Demand analysis of perioperative nursing service needs for patients with cervical spondylosis based on the Kano model: a cross-sectional study

Abstract

Background

This study uses the Kano model as its theoretical foundation to classify the needs of patients with cervical spondylosis according to their perioperative nursing service needs. It defines, prioritizes, and categorizes these needs to identify the core requirements of perioperative nursing services for patients with cervical spondylosis. The aims of this study are to provide high-quality medical and nursing services during the perioperative period for patients with cervical spondylosis and to offer evidence for improving patient satisfaction. The aim of this study was to explore the needs of perioperative nursing services for patients with cervical spondylosis using the Kano model.

Methods

Using the Kano model as the theoretical framework, a questionnaire on the perioperative nursing service needs of patients with cervical spondylosis was developed through a literature review, semi structured interviews, and expert consultation methods. A cross-sectional survey was conducted on 200 adult patients who received cervical spine surgery in the orthopedics departments of tertiary Grade A hospitals in China from March 2024 to December 2024 to explore the perioperative nursing service needs of patients with cervical spondylosis. Data on the demographic characteristics’ questionnaire and the Kano model-based questionnaire for the perioperative nursing service needs of patients with cervical spondylosis were collected through convenience sampling. Based on the Kano model, the attributes of each requirement are determined, the satisfaction coefficient is calculated, and a two-dimensional matrix graph between demand and satisfaction is constructed.

Results

A total of 181 valid questionnaires were collected in this study, with a valid response rate of 90.50%. The findings revealed that 26 fundamental attributes were required to meet the perioperative nursing service needs of patients with cervical spondylosis. The Kano model was used to categorize and prioritize the 26 quality attributes. Kano analysis revealed that 20 attributes were categorized as “one-dimensional attributes”, 3 attributes were categorized as “attractive attributes”, 2 attributes were categorized as “must-be attributes”, and 1 attribute was an “indifferent attribute”. A two-dimensional matrix diagram is shown: 22 attributes were located in Predominance Area I; 1 attribute were located in Improving Area II; 1 attribute was located in Secondary Improving Area III; and 2 attributes was located in Reserving Area IV.

Conclusion

The Kano model revealed that cervical spondylosis patients had a positive attitude toward the need for perioperative nursing services. The one-dimensional and must-be attributes of the perioperative nursing service needs of patients with cervical spondylosis mainly focus on pain management, wound and drainage tube care, swallowing and respiratory care, rehabilitation and positioning care, dietary and nutritional guidance, and disease- and surgery-related knowledge. The attractive attributes primarily concentrate on enhancing family caregiving capabilities, providing multichannel medical information, and maintaining patients’ personal image. It is suggested that medical institutions and medical staff continue to maintain and improve the supply of must-be attributes and one-dimensional attributes services, develop attractive attribute services according to the actual clinical situation, and objectively analyze and optimize the indifferent attribute services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-03764-9.

Introduction

Cervical spondylosis (cervical spondylosis) is a disease in which degenerative changes in cervical intervertebral disc tissue and its subsequent pathological changes affect surrounding tissues and structures, and clinical manifestations corresponding to imaging results appear [1]. At present, the incidence of cervical spondylosis in China is 3.8–17.6%, and it continues to rise [2, 3]. With the continuous development at the modern medical level and the continuous change in patient concepts, surgical treatment has become an important way to treat cervical spondylosis [4]. Anterior cervical surgery requires an incision at the front of the neck, near the esophagus and trachea. To fully expose the vertebral body during the procedure, it is necessary to pull aside the trachea and esophagus to create optimal surgical access. Consequently, post-surgery complications such as wound pain, dysphagia, and respiratory tract irritation may arise. Additionally, there is a risk of other complications, including neck hematoma, spinal cord injury, and infection. These complications can lead to depression, anxiety, nutritional imbalance, reduced self-care ability, and in severe cases, they may be life-threatening [5–8]. Therefore, perioperative nursing for patients with cervical spondylosis is very important and directly affects the outcome of patient care.

