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

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