Narrative Nursing and Perioperative Psychological Outcomes in Women Undergoing Cervical Cerclage: The Potential Indirect Role of Fear of Childbirth

Vollständiger Abstract

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ABSTRACT Background Women undergoing cervical cerclage commonly experience fear of childbirth, anxiety, and depressive symptoms, while evidence on the psychological effects of narrative nursing in this population remains limited. This study evaluated the association of narrative nursing with perioperative psychological changes and explored the potential indirect role of fear of childbirth in these associations. Methods This quasi‐experimental study included 230 women undergoing cervical cerclage between January 2023 and December 2024. Participants were nonrandomly allocated to either a narrative nursing group ( n = 115) or a routine nursing group ( n = 115) according to the nursing model implemented at the hospital campus where they received care. Fear of childbirth, anxiety, and depression were assessed using the Mandarin Chinese versions of the W‐DEQ‐A, SAS, and SDS at baseline before surgery (T0), on postoperative day 3 (T1), and before discharge (T2). Longitudinal changes were analyzed using linear mixed‐effects models incorporating group, time, and group × time interaction terms. Exploratory single‐mediator analyses with 5000 bootstrap resamples were conducted using the T1 W‐DEQ‐A score as the potential mediator and the T2 SAS or SDS score as the outcome. Results Significant group × time interactions were observed for W‐DEQ‐A, SAS, and SDS scores (all p ≤ 0.005). Compared with routine nursing, narrative nursing was associated with lower adjusted W‐DEQ‐A scores at T1 and T2, lower SAS scores at T1 and T2, and a lower SDS score at T2. At T2, the adjusted between‐group differences were −5.7 points for the W‐DEQ‐A, −3.3 points for the SAS, and −2.6 points for the SDS. Exploratory mediation analyses identified significant indirect associations through T1 fear of childbirth for both T2 anxiety (estimated indirect association, −0.54; 95% bootstrap CI, −0.93 to −0.23) and T2 depression (estimated indirect association, −0.45; 95% bootstrap CI, −0.81 to −0.18). The direct associations remained statistically significant in both models. Conclusion Narrative nursing was associated with greater short‐term reductions in fear of childbirth, anxiety, and depression among women undergoing cervical cerclage. Exploratory findings were consistent with a potential partial indirect role of fear of childbirth.