, the lesions may gradually enlarge and be accompanied by certain changes in morphology and tissue structure, thereby significantly increasing the risk of cancer[1]. At present, endoscopic resection is the main treatment for this disease[2]. Among them, endoscopic ultrasound has shown outstanding performance in improving surgical safety and efficacy due to its unique advantages, and has become a key means of treating complex colonic polyps[3]. However, as an invasive operation, this technique will still cause physical trauma to patients and trigger stress reactions including preoperative anxiety, intraoperative tension and postoperative pain[4]. Such adverse physical and mental reactions may not only reduce the patient’s treatment compliance, but also delay the postoperative recovery process and affect the final efficacy[5]. Therefore, while ensuring the precise implementation of the technique, how to alleviate the patient’s psychological burden and pain experience through systematic and humane postoperative care has become an important direction of clinical nursing work. Traditional postoperative care is mostly focused on the observation of physiological indicators and the prevention and control of complications, and the psychological and social support for patients is relatively limited. Psychological resilience, as a core concept in the field of positive psychology, refers to the positive qualities of an individual in maintaining psychological balance and adaptability when facing stress. High levels of psychological resilience help patients adjust their negative cognition of pain and reduce negative catastrophic thinking[6]. Studies have shown that good nurse-patient communication and humanistic care can enhance patients’ sense of security and autonomy, thereby promoting psychological resilience and alleviating pain[7]. The Connect, Introduce, Communicate, Ask, Respond, Exit (CICARE) communication model, as a standardized, patient-centered structured communication framework[8]. Humanistic care nursing is a care model aimed at promoting patient recovery. It emphasizes comprehensive attention to patients’ needs at the psychological, emotional, and social levels, providing a personalized guidance framework for nursing work and helping nurses to more accurately grasp the timing and methods of care intervention[9]. The combination of the two can systematically and humanistically guide the entire process of nursing communication. Therefore, this study intends to analyze the effect of the CICARE communication model combined with humanistic care nursing on patients after endoscopic ultrasound-guided colon polypectomy, focusing on its impact on patients’ psychological resilience and pain level, in order to provide a more humanistic and scientifically supported nursing practice reference for this postoperative group.

MATERIALS AND METHODS

General information

Ninety-eight patients who underwent endoscopic ultrasound-guided polypectomy for colonic polyps in our hospital from January 2026 to March 2026 were selected as the study subjects. They were randomly divided into an observation group (n = 49) and a control group (n = 49) using a random number table. There were no statistically significant differences in the general characteristics of the two groups (P > 0.05), and they were comparable. This study is a prospective randomized controlled trial that has been approved by the Ethics Committee of the Second Affiliated Hospital Zhejiang University School of Medicine. All patients have signed informed consent forms.

Exclusion and inclusion criteria

Inclusion criteria: (1) Diagnosed with colon polyps by endoscopic ultrasound; (2) Underwent endoscopic ultrasound-guided colon polyp removal at our hospital; (3) No history of mental illness or cognitive impairment, and able to communicate normally; and (4) Patients are at least 18 years old.

Exclusion criteria: (1) Coexisting neurological or hematologic diseases; (2) Coexisting immune dysfunction or liver and kidney dysfunction; and (3) Coexisting with other intestinal malignancies or suspected carcinomas.

Removal criteria: (1) If a candidate is found to meet the above exclusion criteria after being selected; (2) If a candidate withdraws from the study due to personal reasons or other factors after being selected; and (3) If a candidate is transferred to another hospital or lost to follow-up.

All 98 patients included in this study completed the entire research process without exclusion, loss to follow-up, or withdrawal. All scales were fully collected with no missing data.

Sample size calculation

The formula for calculating the sample size is: n₁ = n₂ = [2 × (Z_α/2 + Z_β)² × σ²]/δ². Among them, the significance level is set as α = 0.05 (two-sided), Z_α/2 = 1.96; the test power is 80%, and Z_β = 0.842. Referring to the study on patient psychological resilience intervention by Wang and Pan[10], the SD (σ) of the Connor-Davidson Resilience Scale score used in their report is about 10. In combination with clinical practice, the minimum clinically significant difference (δ) between groups in this study is set as 6. Substituting into the formula, it is found that each group needs at least 44 subjects. Considering the possible loss to follow-up and dropout during the study, the sample size is usually increased by 10% to 20%. Therefore, each group ultimately needs about 48 cases to 53 cases, and the total sample size is about 96 cases to 106 cases. According to the sample size calculation results, it is planned to include 98 patients. In the actual study, a total of 98 patients were recruited and randomly assigned to meet the sample size requirements.