Patients have a wide range of needs for nursing services during the perioperative period, and there are significant differences in the level and content of nursing services among different patients. Due to the complex anatomical structure of the cervical spine, cervical spondylosis has high risk of surgery and many postoperative complications, so patients have higher requirements for perioperative nursing [9]. In addition, patients may lack the knowledge of disease and rehabilitation, so they expressing a strong demand for nursing services [10]. Studies have shown that by identifying patients’ different levels of nursing needs, medical services can be provided in a targeted manner, thus effectively improving the quality of care [11]. Renovanz et al. [12]. developed a Spinal Neurosurgery Question Prompt List (SN-QPL) for spinal surgery patients to assist patients in obtaining information during informed consent consultations and to assess their information needs. Wu et al. [13] developed a measurement tool suitable for assessing the continuous nursing needs of postoperative patients with cervical spondylosis myelopathy. This tool evaluates three aspects: health education, daily care, and functional exercise. Fischbeck et al. [14] conducted a study that revealed 32% of spinal surgery patients reported unmet knowledge needs regarding complications and prognosis. High-anxiety patients were more likely to experience information gaps due to passive questioning or doctors avoiding sensitive topics. Berger et al. [15] integrated risk assessment and prediction tools (RAPT) with age to predict the post-hospitalization needs of cervical spine patients and optimize early discharge plans accordingly. Wang et al. [16]reported that Demand-based Health Education Based on Whole-course Disease Management effectively improved patients’ satisfaction and reduced their anxiety in the nursing intervention of cervical spondylosis patients.

However, there are few studies on the perioperative nursing service needs of patients with cervical spondylosis, both domestically and internationally. The relevant studies mainly focus on continuous nursing [10], health education [16] and improving satisfaction [17]. There is no uniform standard for evaluation tools and there is a lack of systematic analysis on how to classify and prioritize these needs. The Kano model [18, 19] was formally constructed by Dr. Kano of Tokyo Institute of Technology in 1984. The Kano model analyzes customer demand and satisfaction data to nonlinearly express users’ trust in products. The Kano model is a simple and easy-to-use technology for identifying service attributes. In recent years, it has been widely used in the medical field such as Design of mHealth Applications [20], Demand analysis [21, 22], system optimization [23, 24]. This model helps hospitals deeply understand the needs of patients at different levels, guides nurses to focus on core projects, meets the expected attributes as much as possible on the basis of providing necessary attributes, and realizes the continuous improvement of nursing service quality, which is feasible for improving the quality of medical service and patient satisfaction [19].

This study uses the Kano model as its theoretical foundation to classify the needs of patients with cervical spondylosis for perioperative nursing services. It will define, prioritize, and categorize these needs to identify the core requirements of perioperative nursing services for patients with cervical spondylosis. The aims of this study are to provide high-quality medical and nursing services during the perioperative period for patients with cervical spondylosis and to offer evidence for improving patient satisfaction.

Methods

Study design and participants

This cross-sectional study was conducted from March 2024 to December 2024 in the orthopedic departments of tertiary Grade A hospitals in Chongqing, China. Convenience sampling was used to select the patients. The following are the criteria for inclusion and exclusion of the study participants. The inclusion criteria for patients were as follows: (1)received cervical surgery; (2) aged ≥ 18 years; (3) provided written informed consent; and (4) voluntary participation. The exclusion criteria were as follows: (1) patients with severe underlying conditions, such as heart disease; and (2) patients with mental illness or impaired consciousness who could not cooperate with the survey.

Sample size calculation

The sample size was determined on the basis of 5 to 10 times the number of items in the questionnaire [25], considering a 10% dropout rate. The questionnaire included 26 items, resulting in a sample size range of 143 to 286 cases. This study was approved by the Ethics Committee of the Second Affiliated Hospital of the Army Medical University (2024-Research No.024 − 01).

