Impact of psychological nursing on anxiety, depression, wound healing, and satisfaction in patients with superficial basal cell carcinoma

Abstract

BACKGROUND

Superficial basal cell carcinoma (BCC) is a common skin cancer for which surgical treatment is currently the primary clinical approach. However, due to the large surgical incision, noticeable scarring can easily occur postoperatively, affecting the patient’s facial aesthetics. As such, providing appropriate nursing support during the perioperative period is essential.

AIM

To investigate the impact of psychological nursing on anxiety, depression, wound healing rates, and satisfaction in patients with superficial BCC.

METHODS

Clinical data from 87 patients with superficial facial BCC, who were treated at the Central Hospital of Enshi Prefecture Tujia and Miao Autonomous Prefecture between February 2023 and February 2025, were retrospectively analyzed. Patients were divided into 2 groups according to nursing method: Control (routine nursing, n = 42); and intervention (psychological in addition to routine nursing, n = 45). Anxiety and depression symptoms, wound healing rate, pain level, postoperative complications, quality of life, and satisfaction with nursing were compared between the groups.

RESULTS

After the nursing intervention, the study group exhibited significantly lower Hamilton Anxiety and Depression Scale scores than the control group (P < 0.05). The wound healing rate in the intervention group (91.11%) was significantly higher than that in the control group (80.95%) (P < 0.05), and the visual analog scale score was lower in the intervention group (P < 0.05). The total incidence of complications in the intervention group (6.67%) was lower than that in the control group (19.05%) (P < 0.05). Postoperative quality of life and satisfaction with nursing were higher in the intervention group (P < 0.05).

CONCLUSION

Psychological nursing intervention(s) effectively alleviated negative emotions, promoted wound healing, reduced pain, improved satisfaction, and reduced postoperative complications in patients with superficial facial BCC.

Key Words: Anxiety; Depression; Satisfaction with nursing; Psychological nursing; Postoperative pain; Superficial basal cell carcinoma

Core Tip: This study investigated the impact of psychological nursing care on anxiety, depression, wound-healing rates, and satisfaction with nursing in patients diagnosed with superficial basal cell carcinoma. After the nursing intervention, the study group exhibited significantly lower Hamilton Anxiety and Depression Scale scores than the control group (P < 0.05), a better wound healing rate (91.11% vs 80.95%) (P < 0.05), a lower visual analog scale score (P < 0.05), a lower incidence of complications (6.67% vs 19.05%) (P < 0.05), and better postoperative quality of life and satisfaction with nursing (P < 0.05). These results support the effectiveness of psychological nursing care in patients with superficial facial basal cell carcinoma.

INTRODUCTION

Non-melanoma skin cancer results from the abnormal proliferation of skin cells caused by DNA mutations or genetic defects[1]. Malignant melanoma is the leading cause of skin cancer-related death and its incidence is increasing faster than that of other types of cancer[2,3]. Basal cell carcinoma (BCC) is the most common type of malignancy within the non-melanoma skin cancer category, representing approximately 80% of these tumors globally, with an annual incidence of almost 10%[4,5]. Originating from keratinocytes, BCCs are commonly localized skin cancers with low malignancy rates[6]. BCC typically occurs in areas exposed to ultraviolet radiation, particularly the head and face, and can severely affect an individual’s appearance[7,8].

BCC is generally associated with good prognosis. Although the mortality rate associated with BCC is low, it can easily cause local tissue damage, leading to a high probability of disfigurement[9]. Surgical excision is the preferred treatment for BCC affecting the head and face[10]. BCC commonly occurs in areas exposed to ultraviolet radiation, such as the perioral region, eyelids, and nose[11]. Patients with lesions in these specific areas often have high functional and aesthetic needs[12]. Mohs micrographic surgery can ensure complete tumor removal with minimal tissue damage; however, it is difficult to implement widely in primary hospitals because of its complexity, length of the procedure(s), need for intraoperative frozen section capabilities, and close collaboration with pathologists[13]. As such, standard surgical excision is the most widely used procedure[14,15]. Although surgery can remove tumors to a greater extent, surgery performed on the face inevitably removes some tissue, often leaving visible scars. Patients usually have a longer life expectancy due to the low malignancy of BCC; however, these permanent scars can be a burden on the patient and lead to long-term suffering. Routine nursing measures lack comprehensive content, fail to emphasize the psychological needs of patients and the importance of facial aesthetics, and may threaten other organs and tissues as the disease progresses and worsens[16]. This causes great psychological distress because anxiety and depression in patients with BCC are not only due to concerns about the disease itself, but also long-term social integration, self-image, and quality of life, which can persist even after wound healing. Psychological care interventions, such as cognitive behavioral therapy and supportive counseling, aim to alleviate persistent psychological issues by addressing social inclusion fears and improving self-image perception, which are extremely important for the mental health of those diagnosed with BCC. To minimize functional deficits and maximize aesthetic appearance, standard surgical excision aims to preserve key adjacent tissues and organ structures; however, this can lead to the development of residual tumors[17]. Although postoperative psychological nursing interventions have yielded positive effects in patients with other cancers, their effect on wound healing and satisfaction with nursing in patients diagnosed with BCC remains unclear.