Study design

All patients randomly assigned to the two groups (control group and observation group) received basic routine care from our department after endoscopic colon polypectomy, including vital sign monitoring, acid suppression and gastric mucosal protection treatment according to medical advice, and routine observation and management of complications.

Control group

Implement standard humanistic care nursing plans on top of basic routine nursing. Including: (1) Postoperative feedback and health education: After the surgery, nursing staff will briefly inform the patient of the surgical results and provide written postoperative precautions, covering early activity recommendations such as transitioning from liquid to regular food, avoiding straining and lifting heavy objects, as well as self-observation points for complications; and (2) Psychological support: Non responsible nurses provide a systematic 30 minute psychological counseling session within 24 hours after surgery, which mainly includes listening to patient complaints, providing comfort and encouragement, and answering general questions. This process aims to help patients alleviate initial anxiety, without using CICARE’s structured communication process, while daily communication between nurses and patients follows the department’s routine methods.

Observation group

Implement the CICARE communication model combined with humanistic care nursing in basic routine nursing. The specific implementation steps are as follows.

Team building and training: An intervention team was established, consisting of one head nurse and five experienced nurses from the ultrasound and gastroenterology endoscopy center. Led by the head nurse, a four-week intensive training course was designed, focusing on the characteristics of endoscopic ultrasound-guided colon polypectomy, the core principles of the six steps of the CICARE communication model, the concept of humanistic care, and practical skills. Professionals from the hospital’s psychology Department of Psychology were invited to lecture on common postoperative patient psychological reactions and supportive communication techniques. Upon completion of the training, a standardized theoretical and scenario-based assessment was conducted; only those scoring at least 80 points were eligible for intervention, ensuring the standardization and professionalism of nursing practice.

