Humanistic nursing combined with Neuman’s nursing in the application for oncology patients

Abstract

Objective:

We aimed to explore the application effects of humanistic nursing combined with Neuman’s nursing in oncology patients.

Methods:

One hundred oncology patients were randomly divided into the observation and control groups, with 50 patients in each. Comparisons were made between both groups in terms of SF-36 scores, treatment compliance, nursing quality scores, Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores, and Pittsburgh Sleep Quality Index (PSQI) scores.

Results:

The observation group showed higher scores in the physical domain, physiological function, material life, and overall health of the SF-36 scale (P < 0.05). The observation group also exhibited higher treatment compliance rate (X² = 9.470), and higher scores in nurse-patient communication, nursing system, nursing service, and nursing environment of the nursing quality assessment (P < 0.05). After nursing, the observation group performed lower SAS and SDS scores (t = 17.556, 10.004), and higher scores in sleep quality, sleep duration, sleep disturbance, sleep onset latency, sleep efficiency, hypnotic medication use, and daytime dysfunction based on the PSQI (P < 0.05).

Conclusion:

The combination of humanistic nursing and Neuman’s nursing improves the quality of life and treatment compliance in oncology patients, with improvements in negative emotions and sleep quality. However, this study’s small sample of 100 cancer patients may not fully represent the diverse characteristics of various cancer types and stages, limiting conclusion generalizability. Furthermore, the short duration may have missed later-stage nursing intervention impacts. Thus, large-scale, long-term research is needed to provide reliable clinical evidence.

Keywords

Humanistic nursing Neuman’s nursing oncology patients nursing quality treatment compliance negative emotions

Introduction

In 2020, approximately 19.3 million new cancer diagnoses were recorded globally, and forecasts anticipate a rise to 28.4 million by 2040.¹ As the population continues to age and grow, the healthcare system is facing an escalating burden due to cancer.² Among patients with advanced cancer, pain can arise from the tumor’s burden or its invasion of bones, muscles, or nerves, which may also negatively impact patients’ quality of life and daily functions.³ Worse still, the diagnosis and treatment of cancer are frequently accompanied by depression and anxiety.⁴ Under these circumstances, the approach to cancer care is of great importance, one that is evolving from disease-centric management to a patient-oriented, customized strategy. A key aspect of high-quality cancer care involves multidisciplinary management that entails developing personalized, optimal treatment plans through collaborative decision-making between healthcare providers and patients.⁵

The nursing profession fundamentally values human beings, reflecting the very essence of care. Consequently, integrating humanism into care practices is not only a fundamental requirement but also a globally recognized priority for enhancing the quality of nursing care delivered^6,7 and serving as a crucial factor in patient satisfaction.⁸ Among the various nursing models, humanistic nursing and Neuman’s nursing model each have their unique characteristics and demonstrate promising application prospects. Humanistic nursing involves interaction between nurses and patients/families, responding to nursing situations, characterized by patient autonomy, empathy, respect for human dignity, and holistic care. Compared to conventional nursing, humanistic nursing shifts from a task-oriented model to a person-centered or relationship-centered model.⁹ It has been reported that humanistic nursing based on the Carolina Care Model can promote recovery in ovarian cancer patients, reduce psychosocial stress responses, and effectively improve quality of life.¹⁰ However, there is no fixed method or process for providing humanistic nursing in clinical settings, as humanistic nursing approaches and behaviors are highly context-specific and should be embedded within a holistic and person-centered perspective, integrating the humanistic spirit into daily practice.⁹

From a holistic perspective, Neuman’s nursing model underscores that the human body is a multifaceted system encompassing psychological, physiological, and spiritual dimensions, all of which can interplay with external stressors. It posits that health is a dynamic and fluid state of balance between an individual and their environment. When this balance is disrupted, defense mechanisms may be compromised, leading to the manifestation of illness.¹¹ It has been reported that by applying the tertiary prevention strategies combined with Neuman’s nursing, patients can excel in managing these stressors and maintaining a balanced state.^12-14 Furthermore, adopting the Neuman’s nursing model for perioperative care of cancer patients can reduce the incidence of psychological and physiological stress, improving nursing quality and patient satisfaction with care.¹⁵

