Specialist Nurse-Led Nursing Management for Patients Undergoing Head and Neck Cancer Surgery

Patients in the control group will receive routine perioperative nursing care for head and neck cancer surgery. Routine care includes admission education, nutritional screening and intervention, disease- and examination-related education, basic nursing care, specialized nursing care, and respiratory function training. Prior to discharge, patients will receive standardized health education regarding daily life precautions, swallowing and voice rehabilitation exercises, wound care, and management of nasogastric and tracheostomy tubes.

Participants in the intervention group will receive a multidisciplinary specialist nurse-led perioperative nursing management program in addition to routine care. The intervention was developed through evidence-based literature review and expert panel discussions and is guided by collaborative care theory. The management model consists of four major components: comprehensive assessment, individualized intervention planning, dynamic follow-up and feedback, and quality assurance with interdisciplinary coordination.

1. Comprehensive preoperative assessment

Following admission, patients will undergo multidimensional assessment and early risk screening performed by specialist nurses from different disciplines, with corresponding interventions initiated when necessary.

Assessment components include:

①Nutritional risk assessment: Registered nurses will conduct screening using the Nutritional Risk Screening 2002 (NRS-2002). Patients identified as being at nutritional risk will undergo further assessment using the Patient-Generated Subjective Global Assessment (PG-SGA) by nutrition specialist nurses and dietitians.

②Pulmonary complication risk assessment: Respiratory specialist nurses will assess risk factors for postoperative pulmonary complications using a structured screening tool developed for patients with head and neck cancer.

③Swallowing and voice function assessment: Rehabilitation specialist nurses will assess swallowing function using the Eating Assessment Tool-10 (EAT-10) and the Kubota Water Swallow Test. Voice function will be evaluated using the Voice Handicap Index-10 (VHI-10).

④Oral health assessment: Oral and maxillofacial specialist nurses will evaluate oral health status using the Oral Health Assessment Tool (OHAT).

Psychological assessment: Responsible nurses will conduct psychological screening using the Patient Health Questionnaire-2 (PHQ-2) and Generalized ⑤Anxiety Disorder-2 (GAD-2). Participants with scores ≥3 on either assessment will undergo further evaluation using PHQ-9 and GAD-7 by psychological counselors. 2. Individualized multidisciplinary intervention

Following comprehensive assessment, the multidisciplinary core team will identify and prioritize patient problems and develop individualized management plans. Standardized management checklists will be used and adjusted according to patient condition and clinical needs.

The intervention is implemented during two phases:

Admission-to-preoperative phase: * Nutritional management ②Respiratory function training

* Oral health management ④Swallowing function training

* Non-verbal communication intervention

* Psychological intervention

Postoperative phase: * Nutritional management

* Airway management

* Oral and skin care

* Swallowing rehabilitation ⑤Voice rehabilitation training ⑥Psychological intervention 3. Dynamic tracking and multidisciplinary follow-up The multidisciplinary team will monitor intervention implementation through daily morning handovers. Team meetings will be conducted at least once weekly to review patient progress, identify key clinical issues, discuss difficult cases, and optimize intervention strategies to ensure implementation throughout the perioperative period. 4. Quality assurance and interdisciplinary coordination Quality assurance measures include daily supervision by nurse managers, standardized departmental training, and structured feedback mechanisms. These approaches are intended to improve consistency of care delivery, maintain nursing quality, and enhance communication efficiency among multidisciplinary team members.

• Postoperative length of hospital stay [Time frame: From postoperative day 1 to the day of hospital discharge (Up to 30 days).]
• Hospitalization costs [Time frame: On the morning of hospital discharge,Nurses will collect and record total hospitalization costs incurred during the hospital stay for participants in both groups.]
• Nursing satisfaction assessed by the Newcastle Satisfaction with Nursing Scales (NSNS) [Time frame: On the morning of hospital discharge.The NSNS questionnaire will be administered by nurses on the morning of hospital discharge, and participants will complete the questionnaire before completing discharge procedures.]