Effect of Intensive Psychological Nursing Intervention on HAMD and SF-36 Scores in Patients with Severe Liver Cancer in ICU.

The aim of the study was to explore the effect of intensive psychological nursing intervention on HAMD and SF-36 scores in patients with severe liver cancer in intensive care unit (ICU). 134 critically ill patients with liver cancer in ICU who underwent resection of primary liver cancer from July 2019 to November 2021 were selected. The patients were randomly divided into control group and study group. The patients in the control group received routine nursing. The patients in the study group received intensive psychological nursing intervention on the basis of routine nursing. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the MOS 36-item short-form health survey (SF-36) scores before and after nursing were compared between the two groups. The satisfaction of the two groups of patients with nursing was counted. The HAMA, HAMD, and SF-36 scores of patients receiving intensive psychological nursing intervention were significantly better than those receiving routine nursing. The nursing satisfaction of patients receiving intensive psychological nursing intervention was significantly higher than that of patients receiving routine nursing. Intensive psychological nursing intervention for patients with severe liver cancer in ICU can significantly reduce HAMD, improve SF-36 score, and patient nursing satisfaction. It is worthy of wide clinical promotion.

1. Introduction

Liver cancer is one of the common malignant tumors in clinic, which has the characteristics of rapid onset and high mortality [1]. Hepatectomy is the main treatment for patients with liver cancer [2]. Because patients with liver cancer are often accompanied by varying degrees of cirrhosis and liver dysfunction, patients undergoing hepatectomy for liver cancer occur or die after operation. Compared with the general surgical ward, the intensive care unit (ICU) has better medical equipment and strict monitoring measures, which plays an important role in the postoperative recovery of large-scale surgical patients [3, 4]. Therefore, it is not uncommon for patients undergoing liver cancer resection to be directly sent to ICU for transitional observation and treatment. ICU treatment needs to be isolated from relatives. In addition, the recurrent disease has many complications. With the emergence of abdominal pain, vomiting, and other symptoms, it is easy to bring more negative effects on the physical and mental health of patients, which will affect the treatment effect of patients to a certain extent. Therefore, it is very important to give patients active and effective psychological intervention [5-7]. Through routine nursing and intensive psychological nursing intervention, this study aims to explore the effects of intensive psychological nursing intervention on Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the MOS 36-item short-form health survey (SF-36) on the scores of depression.

2. Materials and Methods

2.1. Patients

134 critically ill patients with liver cancer in ICU who underwent resection of primary liver cancer from July 2019 to November 2021 were selected. All patients were diagnosed as primary liver cancer by pathological diagnosis and artificial intelligence imaging diagnosis. The trial flowchart process is presented in Figure 1. The patients were randomly divided into two groups with 67 cases in each group. There were 35 males and 32 females in the control group. The average age was (58.46 ± 7.68) years. The tumor diameter was 2.61–7.94 cm, with an average of (4.82 ± 0.74) cm. There were 30 males and 37 females in the study group. The average age was (59.60 ± 8.26) years. The tumor diameter was 2.48–8.07 cm, with an average of (4.61 ± 0.82) cm. There was no significant difference in the baseline data between the two groups. This study was approved by the medical ethics committee of our college.

Figure 1

The trial flowchart.

2.2. Inclusion Criteria

The inclusion criteria are as follows: the patients were diagnosed as primary liver cancer by clinical diagnosis. All patients underwent laparoscopic liver cancer resection. All patients met the admission conditions of intensive care unit. All patients were awake. The patient agreed to the study and signed the informed consent form.

2.3. Exclusion Criteria

The exclusion criteria are as follows: patients with malignant tumors other than liver cancer, patients with severe organ failure, patients with mental disorders and consciousness disorders, and patients who withdrew from the study group due to various factors.

2.4. Nursing Methods

The patients in the control group received routine nursing. Routine nursing methods include maintaining appropriate temperature and humidity in ICU, disinfecting ICU every day, trying to control personnel flow in ICU, communicating with patients, implementing dietary guidance, strengthening health education, and pain nursing. Medical staff and visitors must wear sterile protective clothing before entering the ICU.

