Data of 128 patients with IBD in gastrointestinal surgery from March 2019 to August 2021 were retrospectively analyzed, and they were divided into group A and group B according to different nursing methods, with 64 cases in group A and 64 cases in group B.

Patients matched the diagnostic standards of IBD in the Consensus Opinion on the Diagnosis and intervention of Inflammatory Bowel Disease in gastrointestinal surgery (2018, Beijing)[5]; all patients underwent surgical intervention; and patients signed the consent form.

Patients with chronic heart, liver, and kidney function; patients with lingual function and intellectual impairment; patients with ischemic colitis, infectious colitis, and other colonic diseases; patients with intestinal cancer and obstructive diseases; and patients with incomplete clinical case data.

The lecture discussed patients’ health knowledge of inflammatory enteritis during hospitalization and answered the questions on the spot. Propaganda posters were posted in the department, and medication guidance was given to the patients when hospitalized. The patients were instructed to follow the doctor’s prescription in taking medicine, recognize adverse drug reactions, and ask for return visits regularly.

Group A was given a follow-up intervention based on the Omaha System on the basis of routine intervention for a total of three months. As the framework of nursing practice, Omaha System consists of three parts: Problem classification system, intervention system, and effect evaluation.

Problem classification system: Based on the patient’s clinical symptoms, signs, and basic personal situation, the related nursing problems were put forward from the physiology, psychology, health behavior, and ecological perspectives of the Omaha System. The nursing problems were described and ranked in the priority order by evaluating the patients’ coping styles, disease awareness, and self-nursing ability using corresponding scales. The nursing problems include low awareness of the disease, high psychological pressure, and poor living habits.

Health education, guidance, and consultation: Scientific knowledge lectures on inflammatory diseases were organized regularly every week, and on-site guidance and explanation were provided for patients’ problems. A patient association, an example, or a mutual aid group can be established. The patient with outstanding comprehensive quality was selected as the group leader, showing strong self-management ability, outgoing personality, sense of responsibility, and communication ability. The purpose was to assist the nursing staff of the transitional care group in managing IBD patients. Tencent’s official account of inflammatory diseases in our department was established. Patients used the scale in the official account to conduct self-assessment, and targeted intervention was given based on the evaluation results of patients. The Handbook of Out-of-Hospital Self-nursing for IBD Patients was issued (compiled by members of the transitional care team based on clinical nursing experience and literature, approved by physicians). This manual included knowledge of IBD disease, dietary advice, behavioral contraindications, common symptoms during the recovery period, intervention plans in case of particular accidents, and other matters needing attention. Health registration forms were issued, which were registered by the nursing staff while the patient was in the hospital. After discharge, the record of the diet, exercise, medication, adverse reactions, self-feeling, and other symptoms of patients were performed by patients themselves. WeChat groups and QQ groups for doctor-patient interaction were created. Each patient or his or her family members were ensured in the group when discharged. Their real names were marked to facilitate follow-up disease communication, doubts answering, supervision and guidance. Each patient was informed of the department’s hotline. WeChat official account to ensure that each patient records and follows, as well as the push cycle and content arrangement of the WeChat official account (regular push at 13:00 on Mondays, Wednesdays, and Fridays, mainly with pictures and texts, supplemented by videos, and the pushed content included disease knowledge, self-nursing knowledge, and health knowledge).

Operating procedures: (1) Medication guide: Based on the registration form of the patient during hospitalization and the recovery status of the patient, the relevant knowledge of medication was popularized to the patient and his family members, and the adverse reactions and symptoms of the drug were informed, the time and dosage of medication were told to the patient, and the dosage of medication was ensured; (2) Diet nursing: The nursing staff emphasized the importance of dietary care to the patients and their families. Eating foods rich in cellulose, protein, easy to digest, and high calories and prohibiting functional stimulant foods are suggested. If the patients suffer from food intake obstruction, it is suggested that the patients should be hospitalized for a follow-up visit. The intravenous injection of nutrients was taken to reduce the burden on the digestive system, and the patients and their families were guided to write diet diaries; (3) Abdominal pain nursing: Analgesic methods were explained to the patient based on the location, degree, and changes of abdominal pain. Antispasmodic drugs were given according to the patient’s situation, and the dosage of drugs was reminded for the patient; (4) Diarrhea care: Patients with mild diarrhea should strengthen perianal cleaning and nursing, keep the bed dry and smooth to avoid infection, and monitor the occurrence of diarrhea. It is also essential to monitor the number of diarrheas, stool color, bleeding, blood stool care, and severe IBD patients with gastrointestinal pus and blood symptoms should seek intervention immediately; (5) Daily life: Patients were instructed to work and rest regularly and to take low-intensity physical exercises, such as walking and playing Tai Chi; (6) Self-nursing ability: Patients were guided to measure the changes in body temperature and weight regularly every day to identify related symptoms and complications, such as severe abdominal pain and stool bleeding, which were needed to seek medical attention in time; and (7) Follow-up frequency: Home follow-up was conducted once a week after discharge < 1 mo and once every 2 wk after discharge 1-3 mo. The primary objective of the sequel was to diagnose the effect on patients, understand medication compliance, diet, exercise, and psychological changes, answer complex problems encountered during the nursing process on-site, and correct bad behavior, emphasizing the importance of persistent nursing.

