Construction of a health education pathway for patients with gynecologic malignancies based on evidence-based and LEARNS models

Construction of a health education pathway for patients with gynecologic malignancies based on evidence-based and LEARNS models | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Construction of a health education pathway for patients with gynecologic malignancies based on evidence-based and LEARNS models Qiannan Xu, Yuanyuan Yang, Haizhen Lu, Yanxue Zheng, Xiaoqin Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6323668/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective: The aim was to develop a health education pathway system for patients with gynecologic malignancies based on the LEARNS framework, to provide clinical caregivers with a set of systematic and all-encompassing health education strategies, in order to improve the effectiveness of care and the quality of health education for patients with gynecologic malignancies. Methods : In this study, two rounds of correspondence were conducted with 10 experts in the field by using the Delphi method through literature systematic evaluation and group discussion. Based on the preset index screening entries and the experts' feedback, the pathway's content was optimized, and a set of health education pathways for gynecological malignancy patients was finally established. Results : In the two rounds of expert consultation, the positive coefficients of the experts were 90.9% and 100.0%, the authority coefficients of the experts were Cr 0.84 and 0.845, and the Kendall coordination coefficients of the expert's opinions were 0.171 and 0.111, respectively (both P<0.001), and the finalized health education pathway covered the 10 core first-level indicators and 83 secondary indicators. Conclusion : The health education pathway for gynecologic malignant tumor patients based on the LEARNS model constructed in this study is scientific, comprehensive, and operable. LEARNS model gynecologic malignancies health education pathways 1. Introduction The incidence of gynecologic malignancies remains high worldwide, with cervical, ovarian, and endometrial cancers known as the three major malignant threats to the female reproductive system [ 1 ] . According to the latest statistical report of the International Agency for Research on Cancer (IARC), the number of new cases of cervical cancer, ovarian cancer, and endometrial cancer worldwide is 604,000, 314,000, and 417,000, respectively, which accounts for 18.6% of the total number of new cancer cases in the world. At the same time, deaths due to these gynecological malignant tumors account for a remarkable proportion of cancer deaths in the world, which is as high as 13.5% [ 2 ] . According to the most recent data from the National Cancer Center of China, the incidence and mortality rates of gynecologic malignant tumors, mainly cervical, ovarian, and endometrial cancers, are among the highest among female cancers [ 3 ] . The treatment strategy for gynecologic malignant tumors usually adopts a comprehensive treatment model centered on surgery, supplemented by chemotherapy and radiotherapy. However, multiple factors, such as the aggressiveness of the disease itself, the trauma caused by surgery, and the side effects of radiotherapy, often subject patients to both physical and psychological stress, resulting in limited physical activity, reduced social participation, impaired physiological function, and decreased psychological adjustment, which in turn seriously affects their quality of life. Given the grave situation of gynecologic malignant tumors and their profound impact on patient's quality of life, it is imperative to explore efficient and systematic health education pathways. The guidelines for Promoting Patient-Centered Learning [ 4 ] were developed by the Registered Nurses Association of Ontario (RNAO), Canada, and have at their core the LEARNS model, which consists of the six English words: Listen, Establish, Adopt, Reinforce, Feedback, Teach, Name, and Strengthen. Its core LEARNS model, composed of the acronyms of Listen, Establish, Adopt, Reinforce, Name, and Strengthen, is used to guide clinical nursing workers in health education to promote patients' cognitive and behavioral competence in health education in this way. Overseas studies [ 5 , 6 , 7 ] have shown that the LEARNS model can improve the self-management level of diabetic patients and the self-efficacy of coronary heart disease patients. Relevant studies in China have proved [ 8 , 9 ] that the LEARNS model can improve the health education of type 2 diabetes patients, and it also has a positive impact on the level of knowledge, bone mineral density, and self-efficacy of osteoporosis patients. The application of the LEARNS model in our country has a better effect. However, the research is still tiny, so based on the national conditions of our country and the actual needs of gynecological malignant tumor patients, it is urgent and necessary to explore the health education and nursing pathway suitable for gynecological oncology patients in our country. 2. Information and methods 2.1 Establishment of a Study Group The study team consisted of 8 members, with the following composition and responsibilities: 1 nurse with a postgraduate degree served as the core of the entire protocol construction process and was responsible for coordinating resources and controlling the quality of the study; 1 chief gynecologist was responsible for the clinical guidance of the protocol implementation; 4 gynecological nurse leaders were involved in the initial Development of the protocol, the Development of correspondence questionnaires, and the analysis of the clinical appropriateness of the evidence-based evidence; and two master's degree students were responsible for literature search and analysis, as well as the distribution, retrieval, and collation and analysis of the results. Two master's degree students were responsible for the literature search and analysis, distributing and collecting correspondence questionnaires, and compiling and analyzing results. All team members had a bachelor's degree or above, with an average working experience of 10 years, which ensured the professionalism of the research team. This study was approved by Affiliated Hospital of Jining Medical University Ethics Committee (approval number: 2024-06-C025). 2.2 Initial Development of Health Education Pathways Based on the in-depth analysis and understanding of the theory of the LEARNS model, combined with the results of the literature review and group discussion, we initially constructed a framework for the health education pathway. We conducted a comprehensive search of PubMed, Web of Science, Sinomed (China Biomedical Literature Database), CNKI (China Knowledge), Wanfang Data (Wanfang Database), and VIP (Wipu Journal Resource Integration Service Platform) databases. The period was from the beginning of the construction of the databases to the latest results of May 2024. In Chinese, "nursing pathway," "health education pathway," "gynecologic malignancy," and "health education" were used as subject terms. And "health education" in Chinese. In English, "care pathway, health education pathway," "gynecological malignant tumors," and "health education" were used as the theme words, and "health education" was used as the subject term. A total of 238 documents were obtained after the search. After eliminating duplicates, reading the titles and abstracts, and rereading the full text for re-screening, 10 documents were finally included. The time, content, evaluation indexes, and intervention effects of health education in the included literature were further sorted out and summarized. A preliminary draft of a health education pathway for gynecologic malignant tumor patients was formed, which covered health education content on the day of admission, preoperative, postoperative, and pre-discharge at several key time points, aiming to provide comprehensive, continuous, and personalized health education services for patients. At the same time, the research team also considered the individual differences and unique needs of different patients, trying to make the content of the pathway closer to the clinical reality and patient needs. 2.3 Expert correspondence 2.3.1 Development of the questionnaire for expert correspondence Prepare an expert correspondence questionnaire based on the preliminary draft of the health education pathway, including the following: ①Letter to experts: background information, purpose, expected value, and significance of this study. At the same time, the deadline for submission of the questionnaire and the researcher's contact information were clarified to ensure smooth and efficient communication. ②General information of experts: collect basic information including education, title, years of professional work experience, and organization. In addition, it includes a survey on the expert's familiarity with the content of this study and the basis for their judgment to calculate the expert authority coefficient to ensure the reliability of the consulting results. ③The central part of the questionnaire adopts the Likert five-level scoring method, ranging from "very important" (5 points) to "very unimportant" (1 point) and from "very important" to "very unimportant" (1 point). In the body of the questionnaire, a five-point Likert scale was used, ranging from "very important" (5 points) to "very unimportant" (1 point), and experts were invited to score each entry. In addition, there is an open-ended comment box after each entry, allowing experts to make specific suggestions for "additions," "deletions," or "modifications" with reasons in order to collect and integrate expert feedback comprehensively. Expert feedback is collected and consolidated comprehensively. 2.3.2 Selection of Consultants Inclusion criteria: ①engaged in gynecology medical or nursing work in a tertiary hospital; ②education of bachelor degree or above; ③title of intermediate or above; ④engaged in related work for 10 years or above; ⑤voluntarily participated in this study. Exclusion criteria: experts who are not familiar with the content of this study or who voluntarily withdrew. 2.3.3 Questionnaire distribution and retrieval The questionnaires were distributed via WeChat and e-mail, with detailed instructions for completion and submission requirements, and experts were asked to respond within 2 weeks to review and provide feedback thoroughly. Based on the pathway entries meeting the mean importance score of≥3.5, the coefficient of variation of≤0.25, and the full score ratio of>0.20 [10] , the corresponding entries were deleted and improved through the group discussion, and in light of the actual clinical situation. 