The Kano model

The Kano model divides service quality attributes into six categories: one-dimensional attributes (O), must-be attributes (M), attractive attributes (A), indifferent attributes (I), reverse attributes (R), and problematic answers (Q). O means that the satisfaction of demand will increase when it is met, and the satisfaction will decrease when it is not met, which corresponds to linear demand; M refers to the items that patients think the hospital must provide. When there is no such item, patients are very dissatisfied, and when there is such an item, patients may not show satisfaction because of it. A refers to the fact that with the increase in the degree of patient needs being met, patient satisfaction will also rise sharply, and patients will not show obvious dissatisfaction when their needs are not met. I means that the patient’s satisfaction is not affected by whether the project is provided. R indicates that the patient has no such demand, and patient satisfaction will decrease after the provision. Q refers to the error in the statement of the question or the wrong judgment made by the answerer due to misunderstanding of the question. The classification of service requirement attributes in the Kano model is shown in Table 1.

Table 1.

The Kano model attribute classification criteria

Functional question (How do you feel when the nurse provides you with adequate sleep time and quality?)	Dysfunctional question (How do you feel when the nurse does not provide you with adequate sleep time and quality?)
	I like it that way	It must be that way	I am neutral	I can live with it that way	I dislike it that way
I like it that way	Q	A	A	A	O
It must be that way	R	I	I	I	M
I am neutral	R	I	I	I	M
I can live with it that way	R	I	I	I	M
I dislike it that way	R	R	R	R	Q

Research tools

Demographic characteristics questionnaire

The research team designed the survey to align with the study’s objectives, encompassing aspects such as age, sex, residence, education level, marital status, type of medical insurance, personal monthly income, smoking history, drinking history, allergy history, surgical history, and the presence of any underlying diseases.

Kano model questionnaire on the perioperative nursing service needs of patients with cervical spondylosis

Using the literature analysis method, systematic searches were conducted on Chinese and foreign websites such as the China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (VIP), China Biomedical Database, PubMed, Web of Science, and Embase, using the following keywords: “nursing service needs, nursing needs, nursing need analysis” and “cervical spondylosis, cervical degenerative diseases.” The aim of this study was to collect literature related to perioperative nursing services for hospitalized patients. After screening and organizing the content of perioperative nursing service needs for patients with cervical spondylosis, a pool of items for the perioperative nursing service indicators for these patients was formulated.

Reviewing the relevant literature, the research team designed an interview outline for the perioperative nursing service needs of patients with cervical spondylosis (Supplementary file 1), which included the following: (1) Do you think there are any improvements needed in the ward environment? (2) What aspects of knowledge about cervical spondylosis do you have? (3) How did you feel psychologically after being admitted? (4) What do you hope doctors and nurses can do for you throughout your hospital stay? (5) Do you have any other needs or suggestions? Informed consent and cooperation were obtained from 5 patients with cervical spondylosis in orthopedics, and semistructured in-depth face-to-face interviews were conducted. Each interview was conducted within 20 to 30 min, avoiding treatment time and trying to avoid factors that might affect the interview results. The interviewees answered freely according to their own subjective feelings and experiences. The interview concludes when the data are saturated and when no new content emerges. Within 24 h after the interview, the content was organized, summarized, and compiled. In combination with the results of the literature review, all the interview contents were integrated to form a questionnaire on the perioperative nursing service needs of patients with cervical spondylosis.

The discussion group consisted of 8 experts, including 1 head nurse of orthopedic nursing, 2 heads of the clinical nursing responsibility group for orthopedic nursing, 2 heads of the teaching group for orthopedic nursing, and 3 clinically responsible nurses for orthopedic nursing, among whom 1 was a doctor and 2 were masters. The importance, rationality and clarity of the items should be evaluated, specific suggestions for the items that need to be modified should be put forward, the items that need to be deleted and supplemented should be pointed out, and the initial draft of the questionnaire on the perioperative nursing service needs of patients with cervical spondylosis should be supplemented.

The questionnaire design method based on the Kano model divides all the items of the initial draft of the questionnaire on the perioperative nursing service needs of patients with cervical spondylosis into positive and negative questions to better understand the level of needs and compile the questionnaire on the basis of the Kano model. For example, for a certain need, the questionnaire should use both positive and negative questioning methods to elicit responses from the subjects. The positive question is “What do you feel when the nurse provides you with adequate sleep time and quality?” The negative question is “What do you feel when the nurse does not provide you with adequate sleep time and quality?” The answers are all “Like,” “Must-be,” “Neutral,” “Live with,” and “Dislike.”