Case management: Achievable goals were made, and corresponding nursing measures were executed based on the ability of patients and caregivers to promote rehabilitation. For example, establishing self-health management, record daily habits, abdominal pain, diarrhea and possible symptoms and signs, guide patients to self-supervision, actively participate in disease management, and improve patients’ self-care awareness and self-health management ability. Patient’s family members can also be invited to participate, urge patients to get rid of bad habits, encourage patients to exercise actively, and promote collaborative management of family members.

Nursing evaluation: The coping style, disease awareness, quality of life, self-nursing ability, disease activity, and compliance of patients after the intervention were evaluated.

Medical Coping Modes Questionnaire (MCMQ)[6], Crohn’s and Colitis Knowledge Score (CCKNOW)[7], Inflammatory bowel disease in gastrointestinal surgery questionnaire (IBDQ)[8], Exercise of Self-nursing Agency Scale (ESCA)[9], The Modified Mayo Endoscopic Score[10], and Beliefs about Medicine Questionnaire (BMQ)[11] date were collected and analyzed of the two groups. MCMQ mainly included three dimensions: Facing (8 objects, 0-32 points), avoidance (7 objects, 0-28 points) and surrender (5 objects, 0-20 points). CCKNOW was used to evaluate patients’ disease awareness before and after the intervention. It mainly included general knowledge (11 questions), diet knowledge (2 questions), drug knowledge (6 questions), and complications knowledge (5 questions). The score ranged from 0 to 23 (the 14^th and 15^th questions applied to Crohn’s disease and respective ulcerative colitis). The score was positively proportional to the awareness of the disease. IBDQ mainly included four aspects: Systemic symptoms, intestinal symptoms, social function, and emotional function, and each aspect included seven items. Each item ranges from 1-8 points, with an overall score of 28 to 224. ESCA mainly included four aspects, including the level of health knowledge, personal care-abilities, self-perception, and self-awareness score, totaling 43 items. The range of a single object starts from 1 to 4 points, and overall the score ranges between 43-172 points. Modified Mayo scoring system included four aspects: Frequency of defecation, frequency of bloody stool, endoscopic performance, and the overall evaluation of doctors. Single objects range from 0-3 points; overall, the score range was 0-12. The score of the disease was positively correlated with the severity of the disease. BMQ were used to assess patients’ medication beliefs. This scale mainly included two dimensions: Medication necessity (5 items) and medication concern (5 items). A single item from 1 to 5 points, and the range of scores was 10-50 points. The score was directly proportional to the more substantial the medication belief.

Data descriptive statistics were analyzed using SPSS (version 22.0). The scoring data were measured as a percentage (%) and then compared between groups using a χ² test. The categorical variables were represented as mean ± SD after the normality test, and then the data of both groups were compared using the independent sample t-test. The paired sample of the t-test was used to compare differences within the groups. GraphPad Prism-5 was used for representing the data in graphs keeping the significance level at P < 0.05.

The study showed no significant differences in the general data between these two groups (all P < 0.05, Table 1).

As before, the intervention showed no significant differences in confronting, avoidance, and surrender scores between both groups (all P < 0.05). After an intervention, it showed that the group A scored higher in confronting but lower in avoidance and surrender scores than the group B (all P < 0.05, Figure 1A). The confronting score of the group A was more significant than the group B, and the avoidance and surrender scores were lower than the group B (all P < 0.05, Table 2, Figure 1A).

