Impact of problem management-guided health education with positive incentive nursing after rectal cancer surgery

Abstract

BACKGROUND

Patients undergoing rectal cancer surgery frequently encounter challenges in their self-care abilities, disease knowledge, and emotional well-being postoperatively. Effective nursing interventions are critical for improving the quality of life and minimizing complications. This study explored the clinical implications of integrating health education guided by problem management with positive incentive nursing to address these challenges.

AIM

To evaluate the effect of this combined nursing model on postoperative self-care ability, disease knowledge, mood state, and complication rates in patients undergoing rectal cancer surgery.

METHODS

Eighty patients who underwent rectal cancer surgery between October 2021 and August 2024 were allocated into reference (routine care) and experimental (problem management-guided health education combined with positive incentive nursing) groups. The outcomes included exercise of self-care agency scale, disease knowledge (hospital-specific questionnaire), mood state (profile of mood states), and complication rates.

RESULTS

The experimental group demonstrated significant improvements in self-care ability (P < 0.05), with higher scores for health knowledge, self-concept, self-care skills, and self-care responsibility than the reference group. Disease knowledge scores also improved markedly in the experimental group (P < 0.05). Mood state scores showed a significant decrease in the negative dimensions (e.g., anxiety and depression) and an increase in energy vitality (P < 0.05). Additionally, the experimental group exhibited a lower complication rate than the reference group (7.5% vs 27.5%, P < 0.05).

CONCLUSION

The integration of problem management-guided health education with positive incentive nursing significantly enhanced postoperative self-care abilities, disease knowledge, and emotional well-being while reducing complication rates. This model demonstrated potential for widespread adoption in clinical practice by offering a structured approach to improve patient outcomes and quality of life.

Key Words: Problem management mode; Health education; Positive incentive nursing; Rectal cancer; Self-care ability; Postoperative care; Emotional well-being; Complication prevention

Core Tip: Effective care measures play a crucial role in enhancing the self-care abilities of patients with rectal cancer that in turn can significantly improve their overall mood and quality of life. These measures are indispensable, particularly in patients undergoing surgical treatment. These include preoperative education to reduce anxiety, postoperative pain management to ensure comfort, and dietary adjustments to promote healing. Furthermore, psychological support is vital for helping patients cope with the emotional challenges associated with cancer diagnosis and treatment.

INTRODUCTION

Rectal cancer, a malignant tumor that predominantly affects the older population, is closely associated with individual dietary habits, lifestyle, and environmental factors[1]. Most patients with rectal cancer do not exhibit typical symptoms in the early stages and are diagnosed at an advanced stage, which severely affects their quality of life. In the clinical treatment of patients with rectal cancer, surgery is the primary modality with satisfactory outcomes. However, postoperative changes significantly affect the patients’ daily routines and tasks, thus necessitating an enhancement in their comprehension of the disease and self-care abilities[2].

Conventional nursing practice lacks comprehensive health education. Health education nursing guided by the problem management model emphasizes assisting patients in comprehending their condition through a process of “identifying”, “evaluating”, and “resolving” challenges, thereby enhancing their comprehension of the diseases[3]. Patients typically experience fear and anxiety related to cancer and surgical treatment, resulting in notable emotional changes that negatively affect their postoperative recovery. Positive incentive nursing, which uses language and behavior to motivate and encourage patients, aims to alleviate negative emotions. Applying positive incentive nursing models postoperatively in patients with rectal cancer positively affected their self-care abilities and improved their adverse emotional states[4].

However, there is a paucity of research on the combined use of positive incentive nursing and problem management-guided health education in patients with rectal cancer. Therefore, we conducted a comparative analysis of 80 patients who underwent rectal cancer surgery at our hospital to clarify the role of combined nursing interventions.

MATERIALS AND METHODS

Eligibility criteria

Eighty patients with rectal cancer, who were treated between October 1, 2021 and August 30, 2024 were selected for observation. All patients met the diagnostic criteria for rectal cancer[5]. The inclusion criteria were as follows: (1) Hospitalized patients with a confirmed pathological diagnosis of rectal tumor; (2) Patients with stable and conscious postoperative condition; (3) Patients who could effectively use network tools such as WeChat; (4) Patients with complete clinical data; and (5) Patients who provided voluntary informed consent. The exclusion criteria were as follows: (1) Estimated survival time < 3 months; (2) Distant metastasis during the study; (3) Other malignancies; (4) Participation in similar health education studies; (5) Communication or hearing impairment; and (6) Mental disorders. The general data of the two groups were comparable (P > 0.05), as shown in Table 1.

Table 1 General data comparison.