2.4 Statistical methods Excel 2010 and SPSS 27.0 statistical tools were used for data entry and analysis, frequency and composition ratios were used for statistical descriptions, and reliability and internal consistency were tested using the recall rate, the mean of importance assignment, the full score rate, the expert authority coefficient, the coefficient of variation, and the coordination coefficient. 3. Results 3.1 Basic information on experts A total of 10 experts completed two rounds of expert correspondence in this study. The age of the 10 experts was 39～51 (48.20± 4.44) years; the number of years of experience ranged from 10 to 31 years; the education level included 2 PhDs, three master's degrees, and five bachelor's degrees; and the job titles included three full-level senior officers and seven associate-level officers. Positions included two medical directors of gynecology, seven gynecological care managers, and one clinical nurse. 3.2 Degree of expert activism The positive coefficient of the experts was calculated using the recovery rate of the questionnaires, with a higher recovery rate representing a higher level of motivation of the experts [11] . Eleven questionnaires were distributed in round 1, and 10 were recovered. In comparison, 10 questionnaires were distributed in round 2, and 10 were recovered, with a recovery rate of 90.9% and 100.0%, respectively, which indicates that the experts were highly motivated to participate in the research topic. 3.3 Degree of authority of experts The coefficient of authority (Cr) of an expert is the mean value of the expert's familiarity with the research content of the topic (Cs) and the basis of judgment (Ca) [12] , and it is usually considered that a Cr ≥ 0.70 is acceptable [13] . The Cs of the two rounds of expert consultation in this study were 0.75 and 0.75, Ca was 0.93 and 0.94, and Cr was 0.84 and 0.845, respectively, indicating a high degree of expert authority. 3.4 Degree of Concentration of Expert Opinion The mean and standard deviation of the importance assignment were used to indicate the degree of concentration of expert opinions; the more significant the mean and the smaller the standard deviation, the more important the indicator and the more concentrated the expert opinions [14] . The mean score for the importance of the first round of expert correspondence was 4.10~ 5.00, with a coefficient of variation of 0 to 0.16. The mean score for the second round of expert correspondence was 4.10~ 5.00, with a coefficient of variation of 0 to 0.16. 3.5 Degree of harmonization of expert advice The degree of harmonization of experts' opinions was measured by the coefficient of variation (CV) and Kendall's harmonization coefficient (W). The smaller the CV, the higher the harmonization of experts' opinions; the higher the value of W, the higher the consistency of experts' opinions [15] . The coefficients of variation for each indicator ranged from 0 to 0.16 in the first round of expert correspondence and from 0 to 0.16 in the second round. Kendall's concordance coefficients for the two rounds of expert correspondence were 0.171 and 0.111, respectively (both P<0.001). 3.6 expert correspondence Valid suggestions adopted and revised in the first round of expert consultation: Revise the first-level indicator “1-3 days after surgery; 4-6 days after surgery; 7 days after surgery - the day before discharge” to “during the postoperative hospitalization period”; add the phrase “warmly receive patient, introduce the regulations, environment, and system of the department, as well as the director of the department, head nurse, doctor in charge and nurse in charge"; add "postoperative follow-up: whether there is any abnormal vaginal bleeding; the situation of urination and defecation after discharge from the hospital; whether there is any urinary fistula; whether there is any sex life; whether there is any swelling of the lower limbs (lymphatic reflux is obstructed); whether there is any VTE; whether to conduct a review and the time of review"; "Use telephone follow-up, network follow-up and other forms of out-of-hospital follow-up of patients. To understand the degree of mastery of the content of previous health education and the occurrence of complications, etc." was revised to "To conduct out-of-hospital follow-ups for patients using telephone and Internet follow-ups. To understand patients' confusion and difficulties in daily life after discharge from the hospital". After further discussion by the health education team, add and revise the content: add "especially emphasize to patients that removal of the uterus/ovaries/vulva is only a treatment tool (not a physical defect)." There were no deletions or modifications in the second round of expert consultation, but only adjustments to the content and wording of some of the entries. These are summarized in Table 1. Table 1. Results of expert consultation on health education pathway for patients with gynecologic malignancies Level 1 indicators LEARNS model Secondary indicators Significance (x±s, points) coefficient of variation Percentage of perfect scores (%) Day of admission L(listen) ① Listen to the patient's complaints; 4.8± 0.42 0.088 80.00 ② Listen to the patient's physical needs; 4.8±0.42 0.088 80.00 ③ Listen to the psychological needs of the patient; 4.7±0.48 0.102 70.00 ④ Listen to the social needs of patients; 4.6±0.52 0.113 60.00 E (establish) Make a good impression and build initial rapport 4.6±0.52 0.113 60.00 A (adopt) ①Welcome patients warmly and introduce the regulations, environment, and system of the department, as well as the director of the department, the head nurse, the doctor in charge, and the nurse in charge; 4.5±0.53 0.118 50.00 ②To obtain general information about the patient's family support and economic conditions; 4.6±0.52 0.113 60.00 ③ Introduce disease-related knowledge, dietary precautions, and targeted personalized psychological guidance to patients and their families; 4.6±0.52 0.113 60.00 ④ Instruct the patient on relevant examination items and precautions; 4.5±0.53 0.118 50.00 ⑤ Introduce the health education platform to patients and their families. 4.5±0.53 0.118 50.00 R(reinforce) Do a good job of disease-related health education to patients and their families, and answer questions and answers from patients and their families. 4.5±0.53 0.118 50.00 N(name) Use the LEARNS model Gynecologic Oncology Patient Health Education Pathway form to document and develop a plan of care based on the patient's condition; ask questions about issues presented and explained; and encourage self-reporting. 4.7±0.67 0.143 80.00 S(strengthen) Correct any responses that the patient misunderstands and repeat for emphasis. 4.5±0.53 0.118 50.00 The day before surgery L(listen) Listening to patients' and families' perceptions of the disease and surgery 4.8±0.42 0.088 80.00 E (establish) Further Development of harmonized partnerships 4.5±0.53 0.118 40.00 A (adopt) ① Instruct patients and family members to watch mission-related videos and read health manuals and health education pushes carefully; 4.7±0.48 0.102 70.00 ② Keep the skin clean to prevent postoperative infection; 4.7±0.48 0.102 70.00 ③ Prepare the respiratory tract with effective coughing and sputum methods; 4.9±0.32 0.065 90.00 ④ Prepare the intestinal tract; instruct the patient to eat a preoperative diet: rotten noodles or rotten noodle skin or steamed eggs at noon, easy-to-digest food (millet porridge, egg soup) for dinner, and forbid pasta, fruits, vegetables, etc., and determine the time when the patient is forbidden to drink water. 4.8±0.42 0.088 80.00 ⑤ Postoperative complication education as well as prevention: For example, measures to prevent VTE include instructing patients on postoperative ankle pumping exercises, straight leg raising and lower extremity flexion, turning in bed, hip lifting exercises, and getting out of bed; 4.8±0.42 0.088 80.00 ⑥Instruction in postoperative Diet and principles; 4.7±0.48 0.102 70.00 ⑦ Focus on the psychological care of patients, especially emphasizing to patients that removal of the uterus/ovaries/vulva is only a treatment (and not a physical defect) and guiding them to correctly understand the surgery based on the results of the psychological assessment. 4.6±0.52 0.113 60.00 R(reinforce) Uniformly trained nursing staff will carefully guide patients and their families in reading the health education booklet, supplemented by an on-site demonstration of postoperative living conditions and care, to improve their understanding and mastery of the condition. 4.7±0.48 0.102 70.00 N(name) Feedback on patients' and families' knowledge and skill mastery through the question-answer-question model and further improve health education based on patients' feedback results 4.8±0.42 0.088 80.00 S(strengthen) Distribution of health education brochures, communication among patients, and viewing of the content of the education platform 4.8±0.42 0.088 80.00 The day after surgery L(listen) ①Listen to the patient's subjective feelings 4.8±0.42 0.088 80.00 ②Listen to the patient's current needs 4.8±0.42 0.088 80.00 E (establish) ①Build a harmonious relationship that allows patients to trust 4.8±0.42 0.088 80.00 ② Conducting postoperative instruction based on the concept of rapid surgical rehabilitation 4.6±0.52 0.113 60.00 A (adopt) ① Postoperative position, method of bed movement, and early bed movement; 4.5±0.53 0.118 50.00 ②Purpose and duration of postoperative fasting; 4.7±0.48 0.102 70.00 ③ Postoperative cardiac monitoring and vital sign monitoring considerations; 4.6±0.52 0.113 60.00 ④ Instruct on the significance, timing, and precautions of leaving various tubes in place; 4.7±0.48 0.102 70.00 ⑤ Oxygenation education, effective postoperative coughing methods and techniques; 4.7±0.48 0.102 70.00 ⑥Postoperative incision dressings, adjunctive therapy (limb pneumatic pressure, red light) 4.6±0.52 0.113 60.00 ⑦ Response to postoperative pain, nausea, and other discomforts; 4.7±0.48 0.102 70.00 ⑧ Names, effects, and adverse reactions of postoperative medications; 4.7±0.48 0.102 70.00 ⑨ Postoperative psychological reassurance to relieve patient anxiety; 4.8±0.42 0.088 80.00 ⑩Specialist guidance: self-observation and monitoring of vaginal bleeding. 4.8±0.42 0.088 80.00 R(reinforce) A detailed explanation of the key points of postoperative care is needed to improve patients' and their families' awareness of and familiarity with the education content. 4.8±0.42 0.088 80.00 N(name) Encourage patients or family members to demonstrate the process and key points on the spot. For example, on the spot, let the patient demonstrate how to do ankle pump exercise and why it is necessary. The educator should raise questions and give guidance to correct any misunderstandings. 