The Development of a Perioperative Nursing Care Model for Patients with Oral Cavity Cancer Undergoing Flap Coverage Reconstruction

Abstract

Background: Oral cancer, if left untreated, will grow in size and spread to other organs. The patient may die from complications. Oral cancer surgery is a complex procedure with a high risk of complications. Nursing care models developed from evidence-based practices and continuous development of operating room nurses' competencies help ensure patient safety during surgery.
Objective: To develop and study the results of using the Perioperative Nursing Care Model for Patients with Oral Cavity Cancer Undergoing Flap Coverage Reconstruction (CA-ORC-FRC).
Study Methods: This is a research and development study with four phases: 1) Situation analysis. Data was collected through a search for evidence-based practices related to the development of guidelines and focus group discussions. Data analysis was performed using content analysis. 2) Design and development of the model. A draft of the nursing practice guideline was created using the concept of Soukup's nursing practice guideline development model, the concept of patient-centered perioperative nursing care, and evidence-based practices extracted from phase 1. 3) Trial and Improvement of the Model. The drafted nursing practice guideline was trialed and refined. Subsequently, operating room nurses applied the guideline to patients undergoing oral cancer surgery. Data was collected using a nursing outcome record form and an assessment form for knowledge and skills in nursing care for oral cancer surgery patients. 4) Development and Evaluation. The process for developing the competency of operating room nurses was designed using the GROW coaching model to train 30 nurses. The nursing practice guideline was then applied to 30 patients undergoing oral cancer surgery. Nursing outcomes for patients who received the oral cancer surgery nursing care model were evaluated. The skills and knowledge of the coached operating room nurses were also assessed. Step 3 and 4: Data was analyzed using descriptive statistics, Chi-Square Test, Mann-Whitney U Test, and Wilcoxon Test.
Results: The oral cancer surgery nursing care model consists of: 1) An evidence-based nursing practice guideline for patients undergoing oral cancer surgery, covering three surgical phases. 2) Competency development for operating room nurses using the GROW coaching technique. The results of using this nursing care model showed that: 1)Patients who received the new care model had a similar level of surgical safety across five aspects compared to patients who received standard care. 2)Patients who received the new care model had a shorter length of hospital stay and a shorter surgery duration than patients who received standard care (p<0.050, p<0.001). 3)The coached operating room nurses showed significantly higher skills and knowledge after the workshop compared to before the training (p<0.010). 4)Operating room nurses' satisfaction with the nursing care model was at a high level, at 96.7%.
Conclusions: The developed surgical nursing care model helps reduce the length of hospital stay and surgery duration. It also increases the knowledge and skills of operating room nurses in providing care for oral cancer surgery patients, who in turn expressed a high level of satisfaction with the nursing care model.