General characteristics	Experimental group (n = 40)	Control group (n = 40)	t/χ2 value	P value
Age (year)	48.80 ± 6.32	49.55 ± 7.28	0.492	0.624
Sex
Male	28	21	2.581	0.108
Female	12	19
BMI (kg/m2)	20.34 ± 1.28	20.28 ± 1.35	0.204	0.839
Educational qualification
Primary school	11	10	0.210	0.901
Junior and senior high school	14	13
College degree or above	15	17
Adjunctive treatment mode (radiotherapy/chemotherapy)	18/22	17/23	0.051	0.822
Tumor stage
Ib-IIa	27	26	0.056	0.813
IIb	13	14

Data are presented as mean ± SD or n (%). BMI: Body mass index.

Control group

Routine nursing interventions were followed for patients in the control group. Upon admission nursing staff introduced the attending physician and surgical team to the patient and informed and assisted them in completing preoperative examinations. Nursing staff explained the surgical procedure, responded to patient queries, and used one-on-one or organized discussions to collect and organize preoperative examination details. After establishing the surgical plan, the patient was informed of preoperative precautions and fasting times. Intraoperatively, the nursing staff guided the patient into the operating room for information verification, provided reassurance, and introduced them to the operating room conditions.

Postoperatively, the attending physician informed the patient of the surgical outcome. Based on the actual conditions, the nursing staff provided ostomy recovery information, demonstrated ostomy bag replacement methods, explained precautions to be followed during replacement, clarified replacement times, and created an ostomy care manual to help patients retain the information. The nurses promptly answered any questions or concerns the patient had and advised them to promptly seek medical attention if any abnormal symptoms were observed after discharge.

Experimental group

A team was established to guide health education using a problem management model combined with positive incentive nursing. Prior to study initiation, keywords such as problem management model, health education, positive incentive nursing model, and rectal cancer were searched in databases such as “VIP” and “CNKI” to evaluate and understand the key applications and specific implementation measures of the problem management-guided health education combined with positive incentive nursing in patients with rectal cancer.

Nursing staff guided patients to identify their health conditions, helped them establish preoperative health concepts, and provided them with a basic understanding of their condition, informing them of preliminary treatment and self-management measures. Nursing staff conducted educational sessions for problem identification, discussed basic rectal cancer knowledge with patients, guided them in identifying psychological issues, and imparted self-care skills for daily activities. They collated patient concerns, organized a second session, and provided more in-depth knowledge on ostomy monitoring, replacing ostomy bags independently, removing clips to release gas, and finally summarized the issues identified by the patients.

Subsequently, they conducted health lectures to facilitate communication and negotiation between patients, providing guidance and verbal encouragement to help patients regain confidence in treatment; however, they avoided excessive or arbitrary encouragement. The nursing staff paid attention to the environment, were sincere in their language, and prevented patients from feeling misguided.

Nursing staff informed family members of the need for increased care, communication, and companionship for patients, invited them to participate in patient health education sessions, and encouraged them to enhance their self-care knowledge along with the patients with rectal cancer.

Moreover, they organized regular communication and exchange among patients, invited patients from the same ward to share self-care experiences, and guided mutual encouragement among patients to create a positive recovery atmosphere. Prior to patient discharge a WeChat group was created to understand the patient’s status after discharge and to regularly share information on postoperative care (including diet and medication), particularly ostomy care knowledge, in the form of video demonstrations and graphic explanations. Patients were followed-up by phone or WeChat once a month.

Observational indicators

Both groups of patients received nursing care for a duration of 3 months. The exercise of self-care agency scale was used to evaluate the self-care abilities of patients in both the groups before and after the implementation of nursing care. The scale consisted of 43 items each scored from 0 to 4 with a total possible score of 172. A higher score indicated a stronger self-care ability, demonstrating a positive correlation between the score and the patient’s self-care capacity.

A hospital-specific questionnaire for rectal cancer knowledge was used to assess the patients’ understanding before and after nursing care in both patient groups, with a maximum score of 100. The questionnaire encompassed four aspects: Basic concepts; etiology and symptoms; diagnosis and treatment; and prognosis evaluation, with each section assigned a maximum of 25 points. A higher score indicated a greater understanding of rectal cancer-related knowledge. The reliability and validity of the questionnaire were ensured with an internal consistency reliability (Cronbach’s α) of 0.83 and a validity coefficient of 0.91.

The profile of mood states was used to assess patients’ mood states in both patient groups before and after nursing care, covering six dimensions. Higher scores indicated a more pronounced mood state in the corresponding dimension.

Complications, such as electrolyte disturbances, parastomal hernia, bleeding, and peristomal skin inflammation, were recorded in both patient groups.

Statistical analysis

SPSS 26.0 and GraphPad Prism 8.0 software were used for analysis, and P < 0.05 indicated statistical significance. Disease knowledge, mood state scores, and self-care ability were the measurement data. They were described by mean ± SD and analyzed as independent variables using the t-test. The complication rate was the count data, described by n (%), and assessed using the χ² test.