4.9±0.32 0.065 90.00 S(strengthen) Encourage the patient and family to review surgical precautions, knowledge of the disease, and heart thoughts. 4.5±0.53 0.118 50.00 During postoperative hospitalization L(listen) ①Listen to the patient for postoperative discomfort. 4.3±0.67 0.156 40.00 ② Listen to what problems the patient has with adaptation to surgery and nursing care 4.7±0.48 0.102 70.00 ③ Ask patients and families if there are unresolved issues with current care and what new issues have arisen 4.6±0.52 0.113 60.00 E (establish) The charge nurse clarifies whether a therapeutic partnership has been established with the patient 4.1±0.32 0.078 10.00 A (adopt) ①Select appropriate educational methods according to the actual situation of the patients, such as watching videos and explaining practical operations, etc., and introduce postoperative precautions to the patients and their families. 4.6±0.52 0.113 60.00 ②Early bed activities: gradually increase the number of bed activities and activity time to prevent postoperative intestinal obstruction; 4.7±0.48 0.102 70.00 ③ Drainage tube care: the significance of tube retention and precautions; observation of drainage fluid; risk assessment of extubation; guidance on extubation, etc.; 4.5±0.53 0.118 50.00 ④Pain management: pain assessment; analgesic drug management; pain relief methods; strengthen pain education; 4.7±0.48 0.102 70.00 ⑤Instruction on incision care: observation of incision drainage and healing, etc.; 4.3±0.48 0.112 30.00 ⑥Focusing on the psychological state of patients: exploring patients' feelings related to the disease since its onset, the adverse emotions they have developed, and their fears and worries about the recurrence of the disease; 4.6±0.52 0.113 60.00 ⑦Instructing patients to change negative emotions: introducing patients to real cases of cured gynecological tumor patients living positively; adopting the methods of guidance, comfort, and encouragement to make patients face up to the elimination of current problems; mobilizing the family support system; and guiding family members to take care of them to increase patients' confidence in recovery; 4.7±0.48 0.102 70.00 ⑧Encourage patients to participate in self-care as early as possible, arrange peer education, strengthen communication among patients, and enhance patients' confidence in self-care. 4.7±0.48 0.102 70.00 ⑨Self-care: Patients and their families participate in developing and guiding future rehabilitation programs, etc. 4.9±0.32 0.065 90.00 R(reinforce) ①Guide patients or their families to understand gynecologic tumors and correctly recognize the characteristics of the disease 4.7±0.48 0.102 70.00 ② Emphasize the importance of maintaining a positive mood; 4.5±0.71 0.158 60.00 N(name) ① Encourage patients or family members to review their knowledge of the tumor and correct any misunderstandings promptly 4.4±0.7 0.159 50.00 ② Evaluate the learning effect of patients and their families, summarize and sort out the problems of understanding difficulties with patients, and further rectification of the subject team members 4.7±0.67 0.143 80.00 S(strengthen) ① Encourage patients and their families to watch the video explanation of the mission center repeatedly; 4.7±0.48 0.102 70.00 ②Take different forms of intensive education for the contents that are ineffective in the mission. 4.5±0.71 0.158 60.00 The day before discharge L(listen) Conduct interviews to understand the patient's knowledge of the disease in the hospital, whether new confusion arises during the period, solve the patient's related problems in a timely manner, and leave a hotline for receiving relevant feedback from the patient after discharge and follow-up to strengthen the education. 4.7±0.48 0.102 70.00 E (establish) Always stand in the patient's point of view, respect the patient's participation in decision-making, rationally adopt the views of the patient, and gradually reach a consensus 4.6±0.52 0.113 60.00 A (adopt) ①Management of cleanliness: keep the abdominal incision clean and dry after discharge from the hospital, remove the stitches for one week and then shower (prohibit the basin bath), keep the perineum clean, and change the underwear diligently; 4.3±0.67 0.156 40.00 ② Diet: After discharge from the hospital, the Diet should be light and easy to digest; it should be high in protein, vitamins, and minerals. 4.9±0.32 0.065 90.00 ③Activity: Combine work and rest. Hysterectomized patients do not lift heavy objects within 2 months. Avoid violent coughing and other actions that increase abdominal pressure. 4.8±0.42 0.088 80.00 ④Sexual life: Sexual life can be resumed after 3 months for total hysterectomy and 1 month for other surgeries. 4.6±0.52 0.113 60.00 ⑤Guidance on taking medication with you when you leave the hospital: How to take and use it. 4.6±0.7 0.152 70.00 ⑥Self-care of incisions: Incision healing; 4.9±0.32 0.065 90.00 ⑦Discharge procedures: Processing, expense reimbursement settlement, etc; 5±0.00 0 100.00 ⑧Guidance on postoperative follow-up: regular outpatient follow-up, adjuvant radiotherapy, and situations that warrant immediate follow-up in the hospital; 4.8±0.42 0.088 80.00 ⑨ Family and social life guidance: postoperative reintegration guidance, change of poor lifestyle. 4.7±0.48 0.102 70.00 R(reinforce) Re-explain the areas where patients have doubts, encourage patients to learn from each other, ask questions, and make sure that patients have mastered all the knowledge and skills until the end 4.4±0.52 0.118 40.00 N(name) Re-evaluate the learning effect of patients and their families to check whether they can correctly articulate their understanding of the key points of oncology care and apply them to their daily lives. 4.5±0.71 0.158 60.00 S(strengthen) Encourage patients and families to deepen their understanding and knowledge of oncology and nursing care through a variety of means 4.8±0.42 0.088 80.00 Follow-up 1 month after discharge L(listen) To follow up with patients outside the hospital by telephone and Internet, and to understand patients' confusion and difficulties in daily life after discharge from the hospital. 4.9±0.32 0.065 90.00 E (establish) Further, it strengthens the already constructed therapeutic partnership with the patient. 4.7±0.48 0.102 70.00 A (adopt) ①Postoperative follow-up: any abnormal vaginal bleeding; urination and defecation after discharge from the hospital; any urinary fistula; any sexual life; any swelling of the lower limbs (obstruction of lymphatic reflux); any occurrence of VTE; whether to have a review and the time of the review. 4.6±0.52 0.113 60.00 ②Guide patients to review the learning during this period, share the gains of participating in the activities and the benefits to disease recovery, and give personalized guidance based on the feedback results. 4.8±0.63 0.131 90.00 ③Patients with malignant tumors involve follow-up treatment and symptom care. 4.6±0.52 0.113 60.00 R(reinforce) A combination of approaches to emphasize daily living considerations when conditions permit 4.5±0.53 0.118 50.00 N(name) Patients and families are asked to follow the instructions in their daily lives and compare how they have changed previously 4.5±0.53 0.118 50.00 S(strengthen) Encourage patients to continue to seek community service resources after discharge, and inform patients of social resources available to them after discharge 4.9±0.32 0.065 90.00 4. Discussion 4.1 The health education pathway for patients with gynecologic malignancies based on the LEARNS model has reliability and scientific validity This study constructed a perioperative health education pathway for gynecologic malignancy patients based on the LEARNS model through a literature review, group discussion, and two rounds of expert correspondence. During the Delphi expert consultation, 90% of the experts had been engaged in gynecological nursing for 10 years, which was professionally representative and ensured the authority and representativeness of the consultation results. The effective recovery rates of the questionnaires for the two rounds of expert consultation in this study were 90.90% and 100.0%, respectively, indicating that the experts' motivation and participation were high, which enhanced the reliability of the study results. The expert authority coefficient remained above 0.70 during both rounds of consultation, proving the authority and broad representation of the expert team [ 16 ] . Meanwhile, the Kendall coordination coefficients were 0.171 and 0.111 (P < 0.05), which not only revealed a high degree of consistency in the experts' opinions but also reflected their wide recognition and positive support for the path content [ 17 ] , so the conclusions of this study are scientific and reliable. 4.2 The health education pathway for patients with gynecologic malignancies based on the LEARNS model is comprehensive and useful Based on the evidence-based "Promoting Patient-Centered Learning" guideline [ 18 ] , this study closely integrates the actual clinical situation and the health needs of patients at different stages and develops primary indicators containing 6-time points (including the day of admission, the day before surgery, the day after surgery, the day of postoperative hospitalization, the day before discharge, and one-month follow-up after discharge) and 83 entries framed by the LEARNS model as The secondary indicators take into full consideration the observation and nursing points required by patients at different stages in the setting of specific contents. The setting of the indicators is in line with the actual clinical work, with specific content, strong scientificity, and operability, and provides a reference tool for clinical health education. This study was conducted one month after patient discharge to provide follow-up instructions, emphasizing the importance of continuity of care in health education. Given the complexity of postoperative care for gynecologic cancers, significant attention has been given to preventive and nursing measures for managing long-term complications. Key areas of focus include monitoring urinary fistulae, managing lower extremity lymphedema (which can occur due to impaired lymphatic flow), and preventing venous thromboembolism(VTE) [ 19 ] . Therefore, it is essential to understand patients' health needs during the first month after surgery and to offer personalized guidance that promotes self-management and life skills [ 20 ] . 