Clinical nursing pathways and psychological care in early liver cancer surgery patients: Effects on anxiety, depression, and pain

Table 1 Components of the clinical nursing pathway and psychological interventions administered to the observation group

Item	Intervention details
Admission guidance	Medical staff set up health files for patients and briefed them on the ward layout, assigned medical staff, and available amenities. Patients received advice on smoking cessation and alcohol avoidance, as well as guidance regarding nutrition, rest, and breathing exercises. On the day preceding surgery, instructions were provided for an 8-hour preoperative fast and a 2-hour water restriction. Furthermore, discontinuation of oral anticoagulants was confirmed
Preoperative preparation guidance	Patients received education on surgery-related information and preparatory exercises such as fist-clenching, ankle pumps, hip raises, deep breathing, and effective coughing. Preoperative personal item preparation and item removal like jewelry and metallic items were also informed
Intraoperative care	Patients’ anxiety and fear were eased through communication and tactile reassurance upon their entry into the operating room. Intraoperative procedures include maintaining continuous monitoring of vital signs and taking measures to avoid hypothermia. During the communication process, the medical staff tried their best to empathize with the patients, gained their trust, and established a good nurse-patient relationship. Besides, they adjusted the nursing procedures in a timely manner according to the individual circumstances of the patients, striving to meet their reasonable needs and positively guiding them. They also briefly and clearly explained the relevant knowledge about the disease to the patients, and elaborated on the available treatment options and prognosis. When necessary, they provided suggestive therapy to guide patients to correctly deal with their own diseases and correct their wrong perceptions, thus prompting them accept treatment and care work with a positive and proactive attitude
Postoperative care	Patients were instructed to start a low-fat semi-liquid diet on the second day after surgery while also administering oral nutritional powder (2-3 times a day, 50-100 mL each time). Increased intakes of vegetables and fruits were also encouraged. On the fourth day, a low-fat regular diet was provided, and on the fifth day, the amount of food intake was gradually increased. The patients were assisted in early ambulation. During bed rest, exercises related to limb mobilization on the bed, like fist clenching and elbow bending and extending, were instructed, 5-10 sets per time, 3-4 times a day. Regular dressing changes were carried out. Instructions were given to the patients and their families on how to perform skin cleaning and care, emphasizing the need to protect the surgical wounds. The ward was kept clean, well-ventilated, and regularly disinfected, with the lighting at night being soft and comfortable. Warming decorations were allowed to be added to the ward. According to the doctor's advice, the patient was given pain relief measures such as a patient-controlled analgesia pump; the patient was instructed to divert their attention from the pain by combining breathing exercises, watching TV, etc.; the nursing staff comforted the patient while understanding their behavioral reactions when experiencing pain, selected beautiful music to relieve pain, and helped the patient relax as much as possible; massage and hot compress methods were used to alleviate the patient's pain level
Discharge guidance	On the 6th day after surgery, the patient was given education on activities, diet, and abnormal conditions after discharge, and the patient and his/her family were asked to elaborate on the relevant precautions

Table 2 Baseline patient characteristics, n (%)/mean ± SD

Indicators	Observation group (n = 122)	Control group (n = 108)	χ2/t	P value
Sex			0.604	0.437
Male	73 (59.84)	70 (64.81)
Female	49 (40.16)	38 (35.19)
Age (years)	59.07 ± 7.72	59.15 ± 7.17	0.081	0.935
ASA classification (grade)			4.679	0.096
I	24 (19.67)	11 (10.19)
II	85 (69.67)	80 (74.07)
III	13 (10.66)	17 (15.74)
Tumor pathology			4.582	0.101
Hepatocellular carcinoma	98 (80.33)	90 (83.33)
Bile duct cell carcinoma	24 (19.67)	15 (13.89)
Mixed cell carcinoma	0 (0.00)	3 (2.78)
Clinical staging			0.108	0.743
I	76 (62.30)	65 (60.19)
II	46 (37.70)	43 (39.81)
Child-Pugh classification			3.224	0.073
A	63 (51.64)	43 (39.81)
B	59 (48.36)	65 (60.19)

ASA: American Society of Anesthesiologists.

Table 3 Cancer-related fatigue measurements, n (%)

Indicators	Observation group (n = 122)	Control group (n = 108)	χ2	P value
Absent	19 (15.57)	5 (4.63)	7.342	0.007
Mild	60 (49.18)	31 (28.70)	10.046	0.002
Moderate	42 (34.43)	66 (61.11)	16.378	< 0.001
Intense	1 (0.82)	6 (5.56)	4.354	0.037

Table 4 Therapeutic adherence measurements, n (%)

Adherence assessment	Observation group (n = 122)	Control group (n = 108)	χ2	P value
Good	55 (45.08)	32 (29.63)
Fair	61 (50.00)	49 (45.37)
Poor	6 (4.92)	27 (25.00)
Therapeutic adherence	116 (95.08)	81 (75.00)	18.799	< 0.001

Table 5 Nursing satisfaction, n (%)

Indicators	Observation group (n = 122)	Control group (n = 108)	χ2	P value
Highly satisfied	62 (50.82)	40 (37.04)
Generally satisfied	54 (44.26)	45 (41.67)
Dissatisfied	6 (4.92)	23 (21.30)
Nursing satisfaction	116 (95.08)	85 (78.70)	13.946	< 0.001