Intervention implementation process: (1) Contact: Nursing staff proactively approach patients with a friendly attitude and calm tone, creating a safe and respectful atmosphere. When collecting basic information and medical data, special attention is paid to protecting patient privacy. The assessment focuses on the patient’s cognitive level, such as their understanding of surgery and postoperative pain, and their information needs; their psychological and emotional level, such as current anxiety, fear, and initial level of psychological resilience; and their behavioral and experiential level, such as past pain experiences, coping strategies, and expectations of nursing care. Simultaneously, the information obtained is systematically recorded and analyzed; (2) Introduction: During the initial contact, nursing staff clearly introduce their role and responsibilities. Depending on the patient’s age, education level, and comprehension preferences, various methods such as verbal explanations, visual manuals, or short videos are used to explain the basic principles of the surgery, normal postoperative reactions such as mild abdominal pain and bloating, the feasibility and importance of pain management, and the overall goals of rehabilitation. This helps patients and their families establish a scientific and objective understanding of the disease and expectations for recovery, reducing fear caused by the unknown; (3) Communication: Nursing staff systematically and clearly explained to patients the necessity of scientific dietary management, activity and rest, pain management, and a positive attitude, focusing on key aspects of postoperative recovery. Regarding dietary management, patients should gradually transition from liquid to a regular diet, while avoiding spicy and stimulating foods. For activity and rest, the benefits and specific methods of early, appropriate ambulation were emphasized, but straining during bowel movements and lifting heavy objects should be avoided. For pain management, patients were taught how to use pain self-assessment tools such as the Numerical Rating Scale score, and the appropriate use of analgesics and non-pharmacological relief methods such as relaxation techniques were explained. Regarding emotional control, the positive impact of a positive and stable mood on reducing pain perception and promoting bodily repair was explained, guiding patients to focus on psychological adjustment; (4) Ask: At key postoperative times, such as after returning to the ward and during daily care, proactively and openly ask the patient: “How exactly are you experiencing pain now? Which areas are uncomfortable?”, “Regarding the precautions I just told you, is there anything you don’t understand or are worried about?”, “How have you been feeling lately? Is there anything that’s causing you particular anxiety?”, etc. By proactively inquiring about the patient’s specific postoperative pain experience, emotional changes, questions about nursing interventions, and difficulties in self-management, we can understand the patient’s grasp of pain coping strategies and psychological adjustment methods, collect their needs and suggestions for nursing services, and respect the patient’s wishes and privacy throughout the process; (5) Response: Provide timely, specific, and personalized feedback to patients’ questions and difficulties. Offer specific guidance, especially regarding pain management, dietary arrangements, and activity plans. For complex or immediately unresolved issues, promptly contact the medical team for collaborative handling. Simultaneously, be aware of patients’ negative emotions and offer empathy and comfort. At appropriate times, share similar, anonymously reported, and successfully recovered cases to help patients see positive outcomes, build confidence in recovery, and enhance psychological resilience. Provide step-by-step guidance and encouragement for specific challenges such as patients’ reluctance to get out of bed; and (6) Conclusion: Before the patient’s discharge, provide summary guidance and empowerment. Provide the patient with written home care instructions covering diet, activity, pain monitoring, wound observation, and medication list; clearly inform them of signs of complications requiring immediate medical attention, such as severe abdominal pain, rectal bleeding, and fever, and provide the hospital’s emergency contact information; encourage family members to participate in the rehabilitation plan, and introduce available community resources or online support platforms; before concluding the communication, sincerely thank the patient for their cooperation and offer positive encouragement, such as, “You have been very cooperative throughout the process, and your recovery is progressing well. Please keep it up, and we wish you a speedy recovery!” to reinforce their positive beliefs. To ensure the accurate implementation of intervention measures according to the plan, the following measures were taken during the study period: (1) The head nurse needs to hold a weekly group meeting to review the implementation of the intervention, discuss the problems encountered during implementation, and emphasize the core points of each step of CICARE; and (2) After the study, 20% of nursing records from each group were randomly selected for review, and it was confirmed that the observation group records reflected the execution content of the six steps of CICARE, while the control group records had no relevant statements.

Control of confounding factors

To avoid confounding bias caused by non-specific factors such as nursing attention and nurse characteristics between the two groups, the following control measures were taken in this study: Nursing attention: (1) The total duration and frequency of daily nursing care received by the two groups of patients remain consistent; (2) Nurse characteristics: Trained nurses from the same group are responsible for nursing two groups of patients simultaneously, ensuring that there are no differences in communication styles and abilities between groups; (3) Physical isolation: Patients in the observation group and control group should be placed in different wards or on both sides of the ward to avoid information exchange; and (4) Outcome blinding method: The researchers responsible for scale evaluation did not participate in nursing interventions and were unaware of patient grouping.

Observation indicators

Main outcome measures: Psychological resilience. The Connor-Davidson Resilience Scale[11] was used to assess patients before and after surgery to examine their psychological health level. The original scale was compiled by Connor and Davidson and translated into a simplified Chinese version with 25 items by Chinese scholars, and the scale has a total of 25 items, covering three dimensions: Resilience, strength and optimism. The scoring range is 0 to 4 points, where 0 points represent “completely non-compliant” and 4 points represent “almost always compliant”. The total score of the scale is 0 to 100 points. The higher the score, the better the individual’s psychological resilience level. In the sample of this study, the Cronbach’s alpha coefficient of the scale was 0.87 [95% confidence interval (CI): 0.83-0.91], and the Cronbach’s alpha coefficients of each dimension were 0.85 (resilience, 95%CI: 0.80-0.89), 0.81 (strength, 95%CI: 0.75-0.86), and 0.74 (optimism, 95%CI: 0.66-0.81), indicating good to acceptable internal consistency of the scale.