5. Conclusions In summary, the health education pathway for patients with gynecologic malignancies, based on the LEARNS model developed in this study, is both comprehensive and practical. It effectively supports clinical nursing practice by providing all-encompassing guidance and services throughout the entire patient care cycle. However, since the Delphi method relies on subjective judgment and evaluation by experts, it has certain limitations. Therefore, we plan to validate the feasibility and effectiveness of this pathway in future studies and continue to explore and optimize its application strategies to benefit a greater number of patients with gynecological malignancies. Declarations Ethics approval and consent to participate: This study was approved by Affiliated Hospital of Jining Medical University Ethics Committee (approval number: 2024-06-C025). he study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The data collection, the purpose of the study, and the survey method were explained to the manager of the institution, and permission to conduct the study was obtained. Written informed consent was obtained from all subjects involved in the study. Consent for publication: Not applicable Data availability ： All data supporting our findings were presented within the manuscript. Conflict of Interests: None declared. Funding : No. Authors' contributions : Each author is expected to have made substantial contributions to the conception XQN design of the work; YYY the acquisition, analysis, LXQ interpretation of data; LHZ the creation of new software used in the work; ZYX have drafted the work or substantively revised it. Acknowledgments We thank the department's experts and colleagues for their guidance and support during this research and thesis collaboration. Clarification: the questionnaire used in your study was developed for this study. Authors' information: Authors and Affiliations 1. First Auther: Qiannan Xu, Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. Kai Liu E-mail: [email protected] ; 2. Yuanyuan Yang, Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. E-mail: [email protected] . 3. Haizhen Lu: Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. E-mail: [email protected] . 4. Equal & Senior author: Yanxue Zheng, Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. E-mail: [email protected] . 5. Equal & Last Corresponding author: Xiaoqin Li: Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. E-mail: [email protected] . References Shilan Zhang, Chen Li, Deliang Liu. Progress of HDAC6 in primary malignant digestive system tumors [J]. World Chinese Digestive Journal,2018,26(14):827-833. CHEN Hui, ZHOU Siyuan, SUN Zhenqiu. Current status of research on the prevalence and burden of disease of three central common gynecologic malignancies[J]. Chinese Journal of Modern Medicine,2015,25(06): 108-1 12. Bray, Freddie; Ferlay, Jacques; Soerjomataram. Isabelle; GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [.J]. . a cancer journal for clinicians. 2018. Registered Nurses' Association of Ontario.Facilitating Client-Centred Learning [M ].Toronto, Canada: Registered Nurses' Association of Ontario Toronto, Canada: Registered Nurses' Association of Ontario, 2012. Garden C, Blomqvist K, Rask M. Challenges in everyday life among recently diagnosed and more experienced adults with type 2 diabetes: A multistage focus group study[J].J Clin Nurs, 2018,27(19-20):3666-3678. Narva A S, Norton J M, Boulware L E. Educating Patients about ClKD: The Path to Self-Management and Patient-Centered Care[J]. Clin J Am Soc Nephrol, 2016,11(4):694-703. Havas K, Douglas C, Bonner A. Person-centered care in chronic kidney disease: a cross-sectional study of patients' desires for self-management support [J] BMC Nephrol, 2017,18(1):17. Zhou Xiaoqin, Wang Zhiping, Dou Xinman. Application of LEARNS model in health education for patients with type 2 diabetes mellitus[J]. China Nursing Management, 2020,20(04):564-568. LIN Qiaoxuan, YOU Yingbin, SUN Yuxin. Application of LEARNS health education model in osteoporosis patients[J]. Qilu Nursing Journal,2020,26(06):66-69. SCOTT E S, MURPHY L S, WARSHAWSKY N E. Nursing administration research priorities: findings from a Delphi study[J]. The Journal of Nursing Administration,2016,46(5):238-244. LIU Xiangyu,CHEN Yongyi,ZHOU Yujuan. Construction of evaluation index system of satisfaction of nursing service for hospitalized patients[J]. Chinese Nursing Journal,2015,50(1):18-21. ZHAO Yuejiao, HUANG Li, ZHANG Jianfeng. Construction of midwifery quality evaluation index system[J]. Chinese Journal of Nursing,2017,52(5):592-598. Feng Xiang,Tian Jun,Wang Binquan,et al. Development of a nurse-led follow-up checklist for postoperative laryngeal cancer patients[J]. Chinese Journal of Nursing,2018,53(8):956-961. ZHANG Ying,JI Conghua,LI Qiushuang. Statistical analysis of the Delphi method is used in formulating and revising clinical practice guidelines of traditional Chinese medicine[J]. Chinese Journal of Traditional Chinese Medicine,2018,33(1):249-251. YANG Xiaoping, WANG Huizhen, QIN Liuhua. Research the weights of the evaluation index system of clinical nursing expert certification[J]. Nursing Research,2006,20(3A):589-592. Zhang Hui. Research on constructing a performance evaluation index system of clinical departments in a county-level public general hospital[J]. China Management Informatization,2015,18(24):141-142. Zeng G. Modern epidemiologic methods and applications [M]. Beijing: Beijing Medical University Peking Union Medical College Joint Publishing House,1994:250-270. Caroline H, Stéphane H, Guillaume H . Implementation of a patient-teaching workshop to improve pharmacy students' competencies in patient-centered communication: a case report[J].BMC Medical Education,2022,22(1):555-555. Hu Jiaqi. Evidence-based nursing research on preventing and managing venous thromboembolism in patients with gynecologic malignancies [D]. Chengde Medical College,2023.DOI:10.27691/d.cnki.gcdyx.2023.000381. Zou Congcong,Su Xiaoyu,Xie Chunli.Analysis of the application effect of LEARNS health education model in patients with gynecological benign diseases with type 2 diabetes[J]. China Health Education,2022,38(02):177-180.DOI:10.16168/j.cnki.issn.1002-9982.2022.02.017. Additional Declarations No competing interests reported. Supplementary Files questionnaire.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 12 May, 2025 Reviewers invited by journal 05 May, 2025 Editor assigned by journal 29 Apr, 2025 Editor invited by journal 11 Apr, 2025 Submission checks completed at journal 10 Apr, 2025 First submitted to journal 10 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Introduction","content":"\u003cp\u003eThe incidence of gynecologic malignancies remains high worldwide, with cervical, ovarian, and endometrial cancers known as the three major malignant threats to the female reproductive system\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. According to the latest statistical report of the International Agency for Research on Cancer (IARC), the number of new cases of cervical cancer, ovarian cancer, and endometrial cancer worldwide is 604,000, 314,000, and 417,000, respectively, which accounts for 18.6% of the total number of new cancer cases in the world. At the same time, deaths due to these gynecological malignant tumors account for a remarkable proportion of cancer deaths in the world, which is as high as 13.5% \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. According to the most recent data from the National Cancer Center of China, the incidence and mortality rates of gynecologic malignant tumors, mainly cervical, ovarian, and endometrial cancers, are among the highest among female cancers\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The treatment strategy for gynecologic malignant tumors usually adopts a comprehensive treatment model centered on surgery, supplemented by chemotherapy and radiotherapy. However, multiple factors, such as the aggressiveness of the disease itself, the trauma caused by surgery, and the side effects of radiotherapy, often subject patients to both physical and psychological stress, resulting in limited physical activity, reduced social participation, impaired physiological function, and decreased psychological adjustment, which in turn seriously affects their quality of life. Given the grave situation of gynecologic malignant tumors and their profound impact on patient's quality of life, it is imperative to explore efficient and systematic health education pathways.\u003c/p\u003e \u003cp\u003eThe guidelines for Promoting Patient-Centered Learning \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e were developed by the Registered Nurses Association of Ontario (RNAO), Canada, and have at their core the LEARNS model, which consists of the six English words: Listen, Establish, Adopt, Reinforce, Feedback, Teach, Name, and Strengthen. Its core LEARNS model, composed of the acronyms of Listen, Establish, Adopt, Reinforce, Name, and Strengthen, is used to guide clinical nursing workers in health education to promote patients' cognitive and behavioral competence in health education in this way. Overseas studies\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003ehave shown that the LEARNS model can improve the self-management level of diabetic patients and the self-efficacy of coronary heart disease patients. Relevant studies in China have proved \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e that the LEARNS model can improve the health education of type 2 diabetes patients, and it also has a positive impact on the level of knowledge, bone mineral density, and self-efficacy of osteoporosis patients. The application of the LEARNS model in our country has a better effect. However, the research is still tiny, so based on the national conditions of our country and the actual needs of gynecological malignant tumor patients, it is urgent and necessary to explore the health education and nursing pathway suitable for gynecological oncology patients in our country.