Application of rehabilitation nursing technology in the pulmonary rehabilitation of the patients after lung cancer operation

ABSTRACT The rehabilitation nursing of lung function at home for lung cancer patients after operation can not only improve the level of lung function and the quality of life but also improve the compliance of patients with treatment and improve their psychological status. Studies have shown that respiratory training, exercise training and rehabilitation nursing techniques of Chinese medicine, such as Six‑Word Qigong , Tai Chi and Baduanjin have better effects on lung function recovery in patients after lung cancer surgery. In this paper, we made review and discussion on the application of the above methods in patients with lung cancer at home after operation.

Keywords: Home nursing, lung cancer, lung function, rehabilitation nursing technology

INTRODUCTION

The latest global cancer statistics in 2018 showed that lung cancer is still the first malignant tumor with morbidity (11.6%) and mortality (18.4%).[1]Surgery is the first choice for the treatment of lung cancer. Due to the reduced compliance of the chest and lungs after surgery, the failure to effectively expel the gas in the alveoli will cause a decrease in the lung function of the patients.[2]Rehabilitation nursing technology mainly refers to the nursing staff assisting the patient to restore the body function through personalized nursing technology intervention according to the treatment plan. Postoperative rehabilitation nursing interventions for patients with lung cancer can improve the level of postoperative lung function and quality of life.[3,4]Lung cancer patients need to be rehabilitated or treated at home or in the community after discharge. Home rehabilitation nursing can be used as a continuation and supplement of inpatient treatment,providing patients with personalized and professional nursing technical services in the family, enabling patients to perform some exercises within their ability to improve the quality of life and psychological state, and reducing their dependence on medical equipment and their economic burden.[5-7]Olivier et al.’s[8]research shows that home-based lung rehabilitation is safe and feasible. This article discussed the application of rehabilitation nursing techniques in the rehabilitation of lung function in patients with lung cancer after surgery.

WESTERN MEDICINE REHABILITATION NURSING TECHNOLOGY

Breath training Lip contraction breath and abdominal breath training

Lip contraction breathing and abdominal breathing are the most commonly used breathing training methods for patients with lung diseases. Lip constriction breathing inhales through the nose as much as possible and exhales slowly as to whistle through the mouth; the ratio of inhalation to exhalation time is 1:2 or 1:3. Abdominal breathing is that the chest remains immobile, bulging the abdomen when breathing in deeply through your nose, and slowly exhaling gas when the abdomen contraction. Lip contraction breathing can increase the expiratory resistance, which is beneficial to the emptying of air in the alveoli; abdominal breathing can increase the range of motion of the diaphragm, expand the vital capacity, and improve the gas exchange efficiency.[9]Hu[10]instructed lung cancer patients to take breath exercise by means of lip contraction and abdominal breathing on the basis of routine nursing. After 15 days of intervention,the levels of forced expiratory volume in fist second (FEVl),forced vital capacity (FVC), and FEVl/FVC of lung cancer patients in the observation group were higher than those in the control group, indicating that lip contraction and abdominal breathing training can improve lung function of lung cancer patients. After lung cancer surgery, patients can effectively improve their lung function by using the methods of lip contraction and abdominal breathing. To enhance the evacuation of residual air volume, abdominal pressure can be given at the end of exhalation.[11]The research results of Xu[12]showed that the lung function level of the patients in the treatment group was higher than that in the control group (P ＜ 0.05). The method of lip contraction and abdominal breathing training is simple, and it is suitable to take breathing exercises at home for patients after lung cancer surgery.