Through a literature review, semistructured interviews, and expert meetings, a total of 26 items from the Kano model questionnaire on the perioperative nursing service needs of patients with cervical spondylosis were ultimately determined (Supplementary file 2). The positive coefficient of the questionnaire expert was 92.30%, the authority coefficient of the expert was 0.875, the Cronbach’s α coefficient of the positive questions was 0.975, and the Cronbach’s α coefficient of the reverse questions was 0.973. The content validity index (ICVI) of each item of the questionnaire was 0.916ཞ1.000, all > 0.780, which proved that the questionnaire had good reliability and validity.

Data collection and analysis

Methods of data collection

The trained members of the research group conducted the survey; explained the purpose, significance, and privacy of the survey to the patients; and obtained their consent to fill in the questionnaire anonymously. After the completion of the questionnaire, the subjects were verified and recovered by the researchers on site. A total of 200 questionnaires were distributed, and 200 were recovered. Six questionnaires with incomplete data and all questions selected the same option were excluded. According to the quality control principle of the Kano model, the questionnaire with “Q” in the answer is regarded as the problem questionnaire. There are 13 questionnaires, and 181 valid questionnaires were obtained in the end, with a recovery rate of 90.50%.

Quality control

A questionnaire was issued by a trained researcher to explain the purpose of the study, research methods, inclusion and exclusion criteria of the research subjects, questionnaire content and completion methods, and interview skills. After the questionnaire was collected, it was cross-entered into an Excel table by two people to ensure the accuracy of the data.

Statistical analysis

Excel and SPSS 26.0 were selected for data collation and analysis. Descriptive statistical analysis of the general demographic characteristics of patients was performed. Kano theory is used to carry out frequency statistics and define demand attributes. The importance matrix analysis method is adopted to calculate the better-worse coefficient of each service index and construct the importance-satisfaction matrix (IPA). Satisfaction (SI) = (A + O)/(A + M + O + I), and importance (DSI) = (M + O)/(A + M + O + I). The closer the result is to 1, the greater the influence of the service demand on the importance and satisfaction of patients with cervical spondylosis. According to the calculation results of DSI and SI, a quadrant matrix is constructed with SI as the vertical axis and DSI as the horizontal axis, and the scatter plot is divided into four quadrants with 0.5 as the dividing line. The first quadrant is the dominant area, also known as the competitive advantage area; when the demand in this area cannot be met, patient satisfaction decreases significantly. The second quadrant is the area to be improved. The needs in this quadrant are important to users, but patient satisfaction is low. The indicators in this quadrant are key improvement indicators. The third quadrant is the observation area, also known as the secondary improvement area. The indicators in this quadrant are not key evaluation indicators, which are not important to patients and have low satisfaction. The fourth quadrant is the maintenance area, which is not important to patients but has a high satisfaction rating.

Results

Demographic characteristics

A total of 181 patients with cervical spondylosis, aged 27–79 (54.87 ± 9.79) years, were included in this study. The general information of the patients is shown in Table 2.

Table 2.

General information of the subjects (n = 181)

Project		Frequency	Percentage
Sex	male	100	55.2
	female	81	44.8
Domicile	country	19	10.5
	town	162	89.5
Nation	the Han nationality	173	95.6
	other	8	4.4
Education level	illiterate	4	2.2
	primary school	52	28.7
	junior middle school	74	40.9
	senior middle school	28	15.5
	professional training	10	5.5
	regular college course	13	7.2
Marital status	married	174	96.1
	unmarried	1	0.6
	divorce	4	2.2
	bereft of one’s spouse	2	1.1
Type of health insurance	Employee health insurance	66	36.5
	Medical insurance for residents	93	51.4
	at one’s own expense	10	5.5
	other	12	6.6
Personal monthly income	< three thousand yuan	56	30.9
	three thousand yuan ~	84	46.4
	five thousand yuan ~	36	19.9
	ten thousand yuan ~	4	2.2
	twenty thousand yuan ~	1	0.6
Smoking history	No	107	59.1
	Yes	74	40.9
Alcohol consumption history	No	109	60.2
	Yes	72	39.8
Allergic history	No	157	86.7
	Yes	24	13.3
Hospital history	No	134	74.0
	Yes	47	26.0
Surgical history	No	130	71.8
	Yes	51	28.2
Merge diseases	No	97	53.6
	Yes	84	46.4