Secondary outcome measures: (1) Anxiety and depression: The comprehensive Hospital Anxiety and Depression Scale (HADS)[12] developed by Zigmond and Snaith in 1983 was used to evaluate the anxiety and depression status of patients before and after surgery. The scale contains 14 items, of which 7 items are used to assess depressive symptoms and the other 7 items are for anxiety symptoms. The total score ranges from 0 to 42 points, of which the scores of HADS-anxiety subscale and HADS-depression subscale range from 0 to 21 points. The higher the score, the higher the individual’s anxiety or depression level; (2) Postoperative pain intensity: At the 24^th hour after surgery, the pain intensity of the patients was measured using the Numerical Rating Scale[13]. The scale uses a scoring rule of 0 to 10 points, where 0 points represent “no pain” and 10 points represent “severe pain”. According to the score range, the pain is divided into four levels: 0 points is no pain, 1 to 3 points are mild pain, 4 to 6 points are moderate pain, and 7 to 10 points are severe pain; (3) Self-management ability and quality of life: Before and after surgery, the self-management ability and quality of life of the two groups of patients were assessed using the Adult Health Self-Management Ability Scale (AHSMSRS)[14] and the European Five-Dimensional Health Scale (EQ-5D) Chinese version[15]. The AHSMSRS has a total of 38 items, covering health awareness, medication adherence, dietary adjustment, and regular follow-up visits. Each item is scored on a 5-level scale, with a maximum total score of 190 points. A higher score indicates better self-management ability. The EQ-5D includes 5 dimensions, such as activity ability, pain perception, discomfort level, and psychological state. Each dimension is divided into 3 levels, with a total score of 15 points. A lower score reflects a higher quality of life. The Chinese version of this scale has been proven to have good reliability and validity among patients with digestive system diseases in China; and (4) Postoperative recovery: The postoperative recovery of the two groups of patients was compared, including the time of first bowel movement, the time of first meal, and the length of hospital stay. The above data were obtained by the researchers through consulting the electronic medical record system, and the researchers were not aware of the grouping. All the above scales were independently evaluated by a research nurse who received unified training and was unaware of patient grouping.

Statistical analysis

This study used SPSS 21.0 statistical software for data analysis. Quantitative data were expressed as mean ± SD. If the comparison between groups conforms to normality and homogeneity of variance, t test is used; otherwise, nonparametric rank sum test is used. Comparison of repeated measurement data before and after intervention using covariance analysis. Count data were described as n (%), and Mann-Whitney U tests were used for comparisons between groups of ordinal data. Calculate the corresponding effect size and its 95%CI. A P < 0.05 was considered statistically significant.

RESULTS

Comparison of general information between the two groups of patients

This study ultimately included 98 cases for random grouping. Both the observation group (49 cases) and the control group (49 cases) completed the study without loss to follow-up, exclusion, or withdrawal. The baseline data of the two groups of subjects were comparable (P > 0.05; Table 1).

Table 1 Comparison of general data between the two groups, mean ± SD/n (%).

Project	Category	Control group (n = 49)	Observation group (n = 49)	t/χ2 value	P value
Age (years)		48.27 ± 5.83	46.86 ± 6.59	1.120	0.265
Body mass index (kg/m2)		23.50 ± 2.4 7	23.15 ± 2.16	0.741	0.461
Gender	Male	27 (55.10)	29 (59.18)	0.167	0.683
	Female	22 (44.90)	20 (40.82)
Education level	Junior high school and below	17 (34.69)	17 (34.69)	0.474	0.789
	High school/vocational school	26 (53.06)	28 (57.14)
	College degree or above	6 (12.25)	4 (8.17)
Polyp types	Adenomatous	23 (46.94)	26 (53.06)	0.367	0.544
	Non-adenomatous	26 (53.06)	23 (46.94)
Polyp site	Transverse colon	18 (36.73)	20 (40.82)	0.179	0.915
	Descending colon	20 (40.82)	19 (38.78)
	Other	11 (22.45)	10 (20.40)
Number of polyps	Single shot	20 (40.82)	23 (46.94)	0.373	0.541
	Frequent	29 (59.18)	26 (53.06)
Polyp diameter (cm)		1.27 ± 0.19	1.30 ± 0.24	-0.699	0.486

Comparison of CD-RISC scores between the two groups

After the intervention, the scores of the subjects in the three dimensions of resilience, strength and optimism in CD-RISC, as well as the total score, were significantly higher than those of the control group (P < 0.05). For details, please refer to Table 2.