The study group received intensive psychological nursing intervention on the basis of the patients in the control group. The strengthening of psychological nursing includes as follows: at first, the patient is accompanied by a specially assigned person. Special personnel shall be arranged to accompany them for conscious patients in ICU. Caregivers should master nursing skills and psychological nursing skills. It fully embodies the patient-centered service concept, with a kind attitude, sincere service, full respect for patients, and care for patients all day as much as possible. The professionalism of caregivers plays an important role in enhancing patients' confidence. The second is to strengthen communication with patients. The nursing staff communicated with the patient's family comprehensively to understand the patient's condition, family, work, and children. At the same time, strengthening communication with patients, establishing a good nurse-patient relationship and win the trust of patients. When the patient is awake, the nursing staff should communicate in time and establish a good nurse-patient relationship, encourage patients to express bad emotions caused by diseases, patiently listen to patients' demands, and express understanding and sympathy to patients. Also, the nursing staff should help patients improve their cognition of disease, treatment and nursing, explain the importance of ICU nursing methods and facilities to alleviate their pain, and obtain the cooperation of patients. During the period of providing nursing services for patients, when communicating with them, they should pay attention to listening to their inner demands and confusion, and encourage patients to talk completely with the help of body language. When talking, they should try to avoid making noise to avoid interruption, give patients full respect, and take care of their daily life during hospitalization. For the problems raised by patients, nurses should explain them in easy to understand language as much as possible to reduce patients' confusion. At the same time, the patients were given psychological nursing and psychological counseling. Because the patient's mind is clear, it increases the psychological pressure of tension, anxiety, and fear of various monitoring equipment. In particular, the warning sound of monitoring equipment will make patients panic. At this time, nurses can communicate with patients, introduce their condition, explain the use method and function of ICU equipment, and inform them of the necessity and temporariness of entering ICU for treatment, so as to eliminate patients' tension and anxiety and increase their confidence in actively cooperating with treatment. In the process of communication with patients, they should not ignore the patients, should not show any impatient and perfunctory behavior, and always keep smiling, soft voice, and gentle goodwill. For patients who cannot speak, they can communicate with patients through body language and other means. Nurses should often use positive language to enhance patients' treatment confidence. If you can tell the patient that your condition today is much better than that of the previous few days, or you are so brave that you can insist on such pain so as to strengthen the patient's treatment confidence and promote the patient to better cooperate with clinical treatment. The condition of patients in ICU is generally serious, and the treatment cost is high. Patients are prone to anxiety and other adverse emotions. Nurses should pay attention to creating a relaxed atmosphere and transmitting positive emotions in nursing. According to the psychological status and personality characteristics of patients, individualized psychological counseling measures should be formulated to alleviate bad emotions. Graded nursing can be implemented according to the specific situation of patients. Patients with mild negative emotions often communicate in a humorous way and use soothing music to alleviate their attention. For patients with serious negative emotions, nurses can consult professionals and provide professional psychological counseling to relieve their negative emotions. If the patient does not cooperate with the treatment or gives up the treatment, the nursing staff should comfort and encourage the patient in time, effectively guide the patient and improve their treatment compliance. Finally, they should arouse the family members' enthusiasm. Nurses can communicate with patients' family members and encourage them to participate in psychological nursing. The ICU ward has only half an hour of visits a day. The nursing staff can relax appropriately according to the patient's mental state, especially when the patient feels lonely, low self-esteem, and irritable. At this time, the comfort of the nursing staff cannot achieve good results. Patients need family care, support, and understanding to reduce anxiety and enhance confidence. The nursing staff should explain to the patient's family members that the patient was conscious, explain the importance of ICU treatment and nursing to the patient's rehabilitation, and win the recognition and cooperation of the patient's family members so that the patient could receive care from the family. Nurses should strengthen communication with patients' family members to help them more deeply and accurately understand the important impact of family care on patients' condition recovery and promote family members to care and be considerate to patients in all aspects of spirit and life.

2.5. Observation Index

Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the changes of anxiety and depression before and after nursing intervention. 29 points indicate severe anxiety and depression, 21∼29 points indicate obvious anxiety and depression symptoms, 14∼21 points indicate anxiety and depression, 7∼14 points indicate that anxiety and depression may exist but are not serious, and <7 points indicate good living conditions [8]. SF-36 was used to evaluate the changes of patients' quality of life before and after nursing intervention, including five dimensions of social function, physical function, emotional function, physiological function, and vitality. Each dimension is a percentage system. The higher the score, the better the patients' quality of life [9]. At the same time, the nursing satisfaction of the two groups was counted.