Breathing trainer training

Breathing training device is a new type of physical therapy that aids to restore normal breathing. At present, the commonly used breathing training is the three-ball breathing training apparatus. Use the breathing trainer to fully dilated the chest and alveoli, help to restore the respiratory function of the lungs, reduce and prevent postoperative complications.[13]Huang and Zhang[14]studied the effect of respiratory training device on the respiratory function of lung cancer patients,four times a day, 5 min rest after each completion. The results showed that PaO2, FVC, and FEV1 in the observation group were significantly higher than those in the control group (P ＜ 0.05), indicating that the use of a breathing trainer for breathing training can effectively improve the lung function of patients after lung cancer surgery. The results of Guo et al.[15]showed that the use of respiratory training device training in patients with pulmonary lobectomy during perioperative period was more conducive to the discharge of sputum. Respiratory trainer is simple and portable, easy for family members and patients to master its use, and can provide scientific and quantitative training methods. The patients and their families can objectively understand the training situation and improve the patients’ confidence in disease recovery. However, Chen et al.[16]pointed out that the effect of resistance breathing training device training on lung function of patients with lung cancer after chemotherapy was not obvious. This needs further studies to prove.

Balloon‑blowing training

Balloon-blowing training can increase the expiratory resistance of lung cancer patients, promote the recovery of lung function, and facilitate the drainage of residual fluid and gas in the thoracic cavity.[17]Li et al.[18]directed the patients with lung cancer after operation to carry out balloon-blowing training. After forced inhalation, all the air in the lungs was blown into the balloon, 5 times/min, 3–4 times/day. The results of intervention for 3 months showed that balloon-blowing training can promote the recovery of respiratory function of patients with lung cancer after a radical operation. Li[19]used balloon-blowing and swinging method to exercise lung function in the intervention group after radical resection of lung cancer. After intervention, FVC, FEV1%, and 6-min walking test in the observation group were significantly improved compared with the control group (P ＜ 0.05). The balloon-blowing training method is simple and intuitive.Patients can master it quickly, and it is safe and effective. It can effectively improve the lung function of patients after lung cancer surgery. At the same time, the materials are cheap and easy to get, and the patients and their families have strong participation. It is easy to carry out lung function rehabilitation training for lung cancer patients in the family.

Respiratory gymnastics

Breathing exercise is a method of adding limb training on the basis of breathing exercise, which can increase respiratory muscle strength and endurance, promote the rehabilitation of lung function, and reduce postoperative complications of lung cancer. The breathing gymnastics is simple, with high safety, so the patient is easy to accept. Ye and Xie[20]provided family rehabilitation breathing gymnastics training for patients with lung cancer after operation, 10 min/time, twice a day, including lateral bending exercise, chest compression exercise, turning exercise, leg lifting exercise, and finishing exercise. The first four items are all carried out in sitting position, while finishing exercise in standing position is combined with respiratory training and sports training.The results show that breathing gymnastics training can effectively improve lung function and psychological state of lung cancer patients. Qu et al.[21]directed the patients in the experimental group to carry out eight steps of early exercise for lung function rehabilitation training, including breathing exercise, effective cough, active fist clenching, upper limb exercise, hip lifting exercise, lower limb exercise, ankle pump exercise, and turning over exercise, 6 times/day. The results showed that the postoperative complications in the experimental group were less than those in the control group.

Exercise training

The main methods of exercise training for pulmonary function rehabilitation are upper and lower limb exercise and aerobic exercise. Aerobic exercise can increase physical endurance and improve cardiopulmonary function. Upper limb exercise can strengthen respiratory muscles, and lower limb exercise can enhance exercise endurance;[22]upper limb training can be carried out step by step through lifting, abduction, circling,etc., and lower limb exercise can be carried out through walking, climbing stairs, pedaling, etc.[11]The exercise time is 30–60 min/time and 3–5 times/week. It is better for patients not to feel tired.[23]The foreign researches[24,25]show that upper and lower limb exercises and exercise intervention of endurance training have a positive impact on the quality of life and physical function of lung cancer patients. Zhang[26]instructed the lung cancer patients to lie on their back and do the bicycle pedals after lobectomy, 10–20 min/time,3 times/day. The results showed that the lung function of the patients improved significantly. In addition to aerobic exercises such as fast walking, jogging, and aerobics,patients can also use fixed bicycles for pedaling exercise, or take cycling exercise according to their own conditions, or exercise on the treadmill.[27]These training can be carried out in family and community not only for the rehabilitation training of lung function but also used as daily exercise;therefore, family members and partners can participate to increase the interaction with patients as well as improve the psychological state of patients.