In light of the evolving approach to cancer care, which is shifting from a disease-centric management to a patient-oriented, customized strategy, it is imperative to address the multifaceted needs of oncology patients. By focusing not only on physiological treatments but also on the psychological and spiritual aspects of care, a holistic approach can be achieved. Therefore, the present study aims to investigate the effectiveness of combining humanistic nursing with Neuman’s nursing model on cancer patients. Based on the above, this study proposes a hypothesis: integrating humanistic nursing with the Neuman’s nursing model can significantly enhance the quality of nursing care for cancer patients, further improving their quality of life and psychological state.

Materials and methods

Ethics statement

Ethical approval for the study was granted by the ethics committee of Xinchang County People’s Hospital, and informed consent was obtained from all participants.

Study participants

One hundred oncology patients admitted from August 2022 to August 2023 were included as study participants. Inclusion criteria: All patients met the clinical diagnostic criteria for malignant tumors and were confirmed by pathological testing; patients had a survival time greater than six months; complete clinical treatment was received. Exclusion criteria: Patients with communication disorders, cognitive impairments, missing data during the study, survival time less than six months, or death during the study. The selected patients were randomly divided into an observation group and a control group. The observation group included 50 patients, with 27 males and 23 females, aged 49 to 74 years (mean: 60.38 ± 6.47 years). Disease types included 19 cases of liver cancer, 14 cases of colon cancer, nine cases of rectal cancer, and eight cases of cervical cancer. The control group included 50 patients, with 30 males and 20 females, aged 48 to 72 years (mean: 59.46 ± 6.32 years). Disease types included 19 cases of liver cancer, 16 cases of colon cancer, 10 cases of rectal cancer, and five cases of cervical cancer. There were no statistical differences in baseline characteristics between the two groups (P > 0.05), making the study results comparable.

Nursing methods

The control group received routine nursing measures, including: strict monitoring of vital signs during hospitalization, head elevation for bedridden patients to ensure smooth breathing; pain management based on the intensity of patient pain, using pharmacological and physical methods for analgesia; supervision of patient diet strictly according to medical advice, with timely reporting of nausea and vomiting; regular turning of bedridden patients by nursing staff to ensure skin cleanliness and dryness, preventing bedsores, pulmonary infections, etc., due to prolonged bed rest.

The observation group received humanistic nursing combined with Neuman’s nursing. Specific operations for humanistic nursing included: Before treatment, nursing staff conducted in-depth communication with patients’ families, explaining the surgical process, postoperative nursing points, and rehabilitation goals in detail, helping families grasp relevant nursing knowledge so they could better meet patients’ needs, making patients feel supported and accompanied by their families, thereby enhancing their confidence in overcoming the disease; during hospitalization, nursing staff always respected patients’ personal wishes, patiently listened to their fears, anxieties, and other emotions, and conducted detailed communication according to patients’ demands, conveying warmth and care to help patients establish a positive mindset. For example, for patients worried about postoperative pain, nursing staff explained the analgesia plan in detail to reduce their psychological burden, while providing verbal comfort and physical touch (such as patting on the shoulder, handshake, etc.) to alleviate patients’ tension and enhance their sense of security; for elderly patients with severe pain, nursing staff developed individualized pain nursing plans based on their personal conditions, using multimodal analgesia methods (such as local anesthesia, nerve block, etc.) to reduce the use of opioid drugs and decrease the risk of side effects, while combining psychological counseling to help patients establish confidence and actively cooperate with treatment; during treatment, nursing staff maintained close communication with patients, dynamically understanding their physical changes and psychological states, explaining treatment progress in a timely manner and possible reactions, helping patients understand the difficulties and challenges of treatment, reducing their fear, and enhancing their willingness to cooperate with treatment through emotional support and encouragement. For example, for patients experiencing discomfort or low mood during treatment, nursing staff provided verbal encouragement and emotional support to help them establish confidence and enhance their enthusiasm for treatment and rehabilitation; in addition, nursing staff created a warm hospital environment for patients, reducing external distractions to help them rest and recover better, while encouraging families to spend more time with patients to create a home-like hospital atmosphere, making patients feel the warmth of home. Through pre-treatment communication, individualized care during hospitalization, pain management for elderly patients, emotional support during treatment, and the creation of a warm environment, patients received emotional comfort, understood the difficulties and challenges of treatment, reduced their fear, and increased their willingness to cooperate with treatment.

