Individualized Nursing Support for Pulmonary Rehabilitation Participation Following Esophagectomy: A Case Report Guided by the Patient Health Engagement Model

Vollständiger Abstract

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Esophagectomy is the cornerstone of curative-intent treatment for resectable esophageal cancer, but postoperative course is frequently complicated by pain, impaired airway clearance, reduced respiratory function, and high risk of pulmonary complications (PPCs), which prolong recovery, increase morbidity and mortality, and can delay oncologic care. Early pulmonary rehabilitation is a core component of enhanced recovery after esophagectomy, yet patient participation is often limited by pain, drainage tubes, fear of movement, and insufficient understanding. The Patient Health Engagement (PHE) model describes patient progression through emotional, cognitive, and behavioral readiness to participate in their own care, offering a practical framework for oncology nursing. We report a 71-year-old man with recurrent thoracic esophageal squamous cell carcinoma (rT3N1M0) who underwent minimally invasive McKeown esophagectomy. Preoperatively he had mild ventilatory impairment, poor breathing and coughing technique, and marked fear of pain, bleeding, wound disruption, and tube displacement postoperatively. On day 1, despite stable status and analgesia, he refused mobilization. PHE-guided nursing support was delivered perioperatively. His participation shifted from passive avoidance to self-initiated ambulation, with walking volume increasing from 500 steps on day 1 to over 7000 steps by day 5. A temporary regression with pleural effusion resolved after drainage and renewed support. At follow-up he continued home exercises without respiratory readmission. This case indicates engagement-oriented nursing care promotes early pulmonary rehabilitation after esophagectomy, warranting evaluation in larger cohorts.