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Figure 1 Comparison of different methods among both groups before and after the intervention (points). A: Medical Coping Modes Questionnaire scores; B: Exercise of Self-nursing Agency scores; C: Disease activity; D: Crohn’s and Colitis Knowledge scores; E: Intervention compliance; F: Inflammatory bowel disease questionnaire scores. ^aP < 0.05, comparison with the group A. ESCA: Exercise of Self-nursing Agency; CCKNOW: Crohn’s and Colitis Knowledge; BMQ: Beliefs about Medicine Questionnaire; IBDQ: Inflammatory bowel disease questionnaire.

Before the intervention, showed no significance in the differences in individual scores and total scores on the ESCA scale between both groups (all P > 0.05). After the intervention, the level of health knowledge, self-nursing skills, self-concept, self-responsibility score, and ESCA total scores of the group A were more significant than the group B (all P < 0.05, Table 3, Figure 1B).

Before the intervention showed no significant differences in the score of disease activity and total scores between the two groups (all P > 0.05), after the intervention, the hematochezia, endoscopic manifestations, overall physician evaluation score, and total score of disease activity in the group A were lower than in the group B (all P < 0.05, Table 4, Figure 1C).

No significant difference was existed between the individual score and total score of the CCKNOW scale (all P > 0.05). After the intervention, the score of general knowledge, drug knowledge, complication knowledge, and total CCKNOW score in the group A was more significant than in the group B (all P < 0.05, Table 5, Figure 1D).

Before the intervention, no significant differences were observed in individual scores and total score of BMQ between the two groups (all P > 0.05). After the intervention, the scores of medication necessity, medication concern, and BMQ total score in the group A were more significant than in the group B (all P < 0.05, Table 6, Figure 1E).

Showed no significant differences in individual scores and total scores of IBDQ between both groups (all P > 0.05). After the intervention, the scores of systemic symptoms, intestinal symptoms, social function, emotional function, and IBDQ total score in the group A were more significant than in the group B (all P < 0.05, Table 7, Figure 1F).

Postoperative follow-up nursing of gastrointestinal surgery patients can effectively improve the quality of life of patients. Currently, a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients. The purpose of this study is to explore a more effective nursing plan for postoperative follow-up nursing of gastrointestinal surgery patients.

The main content of this study is postoperative follow-up care for gastrointestinal surgery patients. Currently, more effective follow-up care plans are needed to improve the prognosis of gastrointestinal surgery patients. The significance of this study is to affirm the effectiveness of new nursing methods for gastrointestinal surgery patients, encourage clinical teams to continue to explore better nursing methods for gastrointestinal surgery patients, and promote continuous improvement and innovation of nursing plans.

The main objective of this study was to compare the nursing effects of different nursing methods, observe the advantages of the follow-up program based on the Omaha System in the follow-up care of intestinal surgery patients, confirm that the follow-up program based on the Omaha System can effectively improve the disease awareness, treatment compliance, self-care ability and quality of life of gastrointestinal surgery patients, and prove that the nursing method has a good nursing effect. It provides a new reference for postoperative follow-up nursing of gastrointestinal surgery patients.

In this study, data of patients with inflammatory bowel disease in gastrointestinal surgery were retrospectively analyzed and grouped according to nursing methods. Then, independent sample t test, paired sample t test and χ² test were used to conduct statistical analysis on the general information, disease coping style, disease awareness, quality of life, self-care ability, disease activity and compliance of the two groups of patients. The characteristics of retrospective study are that it is easier to obtain case data by exploring the causes through the results.

The follow-up program based on the Omaha system has a remarkable nursing effect, with better improvements in patients’ disease coping style, disease awareness, quality of life, self-care ability, disease activity and compliance, providing a new nursing method for postoperative follow-up care of gastrointestinal surgery patients, and further prospective exploration is needed to further explore the effectiveness of inflammation modification nursing method.

The postoperative coping style of gastrointestinal surgery patients can affect their prognosis and quality of life, so clinical nursing should pay attention to improving the coping style of patients and strengthening the psychological nursing management. The follow-up plan based on the Omaha System has a good nursing effect, and the best nursing plan should be given priority in clinic.

Follow-up care based on the Omaha System can improve the objective indicators of gastrointestinal surgery patients, while the impact of subjective indicators on patients such as postoperative recovery and complications needs to be further explored.