REHABILITATION NURSING TECHNOLOGY OF TRADITIONAL CHINESE MEDICINE

Acupoint application

Acupoint application is first seen in the general theory of Suwen (Plain Questions). It is to apply traditional Chinese medicine to the required acupoints or the affected part.Through acupoint stimulation, the external use of traditional Chinese medicine on the skin can achieve the purpose of disease treatment.[28]It is indicated for those who refuse to take medicine or cannot take medicine. The cough ability of lung cancer patients after surgery is reduced, which is easy to cause atelectasis and pulmonary infection, thus affecting the lung function of patients.[29]Zhang et al.[30]studied the effectiveness of acupoint application in the treatment of cough and asthma in patients with advanced lung cancer and selected Feishu, Dingchuan, Fenglong, Shenshu, and other acupoints for external application based on syndrome differentiation of drugs such as raw white mustard, raw asarum, raw ephedra, corydalis, kansui, and borneol and found that acupoint application has good effect in the treatment of cough of lung cancer. Shan et al.[31]treated the cough of the patients with spleen deficiency and phlegm dampness in the intervention group by external application of Zhike Huatan plaster on Tiantu and Dazhui points. It was found that the scores of cough symptoms and visual simulation in the patients with spleen deficiency and phlegm dampness in the intervention group were higher than those in the control group after treatment, which indicated that acupoint application could alleviate the cough symptoms of spleen deficiency and phlegm dampness in the late nonsmall cell lung cancer. In addition, acupoint application of traditional Chinese medicine is simple in operation, cheap,and has few side effects as well as reduces the pain of taking medicine.

Six‑Word Qigong breathing exercise

Six-Word Qigong is a very simple and ancient method of breathing. The earliest documentary records are found in Records of Nourishing the Body and Extending Life, and the more complete records are first seen in Tao Hongjing in the southern and northern dynasties. Through the pronunciation of the six words “xu, he, hu, si, chui, and xi”, it affects the operations of different zang-fu organs, meridians, qi, and blood.[32]“Fitness Qigong--Six-Word Qigong” was created by the General Administration of Sports of the People’s Republic of China. When inhaling and exhaling with combined with the corresponding body movements, it has a very good exercise value for improving the function of respiratory muscles. A foreign literature research[33]shows that the Six-Word Qigong is beneficial to assist the function of respiratory muscles and improve lung function, 6-min walking distance (6MWD), and quality of life, and it is safe and interesting. In the study conducted by Liu,[34]the elderly patients with lung cancer with Qi-deficiency constitution take Six-Word Qigong breathing training, 20 min each time,in the morning and night, the results showed that it can improve the patients’ physique, lung function, life quality,and activity ability. In addition, Six-Word Qigong breathing exercise is easy to learn and does not need special venues and equipment.[35]Therefore, according to the self-healing condition, patients with lung cancer can exercise in a whole set or selectively at home.

Tai Chi

Tai Chi is guided by Chinese traditional martial arts and is formed on the basis of the “I Ching”. It emphasizes the concentration of attention, the unity of body and mind, and exercises energy with the heart during the exercise. It is a low-medium intensity exercise capable of improving the physical quality, enhancing the immune function of the body,and improving the psychological state.[32,36]Currently, Yang’s Tai Chi is widely used.[36]Tai Chi has been widely used in chronic obstructive pulmonary disease (COPD),[37]Parkinson’s disease,[38]and other diseases, with good results achieved.Some studies have shown that Tai Chi provides lung cancer patients with light aerobic exercise, core strength, and upper and lower limb training, which can not only improve exercise ability and cardiopulmonary function but also significantly improve the compliance of patients with exercise, with high safety and feasibility.[39,40]Liu[41]intervened 60 lung cancer patients with 24 Style Tai Chi and practiced for 30 min every day. It was found that the vital capacity, maximum inspiratory volume, and total expiratory time of the patients after practicing Tai Chi were significantly higher than those of the control group (P ＜ 0.05), indicating that Tai Chi exercise had a positive effect on enhancing lung function of lung cancer patients. Moreover, Tai Chi is simple and easy to learn,with high safety, can be adjusted in the amount of exercise according to the individual’s physique, as well as suitable for different ages and physiques. Hence, patients and their families can exercise together to increase the interaction between patients and their families and help to regulate the psychological pressure of patients after lung cancer surgery.