Table 2 Comparison of Connor-Davidson Resilience Scale scores between the two groups (n = 49), mean ± SD.

Group	Resilience		Strength		Optimism		Total score
	Preoperative	Post-surgery	Preoperative	Post-surgery	Preoperative	Post-surgery	Preoperative	Post-surgery
Control group	29.57 ± 3.20	36.37 ± 3.58	20.90 ± 2.74	24.61 ± 2.98	7.18 ± 1.38	8.80 ± 1.15	64.20 ± 4.54	73.84 ± 3.29
Observation group	29.14 ± 3.52	42.92 ± 3.35	20.12 ± 2.58	26.86 ± 2.92	7.10 ± 1.10	9.63 ± 1.30	64.00 ± 3.63	80.31 ± 4.30
t value	0.630	-9.356	1.443	-3.766	0.323	-3.366	0.246	-8.364
P value	0.530	< 0.001	0.152	< 0.001	0.747	0.001	0.806	< 0.001

After intervention, the effect values (Cohen’s d) were 189 [95% confidence interval (CI): 1.41-2.37], 0.76 (95%CI: 0.35-1.17), 0.67 (95%CI: 0.26-1.08), and 1.69 (95%CI: 1.23-2.15), respectively.

Comparison of postoperative anxiety and depression between the two groups

After nursing care, the anxiety and depression scores in the observation group were lower than those in the control group (P < 0.05). See Table 3.

Table 3 Comparison of anxiety and depression scores between the two groups (n = 49), mean ± SD.

Group	Anxiety status score		Depression score
	Preoperative	Post-surgery	Preoperative	Post-surgery
Control group	11.84 ± 1.38	8.16 ± 0.87	9.16 ± 1.56	8.22 ± 1.30
Observation group	12.31 ± 1.72	7.53 ± 1.12	9.14 ± 1.37	6.55 ± 1.16
t value	-1.491	3.117	0.069	6.748
P value	0.139	0.002	0.945	< 0.001

After intervention, the effect values (Cohen’s d) were 063 (95% confidence interval: 0.23-1.03) and 1.36 (95% confidence interval: 0.92-1.80), respectively.

Comparison of postoperative pain levels between the two groups

The evaluation of pain level 24 hours after surgery showed that the postoperative pain level in the observation group was significantly lower than that in the control group (P < 0.05), as shown in Table 4.

Table 4 Comparison of pain levels between the two groups, n (%).

Group	Mild	moderate	Severe
Control group	17 (34.69)	27 (55.10)	5 (10.21)
Observation group	29 (59.18)	18 (36.73)	2 (4.09)
z value			-2.479
P value			0.013

The effect size is r = 0.25 (95% confidence interval: 0.05-0.44), indicating a small effect size.

Comparison of self-management ability and quality of life between the two groups

After nursing care, the AHSMSRS score in the observation group was higher than that in the control group, while the EQ-5D score was lower (P < 0.05). See Table 5.

Table 5 Comparison of self-management ability and quality of life scores between the two groups (n = 49), mean ± SD.

Group	AHSMSRS		EQ-5D
	Preoperative	Post-surgery	Preoperative	Post-surgery
Control group	137.22 ± 14.21	153.29 ± 8.14	9.10 ± 2.10	6.24 ± 1.38
Observation group	136.90 ± 12.36	168.18 ± 8.41	9.18 ± 1.93	5.53 ± 0.98
t value	0.121	-8.909	-0.200	2.957
P value	0.904	< 0.001	0.842	0.004

After intervention, the effect values (Cohen’s d) were 180 (95% confidence interval: 1.32-2.28) and 0.59 (95% confidence interval: 0.19-0.99), respectively.

Comparison of postoperative recovery between the two groups

Compared with the control group, the observation group showed a better trend in clinical rehabilitation indicators (P < 0.05). See Table 6 for details.

Table 6 Comparison of postoperative recovery between the two groups (n = 49), mean ± SD.