As such, the present study investigated the impact of psychological nursing on anxiety, depression, incision healing, and satisfaction with nursing in patients with superficial BCC to provide evidence supporting the development of nursing care strategies.

MATERIALS AND METHODS

Study participants

Clinical data from 87 patients diagnosed with superficial facial BCC, who were treated at the Central Hospital of Enshi Prefecture, Tujia, and Miao Autonomous Prefecture between February 2023 and February 2025, were retrospectively analyzed. Patients were divided into 2 groups according to type of nursing care: Control (routine nursing care, n = 42); and intervention (psychological nursing in addition to routine nursing care, n = 45).

Inclusion and exclusion criteria

The inclusion criteria were diagnosis of superficial BCC of the face, surgical treatment, and availability of complete clinical data. The exclusion criteria were concurrent keratoacanthoma, melanoma, nevus, seborrheic keratosis, pregnancy or breastfeeding, current HIV disease, and recent treatment with immunomodulatory drugs.

Data collection

Data were retrospectively collected from the hospital’s electronic medical records system and nursing documentation. The collected information included the following: Demographic and clinical characteristics (age, gender, lesion location, tumor size, disease duration, and surgical details); nursing intervention records (type, frequency, and duration of psychological nursing measures in the intervention group; details of routine nursing in both groups); outcome measures data [Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), visual analog scale (VAS) and 36-item Short-Form Health Survey (SF-36) score], and a questionnaire addressing satisfaction with nursing; wound healing status; and occurrence of postoperative complications at baseline (preoperatively), 1 week postoperatively, and 1 month post-discharge. Two trained research nurses independently extracted the data; any discrepancies were resolved through discussion with a senior researcher.

Ethics approval

Given the retrospective design of the present study and the use of anonymized patient data, the requirement for informed consent was waived by the hospital ethics committee, approval No. LL20240149. To ensure patient privacy, all data were processed and stored in accordance with the principles of the Declaration of Helsinki and local data-protection regulations.

Nursing methods

Control group: Routine nursing measures were administered until discharge, with a 1-month follow-up after discharge: (1) Preoperative examination: The patient’s facial skin condition was tested and vital signs were closely monitored. Each patient was comprehensively assessed to determine whether the surgical criteria were fulfilled; (2) Health education: Proactive communication and interaction with patients, and clear education about relevant precautions during surgery and the postoperative recovery period; (3) Preoperative preparation: Preparation for disinfection, draping, and anesthesia; (4) Intraoperative nursing: Patients underwent cancer cell removal under general anesthesia and skin graft repair; and (5) Postoperative nursing: Observing changes in the incision and assistance with diet adjustment. On postoperative days 1 to 3, incision changes were observed on postoperative days 1 to 3, focusing on blood leakage, fluid leakage, redness, and swelling. The wound was observed every 2 days on postoperative days 4 to 7 to evaluate healing progress of the incision and to identify signs of infection. The incision was then observed twice weekly until discharge to ensure that the recovery status of the incision could be determined on time.