Baduanjin fitness Qigong

Baduanjin is an important part of traditional Chinese rehabilitation medicine and belongs to aerobic exercise capable of adjusting body, breath, and heart and improving cardiopulmonary function. Practicing it can achieve fitness effect and prevent diseases while making one not feeling tired.[32]Baduanjin can be divided into sitting style and standing style. Sitting style requires less exercise and can be practiced on the bed, while standing style requires more exercise and is suitable for outdoor exercise or group exercise.[42]A study on the influence of Baduanjin Qigong on the elderly’s home-based fitness and mental health shows that after 6 months of intervention, the elderly’s lung function (FVC, MVV) is significantly improved. Moreover,Baduanjin is not only simple and economic but also can improve the physical and mental health status, enhance the strength of lower limbs and waist, and improve the overall quality of life at home.[43]The results of another study showed that after 12 weeks of Baduanjin training, the 6MWD of nonsmall cell carcinoma patients in convalescent stage was significantly higher than that before and in the control group.[44]Han[45]used a randomized controlled method to a group of 61 patients with nonsmall cell lung cancer after surgery. The treatment group practiced Baduanjin exercise for 30 min for 3 months, 5 days/week, twice a day. The results showed that the 6MWD, FVC, and FEV1 of patients with lung cancer in the treatment group were significantly improved,indicating that Baduanjin exercise could improve the heart and lung function and exercise tolerance of patients.

CONCLUSION

The methods of lip contraction breath, abdominal breath,balloon-blowing training, use of breathing training apparatus,and exercise are easy to understand, safe, and effective in improving the lung function and increasing the interest of patients’ training. Taijiquan, Six-Word Qigong, and Baduanjin can be trained in the community and family without the limitation of the site equipment to save the medical expenses and increase the participation of patients and their families. Those TCM rehabilitation nursing techniques can improve the pulmonary function, psychological state,rehabilitation confidence, and quality of life of patients after lung cancer surgery. Although they are applied to the home lung rehabilitation in patients with lung cancer at home,there are still many shortcomings: (1) lack of high-quality randomized controlled trials. In future, we should carry out more high-quality multicenter randomized controlled studies to improve the quality of research on home-based pulmonary function rehabilitation nursing technology; (2) there are no unified standards for the timing, duration, specific methods, and evaluation of the application of rehabilitation nursing technology; professional and simple programs need to be developed and correct evaluation standards need to be established; (3) the patients and their families lack professional guidance, and relevant training for the rehabilitation nursing technology of nursing personnel needs to be increased; and (4) the connection from the hospital to the community or the family lacks professional guidance.

The lung rehabilitation nursing technology of guiding scheme is widely used in the lung function rehabilitation of COPD patients. Home rehabilitation care for lung cancer patients is still in the exploration stage. There is still a need for medical staff to continue to increase research guidance and publicity on home lung rehabilitation nursing technology after lung cancer surgery, explore and improve home lung rehabilitation nursing measures and related technologies,and apply systematic optimization programs to home lung function rehabilitation to allow patients and their families.

Financial support and sponsorship

The study is supported by the Fundamental Research Funds for the Central Universities (grant no. 2019-JYB-JS-053).

Conflicts of interest

There are no conflicts of interest.