Group	Time of first bowel movement (day)	First feeding time (day)	Length of hospital stay (day)
Control group	1.68 ± 0.21	0.74 ± 0.09	2.57 ± 0.96
Observation group	1.46 ± 0.34	0.53 ± 0.07	2.06 ± 0.84
t value	3.874	12.851	2.794
P value	< 0.001	< 0.001	0.006

The effect sizes (Cohen’s d) are as follows:0.78 [95% confidence interval (CI): 0.37-1.19], 2.60 (95%CI: 2.00-3.20), 0.56 (95%CI: 0.16-0.96).

Comparison of two adverse events

During the study period, there were 2 cases (4.08%) of postoperative abdominal pain aggravation and 1 case (2.04%) of rectal bleeding in the control group. One case (2.04%) of postoperative abdominal pain worsened in the observation group, and there were no cases of rectal bleeding. There was no statistically significant difference in the incidence of complications between the two groups (χ² = 0.261, P = 0.609). All complications were relieved after symptomatic treatment, and no serious adverse events occurred.

DISCUSSION

Colonic polyps are a common pathological phenomenon in clinical diagnosis and treatment. In recent years, their incidence has continued to rise and is significantly related to changes in the lifestyle and dietary structure of modern populations[16]. Surgical treatment is the preferred option for this disease. In the clinical management of complex colonic polyps, endoscopic ultrasound-guided resection has become an important intervention strategy due to its significant advantages[3]. However, the surgical intervention process may cause damage to intestinal tissue, which may lead to postoperative gastrointestinal bleeding or intestinal perforation and other complications[17]. In addition, due to the long course of the disease, patients’ psychological state is often more fragile and prone to negative emotions, which reduces their treatment compliance and has an adverse effect on the postoperative recovery process[18]. This study combined the CICARE communication model with humanistic care and applied it to patients after endoscopic ultrasound-guided resection of colonic polyps. The results showed that the observation group was significantly better than the control group in terms of postoperative psychological resilience, pain control, self-management ability, quality of life and early recovery indicators, indicating that this combined intervention model may have good clinical applicability and effectiveness.

First, this study confirms that the CICARE communication model combined with humanistic care may help improve the patient’s postoperative psychological state, enhance psychological resilience and alleviate anxiety and depression. Psychological resilience is an important adaptive mechanism for individuals to cope with adversity[19], while anxiety and depression are common postoperative negatives. This study found that after intervention, the CD-RISC scale scores of the observation group were significantly higher than those of the control group in terms of resilience, strength and optimism, as well as the total score. At the same time, the anxiety and depression scores of the HADS scale were significantly lower than those of the control group. Its mechanism of action may be: On the one hand, the CICARE communication model provides a clear and predictable framework for nurse-patient interaction through its standardized “contact-introduction-communication-inquiry-response-end” process. In the introduction and communication process, nurses use diversified methods such as pictures, texts and videos to systematically explain the postoperative process and self-management points, reducing the patient’s fear of the disease caused by information blind spots[20]. In the inquiry and response phase, we actively explore the patient’s individual concerns and provide specific solutions, such as sharing successful recovery cases, which may help enhance the patient’s sense of control and hope for recovery. This might be a key element in the two dimensions of optimism and strength in psychological resilience and directly alleviates the patient’s anxiety and depression symptoms. On the other hand, the humanistic care nursing integrated throughout the process goes beyond simple technical guidance and emphasizes empathy and respect for the patient’s emotional experience. When nurses come into contact with patients, they create a safe atmosphere and provide emotional support when responding to patients’ questions. This continuous experience of being cared for can meet the patient’s emotional needs, consolidate their inner sense of security, thereby enhance the patient’s resilience and reduce the intensity of anxiety and depression[21]. The combination of the two can improve the patient’s overall psychological state from the two levels of changing cognition and providing emotional support.