2.6. Statistical Analysis

The data were statistically analyzed by SPSS 25.0. The measurement data were expressed as mean ± variance. The two groups were compared by t-test. The counting data were expressed in n (%). The chi-square test was used for the comparison between the two groups. P < 0.05 means the difference is statistically significant.

3. Results

3.1. Comparison of HAMA and HAMD Scores before and after Intervention

The results showed that there was no significant difference in HAMA and HAMD scores between the two groups before and after the intervention. After the intervention, the HAMA and HAMD scores of patients in the study group were significantly lower than those in the control group (see Table 1). The above results show that intensive psychological nursing intervention can significantly improve the depression and anxiety of patients with severe liver cancer in ICU.

Table 1

Comparison of HAMA and HAMD scores before and after intervention.

	n	HAMA		HAMD
		Before intervention	After intervention	Before intervention	After intervention
Control group	67	26.98 ± 1.09	16.44 ± 1.15	25.13 ± 1.29	17.22 ± 1.05
Observation group	67	27.06 ± 1.53	10.83 ± 0.98	25.79 ± 1.08	11.34 ± 1.18
t		0.349	30.390	3.211	30.470
P		0.728	0.000	0.002	0.000

3.2. Comparison of SF-36 Scores before and after Intervention

Before nursing intervention, there was no significant difference between the two groups in the contents of SF-36 scale. After nursing intervention, the scores of social function, physical function, emotional function, physiological function, and vitality of patients in the study group were significantly higher than those in the control group (see Table 2). The above results show that intensive psychological nursing intervention can significantly improve the quality of life of patients.

Table 2

Comparison of SF-36 scores between the two groups before and after intervention.

		Social function	Somatic function	Emotional function	Physiological function	Vitality
Before nursing	Control group	52.64 ± 6.13	60.12 ± 5.86	54.79 ± 5.68	50.67 ± 5.23	60.49 ± 6.08
	Observation group	53.74 ± 5.91	58.96 ± 5.22	56.13 ± 5.46	52.14 ± 5.08	59.17 ± 5.14
	t	1.057	1.210	1.392	1.650	1.357
	P value	0.292	0.229	0.166	0.101	0.177
After nursing	Control group	64.38 ± 6.59	68.94 ± 6.73	69.42 ± 6.79	70.65 ± 6.38	68.19 ± 6.53
	Observation group	74.16 ± 6.85	76.99 ± 7.03	77.26 ± 6.48	78.01 ± 6.94	75.82 ± 7.08
	t	8.422	6.771	6.837	6.391	6.484
	P value	0.000	0.000	0.000	0.000	0.000

3.3. Comparison of Nursing Satisfaction between the Two Groups

The nursing satisfaction of the two groups was counted. After the intervention, the nursing satisfaction of patients in the study group was significantly higher than that of patients in the control group (see Table 3). This shows that intensive psychological nursing intervention can significantly improve the nursing satisfaction of patients with severe liver cancer in ICU.

Table 3

Comparison of nursing satisfaction between the two groups.

	n	Very satisfied	Satisfied	Dissatisfied
Control group	67	10 (14.93)	31 (46.27)	26 (38.81)
Observation group	67	20 (29.85)	34 (50.75)	13 (19.40)
X 2			7.805
P value			0.020