Intervention group: The study group received psychological nursing based on routine nursing until discharge, with a 1-month follow-up after discharge.; (1) Preoperative nursing: After admission, the ulcerated area was cleaned using a 0.9% sodium chloride solution, and a wet dressing with ethacridine lactate solution was applied locally. The area of the tumor lesion was banded (local treatment); (2) Preoperative preparation: One to 3 days before the operation, nursing staff removed hair from the affected area and cleaned the underlying skin. If skin grafting was required, the routine donor site, either the abdomen or the inner thigh, was prepared and cleaned simultaneously; (3) Preoperative examination: In addition to testing the patient’s facial skin condition, instructions were provided to complete routine blood and urine tests and electrocardiograms to avoid errors in preliminary examination results that could affect the surgical outcome; and (4) Psychological counseling: Most patients lack an understanding of their own disease and medical procedures, and are prone to negative emotions such as fear, apprehension, or anxiety when facing surgical treatment. As such, nursing staff provided health education through appropriate communication and easily understandable language to help patients fully understand surgery-related matters and reduce psychological stress. This included individual counseling sessions (20-30 minutes per session, 2-3 times preoperatively) and the provision of educational materials. Nurses used active listening techniques to identify patients’ specific concerns (regarding scarring and social acceptance) and addressed them using evidence-based information.

Intraoperative nursing: Nursing staff assisted physicians in performing skin flap transplantation surgery, strengthened patient vital sign monitoring during the operation, and placed a urinary catheter depending on operative duration: (1) Body position intervention: For 24 hours postoperatively, the nursing staff instructed patients to maintain absolute bed rest, adjust to a healthy lateral or supine position, and elevate the head of the bed by approximately 30° to relieve discomfort, such as swelling, pain, and oozing in the surgical area, to promote early recovery; (2) Condition monitoring: Changes in patient vital signs, as well as exudate and bleeding from the surgical site, were closely monitored, and the dressing(s) was changed promptly to avoid complications such as infection. Pressure bandages were applied to the surgical area. Patients experiencing discomfort, such as nausea, pain, or vomiting, were attended to. Temperature, color, pain, and swelling of the skin flap were assessed. The color of the skin flap gradually recovered within 1-2 days postoperatively. The nursing staff gently applied pressure the skin flap with cotton swabs, and abnormalities were promptly reported; (3) Drainage tube care: The nursing staff implemented the appropriate measures to maintain the subcutaneous negative-pressure drainage tube of the skin flap in a patent state, aspirated the drainage fluid regularly, and observed its nature and color. Patients were instructed not to move their heads vigorously to avoid twisting, compressing, or dislodging the drainage tube; (4) Pain intervention: After anesthesia was discontinued, postoperative pain level was assessed. Music therapy, whole-body relaxation therapy, and other methods were used to treat patients experiencing mild pain. Analgesics were administered according to the attending physician’s instructions when pain was severe and unbearable; and (5) Rehabilitation guidance: Protective measures were implemented for skin flaps. The edges of the skin were cleaned with warm water, skin tension was promptly reduced using skin closure devices, and pressure bandages were applied to avoid hypertrophic scar formation. Simultaneously, postoperative cleaning and dressing changes were performed; blood scabs were promptly removed; blood supply to the skin flap was monitored; and related complications, such as bleeding, redness, or infection, were promptly addressed.

Postoperative psychological support

Within 3 days after surgery, the nursing staff conducted daily follow-up conversations (15-20 minutes each) to assess patients’ emotional states, provided positive feedback on wound healing progress, and addressed concerns regarding scarring and appearance. For patients with persistent anxiety or depression (HAM-A score > 14 or HAM-D score > 17), additional counseling sessions (twice weekly) were conducted in collaboration with a clinical psychologist.

Observed indicators

Psychological status[18,19]: The HAM-A includes 14 items rated from 0 to 4, on which higher scores signify greater anxiety. The HAM-D consists of 17 items with a hierarchical scoring method. Items 1, 2, 3, 7, 8, 9, 10, 11, 15, and 17 are scored from 0 to 4, whereas items 4, 5, 6, 12, 13, 14, and 16 are rated from 0 to 2. Higher total HAM-D scores indicate more severe depression. HAM-D score ≤ 7, non-depression; HAM-D score 8-17, mild depression; no anxiety: HAM-A score ≤ 7; mild anxiety: HAM-A score 8-14; moderate anxiety: HAM-A score 15-23; and severe anxiety: HAM-A score ≥ 24. HAM-D score 18-24, moderate depression; HAM-D score > 24, severe depression.