Specific operations for Neuman’s nursing included: Upon admission, nursing staff conducted a comprehensive assessment of patients, including health status, social support, and environment, formulating individualized nursing plans based on patients’ overall condition and family support, determining the nursing goals and specific implementation process; guiding patients to follow a reasonable diet plan according to medical advice, introducing the treatment process to reduce patients’ fear of malignant tumors; creating a comfortable hospital environment, collaborating interdisciplinary with other members of the hospital, conducting health education for patients’ families, sharing success stories with patients to help them better manage themselves and cultivate positive thinking; follow-up after discharge was conducted through bi-weekly telephone communication for three months, during which patients’ conditions were monitored, complications were checked, additional health education was provided, and patients’ questions were addressed.

Observation indicators

Patient quality of life scores after nursing were recorded using the Short Form 36 Health Survey (SF-36).¹⁶ The SF-36 includes four domains: physical domain, physiological function, material life, and overall health, with a maximum score of 100 for each domain. Higher scores indicate a better quality of life. The Cronbach’s α coefficient was 0.79.

Treatment compliance was evaluated during the nursing period using a self-made compliance questionnaire, which was divided into three levels: compliance, partial compliance, and non-compliance. The total score was 10 points, with 8-10 points considered compliance, 4-7 points partially compliance, and 0-3 points non-compliance. Compliance was calculated as [(compliance + partial compliance)/total number of cases] × 100%.

Nursing quality was evaluated using a self-made nursing quality survey questionnaire developed by our hospital, which includes nurse-patient communication, nursing system, nursing service, and nursing environment. Each domain has a maximum score of 100, rated by patients based on the nursing effects. Higher scores indicate higher nursing quality.

Scores from the Self-Rating Anxiety Scale (SAS)¹⁷ and the Self-Rating Depression Scale (SDS)¹⁸ were recorded before and after nursing. The SAS consists of 20 questions with a 4-point scoring system; higher scores indicate more severe anxiety. The SDS also consists of 20 questions with a 4-point scoring system; higher scores indicate more severe depression. The Cronbach’s α coefficient for the SAS score was 0.82, and for the SDS score, it was 0.84.

Patient sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI)¹⁹ scale, which includes seven components: sleep quality, sleep duration, sleep disturbance, sleep onset latency, sleep efficiency, hypnotic medication use, and daytime dysfunction. Each component was converted to a score out of 100; higher scores indicate better sleep quality. The Cronbach’s α coefficient was 0.73.

Statistical analysis

The data were analyzed using SPSS 23.2 statistical software and GraphPad Prism 10.0. Normally distributed measurement data were presented as mean ± standard deviation (x ± s), with independent-sample t-tests for intergroup comparisons and paired-sample t-tests for pre- and post-nursing comparisons. Categorical data were presented as percentages (%), with χ² tests for intergroup comparisons. A P-value < 0.05 was considered statistically significant.

Results

Quality of life

The SF-36 scores of the observation group in the physical domain, physiological function, material life, and overall health were significantly higher than those of the control group (t = 7.311, 9.679, 9.165, 8.034, respectively; Cohen’s d = 1.554, 1.934, 1.832, 1.607; P < 0.05; Table 1; Figure 1).

Table 1.

Comparison of SF-36 scores between the two groups.

Group	n	Physical domain	Physiological function	Material life	Overall health
Observation group	50	88.66 ± 7.21	88.32 ± 6.76	89.66 ± 5.75	89.50 ± 6.30
Control group	50	78.58 ± 6.57	76.32 ± 5.59	77.66 ± 7.26	79.06 ± 6.69
t		7.311	9.679	9.165	8.034
P		< 0.001	< 0.001	< 0.001	< 0.001
Cohen’s d		1.554	1.934	1.832	1.607

Treatment compliance

The treatment compliance rate in the observation group was 98%, remarkably higher than the 78% in the control group (X² = 9.470, P < 0.05; Table 2).