4. Discussion

After critically ill patients enter the ICU ward, there are a large number of instruments and equipment. At the same time, medical staff will continuously implement some complex operations, which will exert certain pressure on the psychology of patients. In the ICU, in order to facilitate the observation and treatment of the disease, the light is usually kept on and very quiet. In this environment, patients are prone to anxiety [10-12]. The ICU ward does not allow family visits, which will make it very lonely. There are many kinds of monitoring instruments in ICU ward. Patients are in bed to avoid catheter falling off. Due to limited activity, patients are very likely to develop depression [13]. Most patients do not know much about their condition and treatment and often feel uneasy and anxious. Introverted patients will have anxiety and depression, reduced treatment confidence, and will not actively cooperate with treatment and nursing [14]. At this time, providing effective psychological nursing for patients in ICU is of great significance to improve their psychological status. Effective nursing programs can shorten the length of stay of patients in ICU, but due to the limitations of working system, doctors and pharmacists cannot control and adjust patients' drugs all day [15]. At this time, nurses should provide scientific psychological nursing for them. After effective evaluation of the actual situation of patients and reasonable adjustment of drug dose and dropping speed, nursing monitoring and drug regulation can be realized at the same time so as to enhance the effect of clinical psychological nursing, prevent deficiencies in nursing practice, and speed up the rehabilitation of patients [16]. In practice, the state of patients can be scientifically evaluated, and the drug dropping rate can be adjusted according to the scientific evaluation results so as to reduce the adverse reactions caused by drug accumulation and ensure the treatment effect.

Patients in ICU are suffering from disease and treatment, and life danger may appear at any time, which is prone to anxiety and depression, which has an adverse impact on patients' treatment. As the main practitioner of psychological nursing for patients in ICU, nurses play an important role in regulating their psychological status and alleviating their pain [17, 18]. Therefore, nurses should pay attention to caring and comforting patients in nursing operation and should not ignore the psychological nursing of patients due to the large nursing workload so as to give patients more attention, build a harmonious nurse-patient relationship with patients, promote them to better accept the disease, and establish the confidence to overcome the disease. At the same time, hospitals should increase the training of nurses' mental health knowledge [19]. Through lectures, meetings, and other forms to promote nurses to have a better understanding of psychological support, provide corresponding intervention measures for patients, have a positive impact on patients' mental health, and take effective ways to guide nurses to take effective and reasonable measures to provide psychological support. Effective psychological nursing services can have a positive impact on the prognosis of patients [20, 21]. Therefore, nurses should maintain a positive working attitude in nursing work, and a good working face should drive the mood of patients. They should encourage patients to build a good relationship with patients in the same ward and obtain corresponding social support to eliminate the loneliness during hospitalization. Scientific psychological nursing has an obvious effect on reducing the intubation time of patients in ICU so as to shorten the hospitalization time and improve the prognosis of patients [22]. During the development of nursing work, nurses should pay attention to the observation of patients, maintain a serious and responsible attitude, actively understand patients' symptoms, personality, and living habits, reflect the patient-centered nursing concept, and create a good environment for patients. Through different methods such as counseling and consolation, we can alleviate the tension of patients, help patients eliminate psychological obstacles, and cooperate with clinical treatment in a good state [23, 24]. At the same time, patients need the care, support, and understanding of their families to reduce anxiety and enhance confidence. The nursing staff should explain to the patient's family members that the patient was conscious, explain the importance of ICU treatment and nursing to the patient's rehabilitation, and win the recognition and cooperation of the patient's family members so that the patient could receive care from the family [25]. Nurses should strengthen communication with patients' family members to help them more deeply and accurately understand the important impact of family care on patients' condition recovery, and promote family members to care and be considerate to patients in all aspects of spirit and life.

The results of this study show that patients with severe liver cancer receiving intensive psychological nursing intervention have significantly improved their satisfaction with nursing, significantly improved HAMA and HAMD scores, and significantly increased SF-36 scores. The above results show that intensive psychological nursing intervention has a very significant psychological regulation effect on patients with severe liver cancer in ICU and can significantly improve the quality of life and nursing satisfaction of patients. The intensive intervention mode of psychological nursing is patient-centered, which integrates patients, their families, and medical staff into disease treatment and nursing, which can reflect the pertinence, personalization and integrity of psychological nursing intervention, help patients master disease knowledge, improve negative emotions, improve physical and psychological comfort, correct bad health behaviors, and improve nursing effect. It helps to improve the quality of life of patients and has significant advantages compared with routine nursing intervention.

In conclusion, the application of intensive psychological nursing intervention in the treatment of patients with severe pancreatitis in ICU will help to regulate the abnormal mood of patients, facilitate the prognosis of the disease, and play a positive role in improving the quality of life of patients, which is worthy of promotion. However, this study only explores the impact of intensive psychological nursing intervention on anxiety and depression in patients with severe liver cancer and has not explored the impact on the treatment and recovery of patients.