Application of evidence‐based nursing in postoperative radiotherapy care for breast cancer

To investigate the effect of evidence‐based nursing on breast cancer patients during postoperative radiotherapy care. In the sample selection, 100 breast cancer patients who received postoperative radiotherapy in our hospital from January 2020 to January 2022 were selected to participate in this study. Patients in the control group received routine nursing program, while patients in the study group applied the intervention of evidence‐based nursing philosophy, the nursing effect was compared between the two groups. According to the nursing effect of the two groups, there was a significant difference under the intervention of different protocols. The patients in the study group showed significant improvements in Self‐Rating Depression Scale and Self‐Rating Anxiety Scale scores under the evidence‐based care intervention, superior to those of the control group, and the difference was significant (p < .05); from the scores of shoulder and elbow functions, the patients in the study group showed more significant intervention effects, superior to that of the control group, and the difference was significant (p < .05); from the skin injury degree of the two groups, the skin injury grade of the study group was significantly superior to that of the control group, with a significant difference (p < .05); from the patient satisfaction indexes, after the evidence‐based nursing intervention, the satisfaction indexes of the study group and the control group were 98% and 82%, respectively, and the difference was significant (p < .05). In the current nursing intervention of postoperative radiotherapy for breast cancer patients, evidence‐based nursing models can effectively relieve the adverse emotions of patients, improve patients' shoulder joint and elbow joint function, reduce the skin damage, and improve patient satisfaction, which has an important clinical spread value.


Abstract
To investigate the effect of evidence-based nursing on breast cancer patients during postoperative radiotherapy care. In the sample selection, 100 breast cancer patients who received postoperative radiotherapy in our hospital from January 2020 to January 2022 were selected to participate in this study. Patients in the control group received routine nursing program, while patients in the study group applied the intervention of evidence-based nursing philosophy, the nursing effect was compared between the two groups. According to the nursing effect of the two groups, there was a significant difference under the intervention of different protocols. The patients in the study group showed significant improvements in Self-Rating Depression Scale and Self-Rating Anxiety Scale scores under the evidence-based care intervention, superior to those of the control group, and the difference was significant (p < .05); from the scores of shoulder and elbow functions, the patients in the study group showed more significant intervention effects, superior to that of the control group, and the difference was significant (p < .05); from the skin injury degree of the two groups, the skin injury grade of the study group was significantly superior to that of the control group, with a significant difference (p < .05); from the patient satisfaction indexes, after the evidence-based nursing intervention, the satisfaction indexes of the study group and the control group were 98% and 82%, respectively, and the difference was significant (p < .05). In the current nursing intervention of postoperative radiotherapy for breast cancer patients, evidencebased nursing models can effectively relieve the adverse emotions of patients, improve patients' shoulder joint and elbow joint function, reduce the skin damage, and improve patient satisfaction, which has an important clinical spread value.
breast cancer, evidence-based nursing, postoperative; radiotherapy care

| INTRODUCTION
In recent years, the incidence of breast cancer is increasing, and as a malignant tumor, patients often need radiotherapy after surgery, which requires high-quality nursing intervention to improve the therapeutic effect of patients. Postoperative radiotherapy for breast cancer patients will cause a large area of dissection wound, excessive edema, scar formation, and pain in the affected limb, resulting in impaired venous return and skin as well as nerve injury, which adversely affects the recovery of the upper limb in the postoperative period. 1 During radiotherapy, although radiation can kill cancer cells, it will also damage normal cells.
Patients often experience arm pain, shoulder pain, and other conditions after radiotherapy, and after lymphatic drainage is blocked, upper limbs and arms will appear to have edema, which affects shoulder and elbow joint activities and causes limb weakness. At the same time, after receiving surgical treatment, patients tend to have different degrees of psychological stress due to traumatic treatment and fear of pain. Under high-dose and prolonged radiotherapy interventions, patients' skin will be damaged to different degrees, which requires effective intervention means to improve the quality of life of patients. 2 As an advanced nursing philosophy, the application value of evidence-based nursing in clinical applications has been fully recognized, and various departments have introduced this model to provide better nursing services for patients. 3 Therefore, this study was conducted to investigate the effect of evidence-based nursing in breast cancer patients during postoperative radiotherapy care based on 100 patients selected as the study sample. From the baseline data of patients, the oldest patient in the control group was 55 years old and the youngest was 32 years old, and the average age was calculated to be (49.46 ± 4.27) years; the longest disease duration was 12 months and the shortest was 1 month, and the average duration was calculated to be (5.47 ± 2.13) months; there were 11 cases of invasive carcinoma, 23 cases of non-invasive carcinoma, and 16 cases were early invasive carcinoma. In the study group, the oldest was 54 years old and the youngest was 33 years old, and the average age was (48.38 ± 4.17) years after calculating the average age; the longest duration was 12 months and the shortest was adequate nutritional support for patients. Again, skin care. Typically, the skin elasticity of breast cancer patients will be affected during postoperative radiotherapy, which requires that clinical care should be directed to the irradiated field skin of patients to reduce their skin reactions. In addition, patients should be instructed to maintain personal cleanliness and hygiene, choose some loose cotton underwear, avoid using irritating bathing supplies, and use skin protectors such as Oxepan and Biafine to protect the skin to avoid