RESULTS

Comparison of self-care ability

Pre-intervention no significant differences in self-care ability scores were noted between the two groups (P > 0.05). The post-intervention self-care ability scores improved in both groups, with significantly higher scores in the experimental group than in the control group in terms of health knowledge, self-concept, self-care skills, and self-care responsibility (P < 0.05) as shown in Table 2.

Table 2 Self-care ability scores before and after intervention.

Group	Case	Health knowledge level (points)		Self-concept (points)		Self-care skills (points)		Self-care responsibility (points)
		Before	After	Before	After	Before	After	Before	After
Experimental group	40	46.25 ± 5.11	69.44 ± 3.28a	28.12 ± 2.85	45.67 ± 4.12a	17.24 ± 2.77	26.34 ± 2.85a	21.34 ± 2.27	28.66 ± 2.44a
Control group	40	46.37 ± 5.08	58.46 ± 5.02a	28.24 ± 2.77	38.74 ± 3.58a	17.34 ± 2.89	22.33 ± 2.74a	21.52 ± 2.34	24.24 ± 2.31a
t value		0.105	11.581	0.191	8.030	0.158	6.415	0.349	8.320
P value		0.916	< 0.001	0.849	< 0.001	0.875	< 0.001	0.728	< 0.001

^aP < 0.05. P calculated compared with the condition prior to care in this group. Data are presented as mean ± SD.

Comparison of disease knowledge mastery

Pre-intervention there were no significant differences in disease knowledge scores between the two groups (P > 0.05). Post-intervention disease knowledge scores increased in both groups, with significantly higher scores in the experimental group than in the control group (P < 0.05) as shown in Table 3.

Table 3 Disease knowledge scores before and after intervention.

Group	Case	Basic concept of rectal cancer (points)		Etiological symptoms (points)		Diagnosis and treatment (points)		Prognostic assessment (points)
		Before	After	Before	After	Before	After	Before	After
Experimental group	40	15.44 ± 1.24	20.89 ± 1.41a	17.48 ± 1.36	20.96 ± 1.17a	18.13 ± 1.32	22.89 ± 0.54a	17.33 ± 1.28	22.12 ± 1.24a
Control group	40	15.22 ± 1.31	18.23 ± 1.08a	17.74 ± 1.44	19.58 ± 1.20a	18.28 ± 1.34	21.34 ± 0.49a	17.42 ± 1.21	20.08 ± 1.11a
t value		0.771	9.472	0.830	5.208	0.504	13.444	0.323	7.753
P value		0.443	< 0.001	0.409	< 0.001	0.615	< 0.001	0.747	< 0.001

^aP < 0.05. P calculated compared with the condition prior to care in this group. Data are presented as mean ± SD.

Comparison of mood state scores

Pre-intervention no significant differences were observed in mood state scores between the two groups (P > 0.05). Post-intervention mood state scores showed significant improvements in both groups. In particular, the experimental group exhibited lower scores in negative dimensions (e.g., tension-anxiety, depression, anger-hostility, and fatigue) and a higher score in energy vitality than the control group (P < 0.05) as shown in Table 4.

Table 4 Mood state scores before and after intervention.

Items	Time	Experimental group (n = 40)	Control group (n = 40)	t value	P value
Nervous-anxiety	Before	21.04 ± 3.89	20.96 ± 3.94	0.091	0.927
	After	8.14 ± 1.82a	11.69 ± 1.95a	8.417	< 0.001
Depressed-dispirited	Before	40.25 ± 4.84	39.81 ± 4.96	0.402	0.689
	After	13.52 ± 2.47a	16.98 ± 2.58a	6.127	< 0.001
Anger-hostility	Before	19.02 ± 2.87	18.73 ± 3.01	0.441	0.660
	After	6.15 ± 1.52a	8.98 ± 1.67a	7.926	< 0.001
Tired-slow	Before	15.05 ± 2.08	14.92 ± 2.12	0.277	0.783
	After	5.24 ± 1.28a	7.18 ± 1.35a	6.595	< 0.001
Confusion-confusion	Before	16.38 ± 2.15	16.10 ± 2.25	0.569	0.571
	After	6.89 ± 1.30a	8.52 ± 1.49a	5.213	< 0.001
Energy-energy	Before	9.08 ± 3.14	8.89 ± 3.20	0.268	0.789
	After	17.52 ± 1.68a	13.24 ± 1.82a	10.929	< 0.001

^aP < 0.05. P calculated compared with the condition prior to care in this group. Data are presented as mean ± SD.

Comparison of complication rates

The experimental group had a significantly lower complication rate (7.5%) than the control group (27.5%) (P < 0.05) as shown in Table 5.

Table 5 Complication rates between groups.