Table 2.

Comparison of treatment compliance between the two groups.

Group	n	Compliance	Partial compliance	Non-compliance	Compliance rate
Observation group	50	36 (72.00)	13 (26.00)	1 (2.00)	49 (98.00)
Control group	50	28 (56.00)	11 (22.00)	11 (22.00)	39 (78.00)
X²					9.470
P					0.002

Nursing quality

The observation group showed markedly higher scores than the control group in nurse-patient communication, nursing system, nursing service, and nursing environment (t = 11.680, 13.680, 14.949, 24.772, respectively; Cohen’s d = 2.336, 2.735, 2.988, 4.957; P < 0.05); Table 3; Figure 2).

Table 3.

Comparison of nursing quality between two groups.

Group	n	Nurse-patient communication	Nursing system	Nursing service	Nursing environment
Observation group	50	90.48 ± 5.95	94.42 ± 3.41	94.72 ± 4.26	95.42 ± 2.85
Control group	50	74.96 ± 7.27	80.60 ± 6.28	79.24 ± 5.96	74.48 ± 5.25
t		11.680	13.680	14.949	24.772
P		< 0.001	< 0.001	< 0.001	< 0.001
Cohen’s d		2.336	2.735	2.988	4.957

Negative emotion

Prior to nursing intervention, no significant difference was observed in the SAS and SDS scores between the observation and control groups (P > 0.05). Following the nursing intervention, both groups exhibited decreased SAS and SDS scores compared to their pre-intervention levels (P < 0.05). Notably, the observation group demonstrated notably lower SAS and SDS scores than the control group (t = 17.556, 10.004; Cohen’s d = 3.511, 2.001; P < 0.05; Table 4; Figure 3).

Table 4.

Comparison of SAS scale and SDS scale scores between the two groups.

Group	n	SAS		SDS
Group	n	Pre-care	Post-care	Pre-care	Post-care
Observation group	50	71.66 ± 5.63	34.34 ± 3.85*	69.58 ± 5.88	36.82 ± 4.01*
Control group	50	70.76 ± 4.75	48.00 ± 3.93*	70.02 ± 4.83	46.96 ± 5.94*
t		0.864	17.556	0.409	10.004
P		0.390	< 0.001	0.684	< 0.001
Cohen’s d		0.173	3.511	0.082	2.001

Note: Compared with the same group before the care, *P < 0.05.

Patient sleep conditions

The observation group exhibited significantly superior scores compared to the control group in terms of sleep quality, sleep duration, sleep disturbance, sleep onset latency, sleep efficiency, hypnotic medication use, and daytime dysfunction (t = 10.842, 21.209, 12.857, 13.518, 16.719, 21.793, 14.312, respectively; Cohen’s d = 2.167, 4.237, 2.574, 2.704, 3.341, 4.363, 2.861; P < 0.05; Table 5; Figure 4).

Table 5.

Comparison of sleep conditions between the two groups.

Group	n	Sleep quality	Sleep duration	Sleep disturbance	Sleep onset latency	Sleep efficiency	Hypnotic medication use	Daytime dysfunction
Observation group	50	75.96± 5.13	78.76± 3.61	74.02± 3.87	74.60± 4.18	77.90± 3.47	78.26± 3.96	73.10± 2.40
Control group	50	66.68± 3.22	65.50± 2.56	64.88± 3.20	64.32± 3.38	66.24± 3.51	63.86± 2.47	63.68 ± 3.99
t		10.842	21.209	12.857	13.518	16.719	21.793	14.312
P		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
Cohen’s d		2.167	4.237	2.574	2.704	3.341	4.363	2.861

Discussion

The results of the study highlight the significance of integrating humanistic nursing with Neuman’s nursing in the care of oncology patients. This comprehensive approach addresses not only the physiological aspects of treatment but also the psychological and spiritual needs of patients, reflecting the evolution of cancer care from a disease-centric to a patient-oriented, customized strategy.