\u003c/p\u003e"},{"header":"2. Information and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Establishment of a Study Group\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study team consisted of 8 members, with the following composition and responsibilities: 1 nurse with a postgraduate degree served as the core of the entire protocol construction process and was responsible for coordinating resources and controlling the quality of the study; 1 chief gynecologist was responsible for the clinical guidance of the protocol implementation; 4 gynecological nurse leaders were involved in the initial Development of the protocol, the Development of correspondence questionnaires, and the analysis of the clinical appropriateness of the evidence-based evidence; and two master\u0026apos;s degree students were responsible for literature search and analysis, as well as the distribution, retrieval, and collation and analysis of the results. Two master\u0026apos;s degree students were responsible for the literature search and analysis, distributing and collecting correspondence questionnaires, and compiling and analyzing results. All team members had a bachelor\u0026apos;s degree or above, with an average working experience of 10 years, which ensured the professionalism of the research team. This study was approved by\u0026nbsp;Affiliated Hospital of Jining Medical University\u0026nbsp;Ethics Committee (approval number: 2024-06-C025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Initial Development of Health Education Pathways\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the in-depth analysis and understanding of the theory of the LEARNS model, combined with the results of the literature review and group discussion, we initially constructed a framework for the health education pathway. We conducted a comprehensive search of PubMed, Web of Science, Sinomed (China Biomedical Literature Database), CNKI (China Knowledge), Wanfang Data (Wanfang Database), and VIP (Wipu Journal Resource Integration Service Platform) databases. The period was from the beginning of the construction of the databases to the latest results of May 2024. In Chinese, \u0026quot;nursing pathway,\u0026quot; \u0026quot;health education pathway,\u0026quot; \u0026quot;gynecologic malignancy,\u0026quot; and \u0026quot;health education\u0026quot; were used as subject terms. And \u0026quot;health education\u0026quot; in Chinese. In English, \u0026quot;care pathway, health education pathway,\u0026quot; \u0026quot;gynecological malignant tumors,\u0026quot; and \u0026quot;health education\u0026quot; were used as the theme words, and \u0026quot;health education\u0026quot; was used as the subject term. A total of 238 documents were obtained after the search. After eliminating duplicates, reading the titles and abstracts, and rereading the full text for re-screening, 10 documents were finally included. The time, content, evaluation indexes, and intervention effects of health education in the included literature were further sorted out and summarized. A preliminary draft of a health education pathway for gynecologic malignant tumor patients was formed, which covered health education content on the day of admission, preoperative, postoperative, and pre-discharge at several key time points, aiming to provide comprehensive, continuous, and personalized health education services for patients. At the same time, the research team also considered the individual differences and unique needs of different patients, trying to make the content of the pathway closer to the clinical reality and patient needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Expert correspondence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.1 Development of the questionnaire for expert correspondence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrepare an expert correspondence questionnaire based on the preliminary draft of the health education pathway, including the following: ①Letter to experts: background information, purpose, expected value, and significance of this study. At the same time, the deadline for submission of the questionnaire and the researcher\u0026apos;s contact information were clarified to ensure smooth and efficient communication. ②General information of experts: collect basic information including education, title, years of professional work experience, and organization. In addition, it includes a survey on the expert\u0026apos;s familiarity with the content of this study and the basis for their judgment to calculate the expert authority coefficient to ensure the reliability of the consulting results. ③The central part of the questionnaire adopts the Likert five-level scoring method, ranging from \u0026quot;very important\u0026quot; (5 points) to \u0026quot;very unimportant\u0026quot; (1 point) and from \u0026quot;very important\u0026quot; to \u0026quot;very unimportant\u0026quot; (1 point). In the body of the questionnaire, a five-point Likert scale was used, ranging from \u0026quot;very important\u0026quot; (5 points) to \u0026quot;very unimportant\u0026quot; (1 point), and experts were invited to score each entry. In addition, there is an open-ended comment box after each entry, allowing experts to make specific suggestions for \u0026quot;additions,\u0026quot; \u0026quot;deletions,\u0026quot; or \u0026quot;modifications\u0026quot; with reasons in order to collect and integrate expert feedback comprehensively. Expert feedback is collected and consolidated comprehensively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.2 Selection of Consultants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria:\u0026nbsp;①engaged in gynecology medical or nursing work in a tertiary hospital;\u0026nbsp;②education of bachelor degree or above;\u0026nbsp;③title of intermediate or above;\u0026nbsp;④engaged in related work for 10 years or above;\u0026nbsp;⑤voluntarily participated in this study. Exclusion criteria: experts who are not familiar with the content of this study or who voluntarily withdrew.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.3 Questionnaire distribution and retrieval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaires were distributed via WeChat and e-mail, with detailed instructions for completion and submission requirements, and experts were asked to respond within 2 weeks to review and provide feedback thoroughly. Based on the pathway entries meeting the mean importance score of\u0026ge;3.5, the coefficient of variation of\u0026le;0.25, and the full score ratio of\u0026gt;0.20 \u003csup\u003e[10]\u003c/sup\u003e, the corresponding entries were deleted and improved through the group discussion, and in light of the actual clinical situation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical methods\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExcel 2010 and SPSS 27.0 statistical tools were used for data entry and analysis, frequency and composition ratios were used for statistical descriptions, and reliability and internal consistency were tested using the recall rate, the mean of importance assignment, the full score rate, the expert authority coefficient, the coefficient of variation, and the coordination coefficient.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Basic information on experts\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 10 experts completed two rounds of expert correspondence in this study. The age of the 10 experts was 39～51 (48.20\u0026plusmn; 4.44) years; the number of years of experience ranged from 10 to 31 years; the education level included 2 PhDs, three master\u0026apos;s degrees, and five bachelor\u0026apos;s degrees; and the job titles included three full-level senior officers and seven associate-level officers. Positions included two medical directors of gynecology, seven gynecological care managers, and one clinical nurse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Degree of expert activism\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe positive coefficient of the experts was calculated using the recovery rate of the questionnaires, with a higher recovery rate representing a higher level of motivation of the experts\u003csup\u003e[11]\u003c/sup\u003e. Eleven questionnaires were distributed in round 1, and 10 were recovered. In comparison, 10 questionnaires were distributed in round 2, and 10 were recovered, with a recovery rate of 90.9% and 100.0%, respectively, which indicates that the experts were highly motivated to participate in the research topic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Degree of authority of experts\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe coefficient of authority (Cr) of an expert is the mean value of the expert\u0026apos;s familiarity with the research content of the topic (Cs) and the basis of judgment (Ca) \u003csup\u003e[12]\u003c/sup\u003e, and it is usually considered that a Cr \u0026ge; 0.70 is acceptable\u003csup\u003e[13]\u003c/sup\u003e. The Cs of the two rounds of expert consultation in this study were 0.75 and 0.75, Ca was 0.93 and 0.94, and Cr was 0.84 and 0.845, respectively, indicating a high degree of expert authority.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Degree of Concentration of Expert Opinion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean and standard deviation of the importance assignment were used to indicate the degree of concentration of expert opinions; the more significant the mean and the smaller the standard deviation, the more important the indicator and the more concentrated the expert opinions\u003csup\u003e[14]\u003c/sup\u003e. The mean score for the importance of the first round of expert correspondence was 4.10~ 5.00, with a coefficient of variation of 0 to 0.16. The mean score for the second round of expert correspondence was 4.10~ 5.00, with a coefficient of variation of 0 to 0.16.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Degree of harmonization of expert advice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe degree of harmonization of experts\u0026apos; opinions was measured by the coefficient of variation (CV) and Kendall\u0026apos;s harmonization coefficient (W). The smaller the CV, the higher the harmonization of experts\u0026apos; opinions; the higher the value of W, the higher the consistency of experts\u0026apos; opinions \u003csup\u003e[15]\u003c/sup\u003e. The coefficients of variation for each indicator ranged from 0 to 0.16 in the first round of expert correspondence and from 0 to 0.16 in the second round. Kendall\u0026apos;s concordance coefficients for the two rounds of expert correspondence were 0.171 and 0.111, respectively (both P\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.6 expert correspondence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eValid suggestions adopted and revised in the first round of expert consultation: Revise the first-level indicator \u0026ldquo;1-3 days after surgery; 4-6 days after surgery; 7 days after surgery - the day before discharge\u0026rdquo; to \u0026ldquo;during the postoperative hospitalization period\u0026rdquo;; add the phrase \u0026ldquo;warmly receive patient, introduce the regulations, environment, and system of the department, as well as the director of the department, head nurse, doctor in charge and nurse in charge\u0026quot;; add \u0026quot;postoperative follow-up: whether there is any abnormal vaginal bleeding; the situation of urination and defecation after discharge from the hospital; whether there is any urinary fistula; whether there is any sex life; whether there is any swelling of the lower limbs (lymphatic reflux is obstructed); whether there is any VTE; whether to conduct a review and the time of review\u0026quot;; \u0026quot;Use telephone follow-up, network follow-up and other forms of out-of-hospital follow-up of patients. To understand the degree of mastery of the content of previous health education and the occurrence of complications, etc.