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RESEARCH ARTICLE
Narrative nursing for tuberculous empyema surgery: A single-center quasi-experimental study of perioperative anxiety and depression
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1 Department of Thoracic Surgery, Wuhan Pulmonary Hospital (Wuhan Institute for Tuberculosis Control), Hubei Branch of the National Clinical Research Center for Infectious Diseases, Wuhan, Hubei , China
2 National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei , China
3 Key Laboratory of Pulmonary Diseases of Health Ministry, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei , China
4 Research Institute of Pulmonary Infectious Diseases, Jianghan University, Wuhan, Hubei , China
†These authors contributed equally to this work.
HPR, 026210104 https://doi.org/10.36922/HPR026210104
Received: 18 May 2026 | Revised: 7 August 2026 | Accepted: 11 August 2026 | Published online: 26 August 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Abstract
Background: Tuberculous empyema surgery combines chronic infectious disease stigma with operative stress, yet conventional perioperative nursing rarely addresses illness identity and self-stigma. Narrative nursing may help reconstruct illness narratives, but evidence remains limited.
Objective: To evaluate whether structured narrative nursing from admission through three months post–chest tube removal reduces anxiety and depression compared with routine care.
Methods: In this single-center, non-randomized quasi-experimental study (December 2022–December 2023), patients admitted during odd weeks received narrative nursing plus routine care; even-week admissions received routine care alone. The intervention comprised eight structured sessions (30–50 min) integrating narrative therapy with perioperative milestones. Primary outcomes were GAD-7 and PHQ-9 scores at baseline and three months after chest tube removal. Analysis of covariance was adjusted for baseline scores, and an E-value sensitivity analysis assessed unmeasured confounders.
Results: Of 96 eligible patients, 92 completed follow-up (46 per group). At three months, the narrative nursing group showed significantly lower mean GAD-7 (4.83 ± 2.11 vs. 7.26 ± 2.58; p < 0.001; d = 1.04) and PHQ-9 (5.37 ± 2.46 vs. 8.04 ± 2.93; p < 0.001; d = 0.99) scores. Moderate-to-severe anxiety (10.87% vs. 30.43%, p = 0.018) and depression (13.04% vs. 34.78%, p = 0.015) were also lower. E-values were 2.8 for GAD-7 and 2.7 for PHQ-9.
Conclusion: Structured narrative nursing is associated with substantially lower anxiety and depression three months post–chest tube removal. Despite large effect sizes, the non-randomized, single-center design limits causal inference. Randomized controlled trials with active controls and longer follow-up are warranted.
Keywords
Narrative nursing
Tuberculous empyema
Thoracic surgery
Anxiety
Depression
Quasi-experimental study
Psychosocial intervention
Stigma
Funding
This work was supported by the Preventive Medicine Association of Hubei Province (No. 2025SWGKY391) and Wuhan Pulmonary Hospital under the “Open Competition for the Best Candidates” program (No. WF2025Y06; No. WF2025Y08). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.
Conflict of interest
The authors declare no competing interests.
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