Previous studies have shown that humanistic nursing, characterized by in-depth communication with patients and their families, providing emotional support, and developing personalized pain management plans, has a positive impact on the quality of life of cancer patients.¹⁰ Additionally, the application of Neuman’s nursing model in the perioperative period for cancer patients can improve their quality of life and satisfaction with care.¹⁵ The results of this study further support the viewpoint that humanistic nursing, when combined with Neuman’s nursing model, could enhance patients’ overall quality of life by providing support for their mental health, emotional well-being, daily living activities, and social functioning. In the study, these nursing interventions also alleviated patients’ anxiety and tension, enhancing their sense of security and overall well-being. As revealed in a study, humanistic nursing based on the Carolina Care Model can promote recovery in ovarian cancer patients, reduce psychosocial stress responses, and effectively improve quality of life.¹⁰ Neuman’s nursing model, which assesses patients’ health status, social support, and environment to formulate individualized nursing plans, further contributes to improving patients’ quality of life by markedly diminishing their psychological and physiological strain, thus decreasing complications.¹⁵

In addition to its benefits on quality of life, humanistic nursing combined with Neuman’s model also appeared to enhance treatment compliance among oncology patients, which is in line with the research that reveals nursing practices rooted in the concept of humanistic care can successfully diminish participants’ negative emotions, augment their levels of hope and treatment efficacy, optimize their health status and adherence to treatment protocols, and decrease the incidence of complications.²⁰ This may be attributed to the increased trust and rapport between patients and nursing staff, which was facilitated by humanistic nursing interventions. When patients feel supported and understood, they are more likely to adhere to their treatment plans, leading to better outcomes.

The study also found that this combined nursing approach was effective in managing negative emotions and sleep quality among oncology patients. Previous studies also demonstrate that Neuman’s nursing model helped alleviate patients’ negative emotions throughout various stages of the perioperative period.¹⁵ In the study, the use of non-pharmacological interventions, such as patting on the shoulder, handshake, and verbal encouragement, likely played a role in reducing patients’ stress and anxiety, thereby improving their sleep quality. Moreover, the individualized pain nursing plans developed for elderly patients with severe pain likely contributed to reducing their reliance on opioid medications, which can have adverse effects on sleep.

Conclusion

In conclusion, the integration of humanistic nursing with Neuman’s nursing represents a promising approach to improving the quality of life, treatment compliance, and managing negative emotions and sleep quality among oncology patients. This comprehensive care model addresses the multifaceted needs of patients, reflecting the evolving approach to cancer care that is increasingly patient-oriented and customized. Future research should continue to explore the benefits of this combined nursing approach and its potential to further enhance the nursing of oncology patients.

However, this study has some limitations. The sample size is limited and not strictly calculated, affecting result stability. Selection bias may exist, as the sample may not represent all cancer patients. The lack of blinding may bias nursing effect evaluations due to psychological expectations. Importantly, external validity is limited, and long-term follow-up data are lacking.

Future studies should conduct strict sample size calculations before initiating the study and expand the sample size. Moreover, it is recommended that future studies adopt a double-blind or triple-blind design, where nurses, patients, and data analysts are unaware of the nursing intervention received, to reduce the impact of subjective bias on study results. At the same time, it is suggested that future studies extend the observation period, at least following patients for a period after treatment ends, to assess the long-term effects of the nursing intervention. Importantly, future studies need to be validated in different populations, environments, or conditions to assess the universal applicability of the nursing model.

Although this study has limitations, the results still have significant clinical implications, not only improving patients’ quality of life, treatment adherence, and nursing quality but also effectively improving their psychological mood and sleep quality. This comprehensive nursing model is worth promoting and applying widely in clinical practice. In light of clinical practice, we propose the following targeted recommendations: nursing staff should receive systematic training in humanistic nursing and Neuman’s nursing model to enhance their nursing skills and competence. Medical institutions should establish a comprehensive implementation mechanism for humanistic nursing and the Neuman’s nursing model to ensure that patients receive standardized and continuous nursing care. Simultaneously, nurses should be encouraged to establish good communication relationships with patients, deeply understand their needs and expectations, and provide personalized nursing care. Additionally, medical institutions should strengthen humanistic care and psychological support for nursing staff, reducing their work stress and burden, thereby improving their job satisfaction and professional identity.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jianhui Zhao

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