\u0026quot; was revised to \u0026quot;To conduct out-of-hospital follow-ups for patients using telephone and Internet follow-ups. To understand patients\u0026apos; confusion and difficulties in daily life after discharge from the hospital\u0026quot;. After further discussion by the health education team, add and revise the content: add \u0026quot;especially emphasize to patients that removal of the uterus/ovaries/vulva is only a treatment tool (not a physical defect).\u0026quot; There were no deletions or modifications in the second round of expert consultation, but only adjustments to the content and wording of some of the entries. These are summarized in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Results of expert consultation on health education pathway for patients with gynecologic malignancies\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"998\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eLevel 1 indicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eLEARNS model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eSecondary indicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eSignificance (x\u0026plusmn;s, points)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003ecoefficient of variation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePercentage of perfect scores (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"13\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eDay of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eL(listen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①\u0026nbsp;Listen to the patient\u0026apos;s complaints;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;\u0026nbsp;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②\u0026nbsp;Listen to the patient\u0026apos;s physical needs;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e③\u0026nbsp;Listen to the psychological needs of the patient;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e④\u0026nbsp;Listen to the social needs of patients;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eE (establish)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eMake a good impression and build initial rapport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eA (adopt)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①Welcome patients warmly and introduce the regulations, environment, and system of the department, as well as the director of the department, the head nurse, the doctor in charge, and the nurse in charge;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②To obtain general information about the patient\u0026apos;s family support and economic conditions;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e③\u0026nbsp;Introduce disease-related knowledge, dietary precautions, and targeted personalized psychological guidance to patients and their families;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e④\u0026nbsp;Instruct the patient on relevant examination items and precautions;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑤\u0026nbsp;Introduce the health education platform to patients and their families.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eR(reinforce)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eDo a good job of disease-related health education to patients and their families, and answer questions and answers from patients and their families.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eN(name)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eUse the LEARNS model Gynecologic Oncology Patient Health Education Pathway form to document and develop a plan of care based on the patient\u0026apos;s condition; ask questions about issues presented and explained; and encourage self-reporting.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eS(strengthen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eCorrect any responses that the patient misunderstands and repeat for emphasis.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eThe day before surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eL(listen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eListening to patients\u0026apos; and families\u0026apos; perceptions of the disease and surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eE (establish)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eFurther Development of harmonized partnerships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e40.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eA (adopt)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①\u0026nbsp;Instruct patients and family members to watch mission-related videos and read health manuals and health education pushes carefully;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②\u0026nbsp;Keep the skin clean to prevent postoperative infection;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e③\u0026nbsp;Prepare the respiratory tract with effective coughing and sputum methods;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.9\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e④\u0026nbsp;Prepare the intestinal tract; instruct the patient to eat a preoperative diet: rotten noodles or rotten noodle skin or steamed eggs at noon, easy-to-digest food (millet porridge, egg soup) for dinner, and forbid pasta, fruits, vegetables, etc., and determine the time when the patient is forbidden to drink water.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑤\u0026nbsp;Postoperative complication education as well as prevention: For example, measures to prevent VTE include instructing patients on postoperative ankle pumping exercises, straight leg raising and lower extremity flexion, turning in bed, hip lifting exercises, and getting out of bed;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑥Instruction in postoperative Diet and principles;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑦\u0026nbsp;Focus on the psychological care of patients, especially emphasizing to patients that removal of the uterus/ovaries/vulva is only a treatment (and not a physical defect) and guiding them to correctly understand the surgery based on the results of the psychological assessment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eR(reinforce)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eUniformly trained nursing staff will carefully guide patients and their families in reading the health education booklet, supplemented by an on-site demonstration of postoperative living conditions and care, to improve their understanding and mastery of the condition.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eN(name)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eFeedback on patients\u0026apos; and families\u0026apos; knowledge and skill mastery through the question-answer-question model and further improve health education based on patients\u0026apos; feedback results\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eS(strengthen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eDistribution of health education brochures, communication among patients, and viewing of the content of the education platform\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"17\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eThe day after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eL(listen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①Listen to the patient\u0026apos;s subjective feelings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②Listen to the patient\u0026apos;s current needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eE (establish)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①Build a harmonious relationship that allows patients to trust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e② Conducting postoperative instruction based on the concept of rapid surgical rehabilitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eA (adopt)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①\u0026nbsp;Postoperative position, method of bed movement, and early bed movement;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②Purpose and duration of postoperative fasting;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e③\u0026nbsp;Postoperative cardiac monitoring and vital sign monitoring considerations;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e④\u0026nbsp;Instruct on the significance, timing, and precautions of leaving various tubes in place;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑤\u0026nbsp;Oxygenation education, effective postoperative coughing methods and techniques;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑥Postoperative incision dressings, adjunctive therapy (limb pneumatic pressure, red light)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑦\u0026nbsp;Response to postoperative pain, nausea, and other discomforts;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑧\u0026nbsp;Names, effects, and adverse reactions of postoperative medications;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑨\u0026nbsp;Postoperative psychological reassurance to relieve patient anxiety;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑩Specialist guidance: self-observation and monitoring of vaginal bleeding.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eR(reinforce)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eA detailed explanation of the key points of postoperative care is needed to improve patients\u0026apos; and their families\u0026apos; awareness of and familiarity with the education content.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eN(name)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eEncourage patients or family members to demonstrate the process and key points on the spot. For example, on the spot, let the patient demonstrate how to do ankle pump exercise and why it is necessary. The educator should raise questions and give guidance to correct any misunderstandings.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.9\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eS(strengthen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eEncourage the patient and family to review surgical precautions, knowledge of the disease, and heart thoughts.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"19\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eDuring postoperative hospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eL(listen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①Listen to the patient for postoperative discomfort.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.3\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e40.