Secondly, this combined intervention program significantly reduced the postoperative pain level of patients. Pain, as a common postoperative complication, may trigger significant physiological and psychological stress responses, thereby reducing the patient’s cooperation with treatment and nursing measures, and ultimately having an adverse effect on the recovery process[22]. The postoperative pain level in the observation group was significantly lower than that in the control group. Supportive psychological guidance and cognitive reconstruction played a fundamental role in this. Namely, through preoperative and postoperative systematic education, helping patients establish a scientific understanding of postoperative pain, normalizing and managing it, reducing anxiety and fear caused by misinterpreting pain signals, thereby directly reducing the helplessness and emotional amplification effect caused by pain[23]. The CICARE communication model further enhanced this effect by optimizing the nurse-patient relationship. The initial trust relationship established in the contact and introduction phase made patients more willing to report pain and trust the advice of nursing staff. In the inquiry phase, the patient’s proactive and specific pain assessment ensured that the pain could be detected and effectively intervened in a timely manner, avoiding the aggravation of pain caused by enduring pain. More importantly, in the communication and response phase, the non-pharmacological analgesia techniques taught by the nursing staff, such as relaxation training, and the timely pharmacological analgesia plans provided, gave patients specific tools and confidence to cope with pain. This personalized pain management based on good communication has achieved a shift from passive endurance to proactive management, effectively reducing or even avoiding negative emotions caused by pain in patients[24].

Finally, this study also observed the positive effects of combined intervention on promoting patients’ self-management ability, quality of life and accelerating physical recovery. The observation group had higher AHSMSRS scores and lower EQ-5D scores, and the time to first defecation, first meal and length of hospital stay were shorter than those of the control group. This series of positive results helped patients recover after surgery, and the reasons for this may be as follows. First, the humanistic care intervention based on the CICARE framework directly improved the patients’ postoperative emotional state and physical comfort by enhancing their psychological resilience and pain management effectiveness. Positive emotions and reduced pain provided a physical and mental foundation for patients to get out of bed early and actively participate in rehabilitation exercises[25]. Second, clear and repeated rehabilitation guidance in structured communication ensured the effective transmission and mastery of health information, thereby helping patients improve their self-management ability. Good self-management behaviors, such as standardized diet, timely activities and correct monitoring of the condition, further promoted the early recovery of intestinal function and reduced the risk of complications, thereby achieving rapid recovery of physiological function and improvement of overall quality of life, which was ultimately reflected in the shortening of the hospital stay. This further confirms that high-quality nursing intervention can positively influence behavior and physiological outcomes by improving psychological intermediate variables, thus generating comprehensive benefits[26]. Although the observation group had a shortened hospitalization time of about 0.51 days and a shortened first meal time of about 0.21 days compared to the control group, their effect sizes (Cohen’s d) were 0.56 and 2.60, respectively, with the former being a moderate effect and the latter being a large effect. Early oral intake helps maintain intestinal barrier function, which is in line with the concept of accelerated rehabilitation surgery. Shortening hospitalization time can improve bed turnover rate. Although implementing the CICARE model requires additional training and time investment, considering that the intervention simultaneously improves multidimensional outcomes such as psychological resilience (Cohen’s d = 1.69), anxiety and depression (Cohen’s d = 0.63 and Cohen’s d = 1.36), and self-management ability (Cohen’s d = 1.80), its comprehensive benefits may exceed the improvement range of individual indicators. However, this study also has the following limitations: (1) It is a single center study with limited sample size, and the extrapolation of results needs to be cautious; (2) The observation period was short, and pain intensity may fluctuate within the initial 48 hours, with no long-term outcomes assessed; and (3) Nursing interventions are difficult to implement blinding for patients and implementers, which may result in implementation bias. In the future, multi center, large sample, long-term follow-up studies are needed to validate this conclusion.

CONCLUSION

In conclusion, combining the CICARE communication model with humanistic care in patients after endoscopic ultrasound-guided colon polypectomy may be a valuable nursing practice choice. It ensures systematic care through standardized procedures, enhancing patients’ psychological resilience at multiple levels - cognitive, emotional, and behavioral - alleviating anxiety and depression, reducing postoperative pain, and improving patients’ self-management abilities, thus comprehensively promoting postoperative recovery and quality of life. This study provides practical evidence for deepening the patient-centered postoperative care model and is worthy of clinical application. Future research can further explore the applicability of this model to different diseases and age groups, and focus on its long-term effects, such as long-term health behaviors.