Study on the application of segmented nursing pathway in daytime anorectal surgery patients

2.1 Clinical data

A convenience sampling method was used to select 146 patients who underwent colorectal surgery in our hospital’s day surgery unit between April 2023 and July 2023. The patients were randomly assigned to two groups using a random number generator, with even numbers assigned to the control group ( n = 72) and odd numbers to the experimental group ( n = 74). The control group received standard nursing care, whereas the experimental group received segmented nursing care in addition to standard care. This study obtained informed consent from the patients and their families and was approved by the medical ethics committee.

2.2 Inclusion and exclusion criteria

Inclusion criteria: 1) patients who meet the requirements for daytime colorectal surgery and have no other diseases; 2) patients who are conscious and willing to cooperate with the surgery; 3) patients and their families who were informed about this study; 4) patients and their families who are aware of preoperative nursing knowledge and are willing to continue to cooperate and complete the nursing after discharge; and 5) patients with contact information, such as telephone and WeChat, for convenient follow-up.

Exclusion criteria: 1) patients with cognitive impairment who cannot understand and attain nursing knowledge; 2) patients who cannot accept the daytime colorectal surgery model; 3) patients with significant underlying diseases, such as malignant tumours; and 4) patients unwilling to participate in this study.

2.3 Surgical procedures

The experimental and control group patients underwent surgical procedures mainly including rectal mucosal prolapse suspension, haemorrhoid ligation and anal papilla tumour resection. All surgeries were performed under local anaesthesia. The surgeries and nursing care for both groups were conducted by members of our hospital’s day surgery team.

2.4 Nursing and intervention measures

3.1 Baseline characteristics of the study participants

The age distribution of the study participants ranged from 20 to 72 years, with a mean age of 40.38 ± 12.54 years and an average length of stay of 25.72 hours. The control group consisted of 33 men and 71 women, with an age distribution of 20–69 years and a mean age of 41.05 ± 12.42 years; the average length of stay was 26.25 hours. The experimental group consisted of 36 men and 36 women, with an age distribution of 23–72 years and a mean age of 39.7 ± 11.93 years; the average length of stay was 25.19 hours. There were no statistically significant differences in general characteristics between the control and experimental groups ( $P>$ 0.05).

3.2 Comparison of preoperative preparation and preoperative anxiety scores between the control and experimental groups

After the implementation of the segmental nursing pathway, the experimental group had higher rates of admission before 8:30 am (77.78% vs 45.95%), knowledge of the daytime surgery process (63.89% vs 24.32%), completion rate of preoperative preparation (81.94% vs 59.46%) and satisfaction with preoperative preparation (94.44% vs 74.32%) compared with the control group ( 0.05), as shown in Table 1. After the implementation of the segmented nursing pathway, the SAS score (43.14 ± 12.44 vs 52.51 ± 13.21) and SDS score (45.03 ± 11.37 vs 55.37 ± 10.14) were lower in the experimental group than in the control group ( 0.05), as shown in Table 2.

There were no significant differences in postoperative complication rates (91.67% vs 93.24%) between the segmented nursing pathway group and the conventional nursing group ( $P>$ 0.05), as shown in Table 3.

After the implementation of the segmented nursing pathway, the experimental group had a higher discharge readiness than the control group (112.42 ± 3.28 vs 95.82 ± 3.41, 0.05), as shown in Table 4.

After the implementation of the segmented nursing pathway, the experimental group had higher nursing satisfaction than the control group (97.22% vs 70.27%, 0.05), as shown in Table 5.

4.1 Significance of segmental nursing pathway for preoperative readiness and anxiety status of patients undergoing day surgery

Day surgery is currently widely performed both domestically and internationally. The successful implementation of day surgery relies on effective medical and nursing management. After the implementation of a segmental nursing pathway, patients are admitted early, have a high awareness of the day surgery process, achieve high completion rates of preoperative preparations and exhibit high satisfaction with these preparations. Studies have shown that comprehensive preoperative preparations are beneficial for the surgical process, effectively reducing surgical risks and improving patient safety [15]. A segmental nursing pathway can provide personalised nursing services by tailoring nursing plans based on the characteristics and needs of each patient, making patients feel cared for and valued. Furthermore, the segmental nursing pathway emphasises the continuity and coordination of the nursing process, reducing information gaps and nursing errors between different stages and increasing patient trust and satisfaction with the nursing process. Lastly, the segmental nursing pathway can provide comprehensive nursing guidance and education, helping patients understand the preoperative preparations and postoperative precautions, thereby enhancing their understanding and acceptance of the surgical process. The improvement of the nurse’s supervision of the preoperative checklist can increase the level of preoperative readiness, ensure adequate surgical preparations, reduce the delay in surgery start time, effectively improve the efficiency of medical resource utilisation and enhance patient satisfaction [16, 17, 18].

Most patients experience negative emotions such as anxiety and tension before surgery. Maintaining a positive mindset prior to surgery is conducive to the safety and recovery of the procedure. Traditional nursing methods often overlook this aspect, and patients may worry about the short duration of day surgery, inadequate care during hospitalisation and post-discharge recovery issues. Day surgery patients are particularly prone to experiencing negative emotions, especially high levels of preoperative anxiety, compared with patients undergoing regular inpatient surgery [19].