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e② Listen to what problems the patient has with adaptation to surgery and nursing care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e③ Ask patients and families if there are unresolved issues with current care and what new issues have arisen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eE (establish)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eThe charge nurse clarifies whether a therapeutic partnership has been established with the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.1\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e10.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eA (adopt)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①Select appropriate educational methods according to the actual situation of the patients, such as watching videos and explaining practical operations, etc., and introduce postoperative precautions to the patients and their families.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②Early bed activities: gradually increase the number of bed activities and activity time to prevent postoperative intestinal obstruction;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e③\u0026nbsp;Drainage tube care: the significance of tube retention and precautions; observation of drainage fluid; risk assessment of extubation; guidance on extubation, etc.;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e④Pain management: pain assessment; analgesic drug management; pain relief methods; strengthen pain education;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑤Instruction on incision care: observation of incision drainage and healing, etc.;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.3\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e30.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑥Focusing on the psychological state of patients: exploring patients\u0026apos; feelings related to the disease since its onset, the adverse emotions they have developed, and their fears and worries about the recurrence of the disease;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑦Instructing patients to change negative emotions: introducing patients to real cases of cured gynecological tumor patients living positively; adopting the methods of guidance, comfort, and encouragement to make patients face up to the elimination of current problems; mobilizing the family support system; and guiding family members to take care of them to increase patients\u0026apos; confidence in recovery;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑧Encourage patients to participate in self-care as early as possible, arrange peer education, strengthen communication among patients, and enhance patients\u0026apos; confidence in self-care.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑨Self-care: Patients and their families participate in developing and guiding future rehabilitation programs, etc.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.9\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eR(reinforce)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①Guide patients or their families to understand gynecologic tumors and correctly recognize the characteristics of the disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②\u0026nbsp;Emphasize the importance of maintaining a positive mood;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eN(name)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①\u0026nbsp;Encourage patients or family members to review their knowledge of the tumor and correct any misunderstandings promptly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.4\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②\u0026nbsp;Evaluate the learning effect of patients and their families, summarize and sort out the problems of understanding difficulties with patients, and further rectification of the subject team members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eS(strengthen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①\u0026nbsp;Encourage patients and their families to watch the video explanation of the mission center repeatedly;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②Take different forms of intensive education for the contents that are ineffective in the mission.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"14\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eThe day before discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eL(listen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eConduct interviews to understand the patient\u0026apos;s knowledge of the disease in the hospital, whether new confusion arises during the period, solve the patient\u0026apos;s related problems in a timely manner, and leave a hotline for receiving relevant feedback from the patient after discharge and follow-up to strengthen the education.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eE (establish)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eAlways stand in the patient\u0026apos;s point of view, respect the patient\u0026apos;s participation in decision-making, rationally adopt the views of the patient, and gradually reach a consensus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eA (adopt)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①Management of cleanliness: keep the abdominal incision clean and dry after discharge from the hospital, remove the stitches for one week and then shower (prohibit the basin bath), keep the perineum clean, and change the underwear diligently;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.3\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e40.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②\u0026nbsp;Diet: After discharge from the hospital, the Diet should be light and easy to digest; it should be high in protein, vitamins, and minerals.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.9\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e③Activity: Combine work and rest. Hysterectomized patients do not lift heavy objects within 2 months. Avoid violent coughing and other actions that increase abdominal pressure.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e④Sexual life: Sexual life can be resumed after 3 months for total hysterectomy and 1 month for other surgeries.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑤Guidance on taking medication with you when you leave the hospital: How to take and use it.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑥Self-care of incisions: Incision healing;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.9\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑦Discharge procedures: Processing, expense reimbursement settlement, etc;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e5\u0026plusmn;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑧Guidance on postoperative follow-up: regular outpatient follow-up, adjuvant radiotherapy, and situations that warrant immediate follow-up in the hospital;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e⑨\u0026nbsp;Family and social life guidance: postoperative reintegration guidance, change of poor lifestyle.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eR(reinforce)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eRe-explain the areas where patients have doubts, encourage patients to learn from each other, ask questions, and make sure that patients have mastered all the knowledge and skills until the end\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.4\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e40.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eN(name)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eRe-evaluate the learning effect of patients and their families to check whether they can correctly articulate their understanding of the key points of oncology care and apply them to their daily lives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eS(strengthen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eEncourage patients and families to deepen their understanding and knowledge of oncology and nursing care through a variety of means\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e80.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eFollow-up 1 month after discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eL(listen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eTo follow up with patients outside the hospital by telephone and Internet, and to understand patients\u0026apos; confusion and difficulties in daily life after discharge from the hospital.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.9\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eE (establish)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eFurther, it strengthens the already constructed therapeutic partnership with the patient.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eA (adopt)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e①Postoperative follow-up: any abnormal vaginal bleeding; urination and defecation after discharge from the hospital; any urinary fistula; any sexual life; any swelling of the lower limbs (obstruction of lymphatic reflux); any occurrence of VTE; whether to have a review and the time of the review.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e②Guide patients to review the learning during this period, share the gains of participating in the activities and the benefits to disease recovery, and give personalized guidance based on the feedback results.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003e③Patients with malignant tumors involve follow-up treatment and symptom care.