Wound healing efficiency: Wound healing was classified into the following categories: Complete recovery (full healing with the scab falling off), significant effect (wound reduced in size but not fully healed, no secretions with healthy granulation), effective effect (decreased secretion and exudate without noticeable enlargement), and ineffective effect (poor healing with pale granulation). Healing efficiency was calculated using the following equation: (Number of significant and effective wounds/total number of wounds) × 100.

VAS score[20]: A VAS was used to evaluate pain levels in the 2 groups. Patients marked their pain on a 10 cm line, with 0 representing no pain and 10 representing the worst pain imaginable.

Postoperative complications: This includes statistics regarding the occurrence of postoperative issues such as incision infections, bleeding, redness and swelling, and blood seepage in the surgical area.

Quality of life[21]: The SF-36 assessed 8 health domains: Physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health. The validated Dutch version of the Medical Outcomes Study SF-36, with a reference timeframe of the past week, was used. Each domain score was computed if 50% of the questions were answered. All scores were linearly converted to a scale of 0-100, with higher scores reflecting better health status.

Satisfaction with nursing was assessed using a tailored questionnaire that focused on the following 5 aspects: Basic care, nursing knowledge, attitude, skills, and skin care. Satisfaction was reported as a percentage (0%-100%), with higher scores indicating greater satisfaction. The thresholds for interpretation were as follows: Scores < 60% indicated dissatisfaction; 60%-80% indicated satisfaction, and scores > 80% indicated high satisfaction. The overall satisfaction rate was calculated as follows: (Very satisfied + satisfied)/total number of cases × 100.

Statistical analysis

All statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, United States). Quantitative data with normal distribution are expressed as mean ± SD, and comparisons between the intervention and control groups were performed using the t-test and Mann-Whitney U test. Categorical data are reported as frequency and percentage, with comparisons made using the χ² test for four-grid tables or row × list formats. Differences with P < 0.05 were considered to be statistically significant.

RESULTS

Comparison of general data

Data from 87 patients were divided into 2 groups: Intervention (n = 45, 55.56% male, 44.4% female); and control (n = 42, 57.14% male, 42.86% female). The mean ± SD ages of the study and control groups were 65.3 ± 11.2 years and 64.9 ± 10.8 years, respectively. Skin phototype III was predominant in both the intervention (46.67%) and control (47.62%) groups. There were no significant differences between the 2 groups in terms of sex, age, skin phototype, sun exposure, or lesion location (P > 0.05) (Table 1).

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

Patients	Study group (n = 45)	Control group (n = 42)	P value
Gender	-	0.139	-
Male	25 (55.56)	24 (57.14)	-
Female	20 (44.44)	18 (42.86)	-
Age (year), mean ± SD	65.3 ± 11.2	64.9 ± 10.8	0.715
Phototype	-	0.381	-
I	5 (11.11)	6 (14.29)	-
II	4 (8.89)	4 (9.52)	-
III	21 (46.67)	20 (47.62)	-
IV	15 (33.33)	12 (28.57)	-
Maximal diameter (cm), mean ± SD	1.56 ± 0.82	1.59 ± 0.85	0.374
Regarding sun exposure			0.458
Sun exposed patients	30 (66.67)	27 (64.29)
Not sun exposed patients	15 (33.33)	15 (35.71)
Sites of the lesions			0.683
Nose	18 (36.0)	15 (33.33)
Scalp	12 (24.0)	11 (24.44)
Ear	10 (20.0)	8 (17.78)
Forehead	8 (16.0)	6 (13.33)
Medial canthus	2 (4.0)	5 (11.11)

Comparison of HAM-A and HAM-D scores

Before implementation of the nursing interventions, there were no statistically significant differences between the 2 groups in terms of HAM-A scores (study group: 22.78 ± 2.43; control group: 21.96 ± 2.02) and HAM-D scores (intervention group: 21.93 ± 1.57; control group: 22.74 ± 1.75) (P > 0.05). However, after the intervention, both groups exhibited significant reductions in HAM-A and HAM-D scores compared with pre-nursing levels, with the intervention group exhibiting significantly lower scores than the control group (P < 0.05) (Table 2).

Table 2 After the nursing intervention, the Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale scores of the two groups were compared.