In this study, the use of a segmental nursing pathway allowed for the development of personalised preoperative psychological health guidance for the patients, alleviating their anxiety and enhancing their treatment confidence. Zhang et al. [20] conducted a study on the psychological resilience levels of 199 patients undergoing hysteroscopy day surgery, and the results indicated that the preoperative psychological resilience levels of the patients were generally low. Therefore, targeted psychological interventions should be implemented by medical and nursing staff pre-surgery to improve patients’ psychological resilience and lay a good foundation for surgery and postoperative recovery. By providing comprehensive preoperative education, emotional support and postoperative recovery guidance, the segmental nursing pathway helps patients better cope with discomfort and fear during the surgical process, effectively reducing the preoperative anxiety in patients undergoing day colorectal surgery. This finding is consistent with the results of Chen et al.’s [21] study on clinical nursing pathways and uterine fibroid surgery.

The results of the present study showed that after the implementation of the segmental nursing pathway, the experimental group of patients had better preoperative readiness indicators and lower levels of preoperative anxiety and other adverse emotions compared with the control group, suggesting that the segmental nursing pathway has a positive impact on improving the preoperative readiness and reducing adverse emotions in patients undergoing day colorectal surgery.

4.2 Reduction in the incidence of postoperative complications in patients undergoing day colorectal surgery using the segmental nursing pathway

In this study, there was no significant correlation between the segmental nursing pathway and the occurrence of postoperative complications in patients undergoing colorectal surgery. This suggests that future nursing efforts should focus on strengthening guidance and skill development for wound care in patients undergoing day colorectal surgery, further improving nursing protocols and seeking more effective nursing measures [22]. Despite these study results, the segmental nursing pathway remains an important nursing management model, one that has demonstrated positive effects in many other types of surgeries or diseases, such as improving patients’ postoperative recovery and reducing the occurrence of complications, thereby improving the quality of nursing care [23]. Liu et al. [24] implemented the segmental nursing model in a nephrology ward and the study results indicated that the segmental nursing approach reduced patient complications, significantly improved nutritional status and increased patient satisfaction. Future research can further explore the effects of the segmental nursing pathway in other surgical procedures, further improving the quality of patient care and satisfaction.

4.3 Segmental nursing pathway improves discharge readiness of ambulatory colorectal surgery patients

Discharge readiness, first proposed by the British scholar, A.M. Fenwick, assesses patients’ physiological, psychological and social aspects to evaluate whether they are ready for appropriate discharge, with adequate postoperative recovery abilities [25, 26, 27, 28]. Colorectal surgery patients often worry about postoperative dietary and bowel issues affecting wound healing, as well as the impact of concealed wounds on recovery [29, 30]. Due to the short duration of ambulatory surgery, patients lack confidence in their prognosis, resulting in a lack of readiness for discharge. The segmental nursing pathway ensures timely and effective care for patients in various stages, both preoperatively and postoperatively, through rational nursing arrangements and coordination. In the preoperative stage, nursing staff conduct detailed assessments and education to help patients understand the purpose, process and risks of surgery, providing appropriate rehabilitation advice and self-management techniques. During the intraoperative stage, nursing staff closely monitor patients’ vital signs and surgical progress, promptly managing and preventing complications. In the postoperative stage, nursing staff provide rehabilitation guidance and care, assisting patients in recovering quickly and adapting to post-discharge life. Through this segmental nursing pathway, patients can better understand their own disease and treatment, improve their rehabilitation and self-management abilities, thereby enhancing discharge readiness. Shi et al. [31] noted in their study on the effects of the segmental nursing pathway in comprehensive ambulatory surgery for large varicose veins that the segmental nursing pathway can enhance discharge readiness, reduce patients’ economic burden and expedite the turnover of hospital beds, thus promoting medical efficiency. In addition, nursing staff develop appropriate individualised discharge guidance plans based on patients’ actual conditions, not only enhancing patients’ confidence in discharge and reducing delayed discharge rates but also promoting patient recovery [32, 33].

Furthermore, the segmental nursing pathway reduces patients’ length of stay and costs through rational nursing arrangements and coordination. Under the traditional nursing model, patients often receive continuous care during their hospitalisation, leading to increased lengths of stay and costs. However, the segmental nursing pathway divides the nursing process into different stages, including preoperative, intraoperative and postoperative, arranging targeted care based on patients’ conditions and treatment progress, and developing personalised discharge plans, thus reducing readmission rates and saving costs [34, 35]. The results of this study indicate that after implementing the segmental nursing pathway, the experimental group had higher discharge readiness than the control group, suggesting the significant role of the segmental nursing pathway in improving discharge readiness in ambulatory colorectal surgery patients.

4.4 Improvement in nursing satisfaction of ambulatory colorectal surgery patients using the segmental nursing pathway

The segmental nursing pathway develops personalised nursing plans based on patients’ characteristics and surgical types, providing continuous and coordinated nursing services to meet patients’ individualised nursing needs. The traditional nursing model has limited patient-nurse interaction and lacks effective communication, while the segmental nursing pathway strengthens the effective communication and interaction between patients and nurses, enhancing the former’s trust and satisfaction with nursing care. Zhang et al. [20] reported in their study on perioperative comprehensive nursing for 100 patients with breast fibroadenoma that the patients’ negative emotions improved, the complications were reduced and, consequently, the nursing satisfaction was increased. Nursing satisfaction reflects comprehensive nursing experience outcomes. In this study, the patients demonstrated higher preoperative readiness, lower SAS and SDS scores, improved discharge readiness and multi-level satisfaction in terms of physiological, psychological and social aspects after receiving segmental pathway nursing care, suggesting the significant impact of implementing this nursing pathway on patient nursing satisfaction.

This study has certain limitations. First, due to the small sample size, there may be some bias in generalising the results, and further multicentre studies with larger samples are needed to validate the effects of the segmental nursing pathway in ambulatory colorectal surgery patients. Second, this study did not conduct regular follow-ups at each stage, and long-term application effects need further observation and research.