Group	Case	Electrolyte disturbances	Parastomal hernia	Hemorrhage	Peristomal dermatitis	Incidence of complications
Experimental group	40	1 (2.50)	1 (2.50)	1 (2.50)	0 (0.00)	3 (7.50)
Control group	40	3 (7.50)	2 (5.00)	4 (10.00)	2 (5.00)	11 (27.50)
χ2 value						5.541
P value						0.019

Data are presented as n (%).

DISCUSSION

This study demonstrated that the combined nursing model of problem management-guided health education and positive incentive nursing significantly improved postoperative self-care ability, disease knowledge, and emotional well-being among patients who underwent rectal cancer surgery while reducing complication rates[6]. These findings highlighted the clinical significance of this approach and its potential for widespread use in clinical practice.

Effective postoperative self-care of an ostomy significantly influenced its adaptation and acceptance[7]. Patients with stronger self-care abilities can easily integrate into the society, achieve self-care of the ostomy, and have faster postoperative recovery and better outcomes. Understanding their disease condition, surgical treatment plans, and basic knowledge of ostomies during hospital treatment can enhance patients’ self-care abilities. However, the optimization of the nursing plan in clinical settings is essential to aid better self-care after discharge for patients with colorectal cancer ostomy. The nursing model, guided by problem management, emphasizes identifying, evaluating, and resolving patients’ challenges, thereby enhancing their abilities to encourage active behavioral changes. This problem-oriented management model can prevent patients from developing psychological and social barriers, thereby promoting proactive behavior[8]. Positive incentive nursing, as a psychological nursing measure, can reinforce patients’ understanding of colorectal cancer through various methods and play a positive role in alleviating their negative emotions[9].

The results of this study indicated that after the nursing intervention, the self-care abilities of both groups of patients improved to some extent, with the experimental group showing higher scores in health knowledge, self-concept, self-care skills, and self-care responsibility than the control group (P < 0.05). These findings suggests that in the nursing care of patients undergoing colorectal cancer surgery the problem management-guided health education nursing model can help identify and compile existing issues, providing targeted health education and guidance to address deficiencies in self-care abilities[10]. This study aimed to help patients improve their capabilities in postoperative ostomy care, diet, self-care, and other related areas[11]. Furthermore, the positive incentive nursing model through verbal encouragement from nursing staff helps patients build confidence in the treatment and recovery from colorectal cancer surgery, thereby increasing their commitment and compliance in enhancing self-care abilities and learning[12].

In this study, the scores of both groups increased in terms of knowledge of colorectal cancer after the nursing intervention with the experimental group scoring higher than the control group (P < 0.05). This result may be attributed to the nursing staff’s use of health education guided by problem management to summarize and collate the gaps in patients’ knowledge of colorectal cancer and create comprehensive materials on colorectal cancer surgery and disease knowledge[13,14]. They used various techniques to explain and simplify this information to patients with the aim of improving their understanding of treatment and prognosis. Positive incentive nursing plays a significant role in this process by fostering a positive and proactive attitude towards treatment that greatly improves the emotional wellbeing of patients undergoing colorectal cancer surgery[15]. This observation was consistent with the findings of this study; after nursing intervention, the experimental group had higher energy vitality scores than the control group, whereas other dimension scores were lower (P < 0.05).

The incidence of complications was lower in the experimental group than in the control group (P < 0.05). The analysis indicated that conventional nursing models lack health education content for patients. The use of problem management in health education through educational sessions helps patients recognize their condition and deficiencies in disease knowledge[16]. Self-care abilities of the patients can be enhanced by understanding postoperative ostomy care and self-care, which actively reduces the rate of complications. In addition, follow-up provided by the nursing staff after discharge fosters a positive attitude towards daily activities and emphasizes the importance of postoperative care and ostomy changes, significantly influencing the control of postoperative complications[17-19].

The novelty of this study lies in the integration of problem management and positive incentive nursing into a cohesive model tailored to patients undergoing rectal cancer surgery[18]. Although previous studies have explored these interventions separately, few have examined their combined effects on self-care abilities, disease knowledge, emotional well-being, and complication rates. Our findings contributed to the existing literature by providing robust evidence for the effectiveness of this combined approach and offering a practical framework for clinical implementation.

In conclusion, the combined nursing model of problem management-guided health education and positive incentive nursing represents a significant advancement in postoperative care for patients with rectal cancer[19,20]. By addressing the limitations of conventional practices and demonstrating evident clinical benefits, this model has the potential to improve patient outcomes, reduce healthcare costs, and enhance overall quality of life. Future research should explore the long-term effects and applicability to other patient populations.

CONCLUSION

The application of problem management-guided health education combined with positive incentive nursing in patients undergoing colorectal cancer surgery significantly enhanced their self-care abilities and understanding of colorectal cancer. Furthermore, it improved the patients’ mood states and to a certain extent controlled the incidence of complications.