Index	Control group (n = 42)	Study group (n = 45)	P value
HAM-A	16.32 ± 2.79	10.16 ± 3.05	< 0.001
HAM-D	16.96 ± 3.18	12.35 ± 2.63	< 0.001

HAM-A: Hamilton Anxiety Rating Scale; HAM-D: Hamilton Depression Rating Scale.

Effective wound healing

After 4 weeks of nursing intervention, wound healing efficiency in the intervention group was 91.11% (41/45) compared with 80.95% (34/42) in the control group, and the difference was statistically significant (P < 0.05) (Figure 1).

Figure 1 Comparison of wound healing efficiency between the two groups after 4 weeks of intervention. ^aP < 0.05 vs control.

VAS pain score

Mean VAS scores for the intervention group were 4.57 ± 1.03, 1.47 ± 0.36, and 0.25 ± 0.13, measured at 1 days, 3 days, and 5 days postoperatively, respectively. In contrast, the control group reported respective mean VAS scores of 4.68 ± 1.26, 2.35 ± 0.36, and 1.79 ± 0.28. Differences in VAS scores between the 2 groups were statistically significant (P < 0.001) (Figure 2).

Figure 2 Comparison of visual analog scale scores in the two groups. ^aP < 0.001 vs control. VAS: Visual analog scale.

Comparison of complication rates

The complication rate in the intervention group was 6.67% (3/45), which was significantly lower than that in the control group (19.05%, 8/42) (P < 0.001) (Figure 3).

Figure 3 Comparison of the incidence of complications between the two groups of patients. ^aP < 0.001 vs control.

SF-36 scores

There were no statistically significant differences in SF-36 scores between the 2 groups before care (P > 0.05). However, the post-intervention SF-36 score was significantly higher in the intervention group than that in the control group (P < 0.05) (Figure 4).

Figure 4 Comparison of 36-item Short Form Health Survey scores between the two groups of patients. ^aP < 0.05 vs before intervention. SF-36: 36-item Short Form Health Survey.

Satisfaction with nursing

Patient satisfaction with nursing care was 93.33% (42/45) in the study group, which was markedly higher than that in the control group (73.81%, 31/42) (P < 0.05) (Figure 5). Representative cases are presented in Figure 6.

Figure 5 Comparison of nursing satisfaction between the two groups. ^aP < 0.001 vs control.

Figure 6 A 54-year-old male with a history of basal cell carcinoma for 5 years. A: Preoperative design; B: Use absorbable sutures’ dermal suture to sew the flap to the defect.

DISCUSSION

Superficial BCC of the face is a common skin malignancy characterized by the presence of stroma-dependent pluripotent basal-like cells. It is a low-grade malignant tumor that differentiates into the epidermis or appendages, and is primarily derived from primitive epithelial germ cells[22]. In recent years, the diagnostic rate of facial BCC has improved with the continuous progress in medical technology in China. After disease onset, the skin tissues of the patients contain various cytokines[23]. Changes in cell expression and interactions between cells lead to abnormal cell proliferation, gradually decreasing apoptosis rates and, in severe cases, even local soft tissue damage[24]. Although surgical treatment has the most profound effects, surgical resection can cause defects in the face and nose, directly impacting facial aesthetics[25]. Therefore, scientifically based and rational nursing interventions are crucial for improving skin lesions in patients with BCC.

Results of the present study revealed that the total incidence of complications in the intervention group was lower than that in the control group (P < 0.05), suggesting that psychological nursing can effectively prevent postoperative complications. This may be because the content of routine nursing includes vital sign monitoring, dietary interventions, and medication guidance. Although these can meet the basic nursing needs of patients, the auxiliary effects of surgical treatment(s) are not always ideal. Psychological nursing standardizes the nursing process by providing psychological care before, during, and after surgery, thereby improving the overall quality of nursing services. It comprehensively considers the patients’ cognitive, medication, dietary, pain, and psychological nursing needs and the timely adjustment of their physical and mental state, which can ensure the smooth progress of surgery and improve treatment safety, thus having an ideal preventive effect on postoperative complications. This finding is consistent with those reported in previous studies[26,27]. Studies have indicated that active participation in health management is closely associated with increased satisfaction with recovery outcomes and reduced functional limitations[28]. This engagement extends beyond physical health maintenance to include effective emotional and social functioning, which collectively contributes to comprehensive patient rehabilitation. In cancer care, the integration of psychological and social factors is essential for high-quality nursing. Psychological interventions can significantly improve patient quality of life, reduce emotional distress, and enhance adherence[29].