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.6\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eR(reinforce)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eA combination of approaches to emphasize daily living considerations when conditions permit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eN(name)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003ePatients and families are asked to follow the instructions in their daily lives and compare how they have changed previously\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.5\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eS(strengthen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 468px;\"\u003e\n \u003cp\u003eEncourage patients to continue to seek community service resources after discharge, and inform patients of social resources available to them after discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e4.9\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e \u003cb\u003e4.1 The health education pathway for patients with gynecologic malignancies based on the LEARNS model has reliability and scientific validity\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study constructed a perioperative health education pathway for gynecologic malignancy patients based on the LEARNS model through a literature review, group discussion, and two rounds of expert correspondence. During the Delphi expert consultation, 90% of the experts had been engaged in gynecological nursing for 10 years, which was professionally representative and ensured the authority and representativeness of the consultation results. The effective recovery rates of the questionnaires for the two rounds of expert consultation in this study were 90.90% and 100.0%, respectively, indicating that the experts' motivation and participation were high, which enhanced the reliability of the study results. The expert authority coefficient remained above 0.70 during both rounds of consultation, proving the authority and broad representation of the expert team \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Meanwhile, the Kendall coordination coefficients were 0.171 and 0.111 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), which not only revealed a high degree of consistency in the experts' opinions but also reflected their wide recognition and positive support for the path content \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, so the conclusions of this study are scientific and reliable.\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.2 The health education pathway for patients with gynecologic malignancies based on the LEARNS model is comprehensive and useful\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBased on the evidence-based \"Promoting Patient-Centered Learning\" guideline \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, this study closely integrates the actual clinical situation and the health needs of patients at different stages and develops primary indicators containing 6-time points (including the day of admission, the day before surgery, the day after surgery, the day of postoperative hospitalization, the day before discharge, and one-month follow-up after discharge) and 83 entries framed by the LEARNS model as The secondary indicators take into full consideration the observation and nursing points required by patients at different stages in the setting of specific contents. The setting of the indicators is in line with the actual clinical work, with specific content, strong scientificity, and operability, and provides a reference tool for clinical health education.\u003c/p\u003e \u003cp\u003eThis study was conducted one month after patient discharge to provide follow-up instructions, emphasizing the importance of continuity of care in health education. Given the complexity of postoperative care for gynecologic cancers, significant attention has been given to preventive and nursing measures for managing long-term complications. Key areas of focus include monitoring urinary fistulae, managing lower extremity lymphedema (which can occur due to impaired lymphatic flow), and preventing venous thromboembolism(VTE) \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Therefore, it is essential to understand patients' health needs during the first month after surgery and to offer personalized guidance that promotes self-management and life skills \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn summary, the health education pathway for patients with gynecologic malignancies, based on the LEARNS model developed in this study, is both comprehensive and practical. It effectively supports clinical nursing practice by providing all-encompassing guidance and services throughout the entire patient care cycle. However, since the Delphi method relies on subjective judgment and evaluation by experts, it has certain limitations. Therefore, we plan to validate the feasibility and effectiveness of this pathway in future studies and continue to explore and optimize its application strategies to benefit a greater number of patients with gynecological malignancies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e This study was approved by\u0026nbsp;Affiliated Hospital of Jining Medical University\u0026nbsp;Ethics Committee (approval number: 2024-06-C025).\u0026nbsp;he study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The data collection, the purpose of the study, and the survey method were explained to the manager of the institution, and permission to conduct the study was obtained. Written informed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eAll data supporting our findings were presented within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests:\u003c/strong\u003e None declared.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e:\u0026nbsp;Each author is expected to have made substantial contributions to the conception XQN design of the work; YYY the acquisition, analysis, LXQ interpretation of data; LHZ the creation of new software used in the work; ZYX have drafted the work or substantively revised it.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e We thank the department\u0026apos;s experts and colleagues for their guidance and support during this research and thesis collaboration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClarification:\u003c/strong\u003ethe questionnaire used in your study was developed for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. First Auther: Qiannan Xu, Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. Kai Liu E-mail:[email protected];\u003c/p\u003e\n\u003cp\u003e2. Yuanyuan Yang, Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. E-mail:[email protected].\u003c/p\u003e\n\u003cp\u003e3. Haizhen Lu: Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. E-mail: [email protected].\u003c/p\u003e\n\u003cp\u003e4. Equal \u0026amp; Senior author: Yanxue Zheng, Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. E-mail:[email protected].\u003c/p\u003e\n\u003cp\u003e5. Equal \u0026amp; Last Corresponding author: Xiaoqin Li: Gynecology Comprehensive Ward of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China. E-mail:[email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShilan Zhang, Chen Li, Deliang Liu. Progress of HDAC6 in primary malignant digestive system tumors [J]. World Chinese Digestive Journal,2018,26(14):827-833.\u003c/li\u003e\n\u003cli\u003eCHEN Hui, ZHOU Siyuan, SUN Zhenqiu. Current status of research on the prevalence and burden of disease of three central common gynecologic malignancies[J]. Chinese Journal of Modern Medicine,2015,25(06): 108-1 12.\u003c/li\u003e\n\u003cli\u003eBray, Freddie; Ferlay, Jacques; Soerjomataram. Isabelle; GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [.J]. . a cancer journal for clinicians. 2018.\u003c/li\u003e\n\u003cli\u003eRegistered Nurses\u0026apos; Association of Ontario.Facilitating Client-Centred Learning [M ].Toronto, Canada: Registered Nurses\u0026apos; Association of Ontario Toronto, Canada: Registered Nurses\u0026apos; Association of Ontario, 2012.\u003c/li\u003e\n\u003cli\u003eGarden C, Blomqvist K, Rask M. Challenges in everyday life among recently diagnosed and more experienced adults with type 2 diabetes: A multistage focus group study[J].J Clin Nurs, 2018,27(19-20):3666-3678.\u003c/li\u003e\n\u003cli\u003eNarva A S, Norton J M, Boulware L E. Educating Patients about ClKD: The Path to Self-Management and Patient-Centered Care[J]. Clin J Am Soc Nephrol, 2016,11(4):694-703.\u003c/li\u003e\n\u003cli\u003eHavas K, Douglas C, Bonner A. 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Chengde Medical College,2023.DOI:10.27691/d.cnki.gcdyx.2023.000381.\u003c/li\u003e\n\u003cli\u003eZou Congcong,Su Xiaoyu,Xie Chunli.Analysis of the application effect of LEARNS health education model in patients with gynecological benign diseases with type 2 diabetes[J]. China Health Education,2022,38(02):177-180.DOI:10.16168/j.cnki.issn.1002-9982.2022.02.017.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"LEARNS model, gynecologic malignancies, health education, pathways","lastPublishedDoi":"10.21203/rs.3.rs-6323668/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6323668/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe aim was to develop a health education pathway system for patients with gynecologic malignancies based on the LEARNS framework, to provide clinical caregivers with a set of systematic and all-encompassing health education strategies, in order to improve the effectiveness of care and the quality of health education for patients with gynecologic malignancies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: In this study, two rounds of correspondence were conducted with 10 experts in the field by using the Delphi method through literature systematic evaluation and group discussion. Based on the preset index screening entries and the experts' feedback, the pathway's content was optimized, and a set of health education pathways for gynecological malignancy patients was finally established.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: In the two rounds of expert consultation, the positive coefficients of the experts were 90.9% and 100.0%, the authority coefficients of the experts were Cr 0.84 and 0.845, and the Kendall coordination coefficients of the expert's opinions were 0.171 and 0.111, respectively (both P\u0026lt;0.001), and the finalized health education pathway covered the 10 core first-level indicators and 83 secondary indicators.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The health education pathway for gynecologic malignant tumor patients based on the LEARNS model constructed in this study is scientific, comprehensive, and operable.\u003c/p\u003e","manuscriptTitle":"Construction of a health education pathway for patients with gynecologic malignancies based on evidence-based and LEARNS models","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 11:00:20","doi":"10.21203/rs.3.rs-6323668/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"8888118807837313116303668953206681614","date":"2025-05-12T18:24:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-05T05:00:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T06:42:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-11T11:10:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-11T00:18:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-04-11T00:17:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63f90f16-9c2d-4ee8-9175-4165e3a8999e","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-09T11:00:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 11:00:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6323668","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6323668","identity":"rs-6323668","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}