Eighteen cases of breast cancer received holistic nursing care, which addressed early complications such as subcutaneous fluid accumulation, upper limb swelling, limb dysfunction, scar contracture, and limited mobility, as well as middle and late-term complications. The reasons for preoperative fear in patients include: (1) worry about the surgery and treatment; (2) fear of the tumor; (3) concerns about postoperative physical changes. In response to these reasons, we implemented the following care measures: (1) warmly receiving patients, introducing attending physicians and nurses, and explaining the ward environment and related regulations; (2) paying attention to the protection of the health care system and introducing good conditions; (3) explaining surgical security and necessity to help patients establish confidence in overcoming the disease; (4) strengthening communication with patients, guiding them to master methods to eliminate concerns and pessimism, such as listening to music, reading newspapers, and walking; (5) providing psychological care to patients regarding physical modification methods, such as bra use, functional exercises of limbs, and restoring their physical appearance and self-care.
For the lack of knowledge, the reasons are: (1) lack of preoperative preparation, anesthesia, and surgical knowledge; (2) lack of health guidance leading to misunderstanding of the disease's formation, development, treatment, and outcome. We took the following care measures: (1) explaining detailed knowledge to breast cancer patients, including the purpose and meaning of preoperative preparation to gain patient cooperation; (2) strengthening communication, explaining skills to patients and their families about the main symptoms of the disease, treatment, and improvement; (3) ensuring good preoperative preparation, such as skin preparation, drug allergy testing, blood availability, and fasting.
Regarding pain, it has a direct relationship with surgery. Care includes: (1) caring for patients, explaining the causes and duration of pain; (2) distracting patients' attention to reduce the body's susceptibility to pain; (3) providing a quiet, comfortable environment for rest to reduce external stimuli, promote sleep, and reduce pain; (4) observing the nature of the pain and administering sedative analgesics as ordered.
To maintain airway patency after general anesthesia is essential. Measures include: (1) training patients preoperatively to cough effectively post-surgery to prevent lung infections; (2) assisting patients every two hours to stand up, tap their backs to promote mucus discharge; (3) conducting aerosol inhalation 2-4 times daily for 20 minutes each; (4) providing painkillers to patients with severe coughs.
Upper limb swelling occurs due to lymph node removal in the axillary or supraclavicular fossa, blocking lymphatic drainage and causing lymph siltation. It may also result from bandages being too tight, obstructing venous return and causing tissue fluid accumulation. For care measures: (1) prohibiting the formation of dead space in the affected limb for infusion and blood pressure; (2) massaging limbs and turning over to promote blood circulation; (3) chest strap bandaged injuries; (4) continuous subcutaneous vacuum suction; (5) closely observing and recording the volume and nature of fluid drainage; (6) changing the negative pressure drainage device daily to prevent infection; (7) increasing nutrition.
Restriction of upper limb activity directly results from surgical trauma and should be related to postoperative scar contracture. Care includes: (1) explaining to patients the importance and necessity of limb activities; (2) detailing exercise methods and procedures; (3) guiding and assisting patients to perform extensor, fist, wrist flexion movements within 1-2 days post-surgery, elbow movement within 3-4 days, practicing ipsilateral finger scratching contralateral shoulder and auricle within 5-6 days, encouraging eating, shoulder exercises within 7 days, raising the upper limb for finger climbing movements within 12 days, and placing the palm on the back of the neck for mild chest movement within 14 days; (4) observing and recording the patient’s limb activity tolerance and progress to encourage patients and boost confidence.
Holistic nursing care reform inevitably leads to improved nurse-patient relationships, increased knowledge levels among nursing staff, timely detection of condition changes, and enhanced analytical skills on specific issues, improving the quality of care and service with far-reaching significance.