The Impact of Nurse's Intentional Presence as a Holistic Intervention on Stress,Anxiety,Depression,and Coping in Patients Undergoing Bowel Obstruction Surgery: A Randomized Controlled Trial

Abstract

Introduction: Emergency surgery for bowel obstruction can significantly impact patients’ coping mechanisms, leading to various physical and psychological complications. The intentional presence of a nurse, as a holistic approach, can aid patients in enhancing their coping strategies and psychological well-being postsurgery. Aim: This study aimed to assess the effect of a nurse's intentional presence, as a holistic intervention, on stress, anxiety, depression, and coping strategies in patients undergoing bowel obstruction surgery. Method: This randomized controlled trial was conducted at Qaem Hospital in Mashhad, Iran, from March 2021 to October 2022. A total of 62 patients were randomly assigned to two groups. The intervention group received nursing care based on the theory of intentional presence over five individual sessions lasting 45–90 min each in the hospital, followed by telephone support for up to 1-month postdischarge. The control group received educational pamphlets. Data were collected using the Filipino Coping Strategies Scale (FCSS) and DASS-21 before, 1 week after, and 1 month after the intervention. Data were analyzed using SPSS 27 with quantile regression models adjusting for baseline covariates. Results: The results showed homogeneity between the two groups regarding age (P = 0.14) and other demographic and disease information (P > 0.05). The Mann-Whitney test revealed significant reductions in anxiety, stress, and depression in the intervention group compared to the control group at 1 month (P < 0.001). Additionally, there was a significant improvement in coping strategies (indicating better adaptation) in the intervention group compared to the control group at 1 month (P = 0.04). Quantile regression confirmed these findings with significant adjusted effects (anxiety: RC = −3.14, 95% CI [−4.89, −1.39]; stress: RC = −1.00, 95% CI [−1.96, −0.04]; depression: RC = −1.00, 95% CI [−1.98, −0.02]; coping: RC = 4.11, 95% CI [1.87, 6.35]). Conclusion: The findings indicate that the intentional presence of a holistic nurse can enhance patient adaptation to disease symptoms after surgery and reduce stress, anxiety, and depression. Further studies with mixed-methods designs are needed to comprehensively assess patient adaptation and the qualitative aspects of the nurse–patient relationship.