| Criteria for observation
To compare the adverse mood scores of the two groups, the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were selected to grasp the depression and anxiety of the patients, and the average scores of the two groups were compared; Mayo Elbow Function Scoring System was used to assess the elbow joint function of the patients, and the higher the score, the better the joint function recovery effect of patients. The percentile system was used to assess the shoulder joint activity of the patients with the help of the University of California Shoulder Scoring System.
The higher the score indicated that the patients recovered better, with a total score of 35 points; combined with the grading criteria for radiation-induced skin injury in Oncology Radiotherapy, the skin injury of the two groups was compared. Evaluation criteria:

| Statistical methods
After collecting the relevant clinical data from patients, input them into SPSS 20.0 and calculate the relevant data. In the counting index, the method of % was used for Χ 2 test, and t test was performed in (x ± s) for the measurement indicator. When p < .05, a significant difference in the indexes was proved.

| Comparison of anxiety and depression scores between the two groups
After the application of the evidence-based nursing program in the study group, the indicators of SDS and SAS scores of the patients were significantly improved, higher than the control group patients, with a significant difference, p < .05.

| Comparison of joint function between the two groups
In terms of the scores of shoulder joint function and elbow joint function, the study group was superior to the control group in both indicators, with a significant difference, p < .05.

| Comparison of the degree of skin injury between the two groups
Patients in the study group showed significant improvement in satisfaction indicators, which were better than the control group, with a significant difference, p < .05.

| Comparison of patient satisfaction between the two groups
In terms of patient satisfaction indicators, the satisfaction of patients in the study group reached 98% and only 82% in the control group, with a significant difference, p < .05.

| DISCUSSION
In clinical treatment, surgical treatment is usually adopted, while some patients need radiotherapy after surgery, and how to guarantee the effect of radiotherapy has become a problem that must be solved in current nursing work. 4 Patients will have different degrees of skin damage after breast cancer surgery, which can achieve effective suppression of cancer cell spread, but at the same time, it will also produce some complications, such as pain, edema, upper limb dysfunction, and so on. Especially after radiotherapy, patients will have abnormalities in the shoulder joint, manifested as shoulder pain and arm soreness, which seriously affects the patient's quality of life, while the patient's elbow joint will also be affected. Radiotherapy would not only kill cancer cells, but also eliminate normal cells, affecting the patient's immunity. 5 Mild skin reactions are manifested as tingling, burning sensation, itching, and so on, and in severe cases, erosion and ulcers are produced, which affect their quality of life. As an emerging nursing means, evidence-based nursing is able to be patient-centered and has more obvious advantages. By analyzing the actual situation of patients, nursing staff review the relevant literature based on the condition, summarize the experience in clinical nursing, and then select the appropriate treatment plan and nursing means. 6 The application of evidence-based nursing philosophy can enhance the comprehensiveness and specificity of nursing measures and provide a reliable guarantee for the development of clinical nursing work.
In recent years, with the deepening of clinical research, evidencebased nursing has been more widely used in clinical practice. In many clinical practices, it has been found that by applying the philosophy of evidence-based nursing in the nursing of patients with breast cancer undergoing postoperative radiotherapy, blindness and subjectivity in clinical nursing can be better prevented, and the systematic and scientific level of nursing work can be improved. 7 At the same time, with evidence-based nursing interventions, the improvement of negative emotions of patients can be achieved, better clinical nursing and treatment effects can be obtained, and laying a solid foundation for improving patient's life quality. 8 In response to the patient's poor skin, aloe vera can be used as an auxiliary tool in the nursing process to not only improve the anti-inflammatory effect, but also inhibit the ulcer, effectively protect the cell mucosa, and then realize the secondary growth of cells. 9 In this study, it was found that after the evidencebased nursing intervention, the SDS and SAS scores of patients were significantly improved, superior to those of patients in the control group, and the difference was significant, p < .05 (Table 1); from shoulder joint function and elbow joint function scores, the study group was also higher than the control group, and the difference was significant, p < .05 (Table 2); in addition, in skin injury and satisfaction indicators, compared with the control group, the study group was significantly improved, p < .05 (Tables 3 and 4  Abbreviations: SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale.
In conclusion, in current clinical nursing, by actively applying evidence-based nursing in radiotherapy nursing after breast cancer surgery, the negative emotions of patients can be better relieved, the improvement of elbow joint and shoulder joint function can be realized, the skin injury can be reduced, the patient satisfaction level can be improved, the quality of life can be improved, which has an important clinical spread value.

AUTHOR CONTRIBUTIONS
Qiuping Zhang: Methodology, investigation, data analysis, writing original draft. Li Lin: Data collection, investigation, data analysis.

CONFLICT OF INTEREST STATEMENT
There is no potential conflics of statement.

ETHICS STATEMENT
The study was approved by the Ethics Committee of our hospital.