Results of this study revealed statistically lower HAM-A and HAM-D scores in the intervention group than those in the control group (P < 0.05), demonstrating that the intervention group achieved significantly better therapeutic outcomes in alleviating anxiety and depression than the control group. The wound healing rate in the intervention group (91.11%) was significantly higher than that in the control group (80.95%) (P < 0.05), and lower than that in the control group (P < 0.05). Postoperative quality of life and satisfaction with nursing were higher in the intervention group than in the control group (P < 0.05). This finding is consistent with those of the previous studies[30]. For example, one study investigating the impact of high-quality nursing combined with psychological interventions on stress responses and negative postoperative emotions in patients undergoing surgery under general anesthesia reported that patients who received psychological interventions demonstrated significant improvements in postoperative stress indicators, anxiety levels, and depression scores[31]. Similarly, another study revealed that psychological care interventions effectively alleviated anxiety and depression in patients with rectal cancer undergoing postoperative chemotherapy, and enhanced treatment compliance and immune function, thereby promoting recovery[32]. This may be because psychological nursing has stronger humanistic characteristics than routine nursing. Improving preoperative preparation, providing rehabilitation guidance, and focusing on adjusting patient psychological state can help meet their physiological and psychological needs, thereby alleviating negative emotions.

Psychological nursing is crucial for patients with superficial facial BCC because of the aesthetic sensitivity of the area affected by disease. Because patients often worry about the effects of postoperative recovery, some experience adverse psychological events, such as anxiety, worry, and insomnia, which makes appropriate nursing care so crucial in these cases. Forming a good nurse-patient relationship between the nursing staff and patient, enabling the patient to feel warm psychologically, and developing a sense of dependence on the nursing staff are the foundations of successful psychological nursing. If a patient experiences postoperative discomfort, the nursing staff should take timely measures to help the patient address the problem and inform them that surgical recovery requires a process to reduce psychological issues during the image disturbance period.

Reducing anxiety and depression through psychological intervention(s) effectively decreases cortisol secretion, improves neuroinflammatory interactions, and reduces oxidative stress and inflammatory responses, thereby accelerating wound healing. Understanding this mechanism provides a theoretical foundation for developing new therapeutic strategies, and underscores the importance of psychological care in clinical practice[33-35].

Limitations

The present study had some limitations. The first was its retrospective design, which may have introduced selection bias with potential differences in patients’ clinical characteristics and baseline data. Although the patients were randomly divided into control and intervention groups, the relatively small sample size may limit the broad applicability and generalizability of the results. Future prospective randomized controlled designs will be used to reduce bias and expand the sample size through multicenter collaboration. Second, the implementation methods and intervention intensity of psychological nursing may vary among patients, which may have affected the evaluation of intervention effects. In addition, the effect of psychological nursing may vary according to patients’ subjective feelings; however, this study mainly relied on scale evaluation and did not fully consider qualitative data. Future large-scale prospective studies are needed to comprehensively evaluate the effects of psychological nursing on this patient population to optimize nursing practices. Therefore, in future clinical practice, group psychoeducation can be led by standardized trained nurses, and research can be promoted from 4 aspects. First, randomized controlled trials and blinded outcome assessments should be implemented to reduce bias. Second, depending on patient age, baseline anxiety level, and other characteristics, a personalized intervention plan should be developed through an adaptive design. Third, biological markers, such as cortisol and inflammatory cytokines, should be introduced to quantify the physiological effects of psychological care. Fourth, a cost-benefit analysis should be performed to clarify the economic value of the intervention promote its application in resource-constrained environments.

CONCLUSION

In summary, psychological nursing interventions can effectively mitigate negative emotions in patients diagnosed with superficial facial BCC, promote wound healing, reduce pain, improve satisfaction with nursing, and reduce postoperative complications. In the treatment and nursing process, various psychological characteristics of patients should be considered to provide the most appropriate psychological support and guidance, establish a good nurse-patient relationship, and provide patients with a comfortable ward environment, thereby strengthening the nursing effect.