Kano attribute results of the perioperative nursing service needs of patients with cervical spondylosis

This study investigated the perioperative nursing service needs of 26 items for patients with cervical spondylosis, among which the Kano attribute was defined as O in the largest proportion, with 20 (76.9%), M attribute 2 (7.7%), A attribute 3 (11.5%) and I attribute 1 (3.8%), and no reverse attribute was found. The specific classification results are shown in Table 3.

Table 3.

Kano attribute results of perioperative nursing service needs for patients with cervical spondylosis (n = 181)

Demand number	Items	Frequency Distribution				Final attribute and its proportion (%)		Importance(DSI) (M + O)/(A + I + M + O)	Satisfaction(SI) (A + O)/(A + I + M + O)
		A	I	M	O
1	Ensure adequate sleep time and quality	37	17	49	78	O	43.1%	0.70	0.64
2	The need for self-assessment of pain	37	23	10	111	O	61.3%	0.67	0.82
3	Guidance on diet and nutrition	25	22	74	60	M	33.1%	0.74	0.47
4	Guidance on defecation and abdominal distension	29	12	62	78	O	43.1%	0.77	0.59
5	Full humanistic care	30	18	59	74	O	40.9%	0.73	0.57
6	Patience and responsibility	35	11	60	75	O	41.4%	0.75	0.61
7	Family and emotional needs	47	21	31	82	O	45.3%	0.62	0.71
8	Good personal image during hospitalization	70	45	19	47	A	38.7%	0.36	0.65
9	Improving the caregiving capacity of family caregivers	82	21	25	53	A	45.3%	0.43	0.75
10	Access to medical information through multiple channels	64	24	43	50	A	35.4%	0.51	0.63
11	Guidance on disease and surgery related knowledge	47	16	60	58	M	33.1%	0.65	0.58
12	Management of neck wound	21	11	40	109	O	60.2%	0.82	0.72
13	Management of wound drainage tubes in neck	32	13	45	91	O	50.3%	0.75	0.68
14	Management of swallowing function	28	15	43	95	O	52.5%	0.76	0.68
15	Airway management	20	16	52	93	O	51.4%	0.80	0.62
16	Guidance on functional exercise and rehabilitation training	23	11	49	98	O	54.1%	0.81	0.67
17	The correct way to get out of bed	21	20	45	95	O	52.5%	0.77	0.64
18	The correct posture of the neck when sitting	23	13	51	94	O	51.9%	0.80	0.65
19	The correct posture of the neck when sleeping	24	15	45	97	O	53.6%	0.78	0.67
20	Types of cervical collar (neck brace) to choose	40	30	48	63	O	34.8%	0.61	0.57
21	Wearing method of cervical collar (neck brace)	18	14	53	96	O	53.0%	0.82	0.63
22	Wearing time of cervical collar (neck brace)	27	16	45	93	O	51.4%	0.76	0.66
23	The range of neck movement when wearing a cervical collar (neck brace)	19	16	53	93	O	51.4%	0.81	0.62
24	The wearing of cervical collar (neck brace) is the management of neck skin	42	33	50	56	O	30.9%	0.59	0.54
25	Maintenance of cervical collar (neck brace)	41	53	41	46	I	29.3%	0.48	0.48
26	Cervical patients choose the right pillow	51	26	48	56	O	30.9%	0.57	0.59

Note: A is the attractive attribute; I is the indifferent attribute; M is the must-be attribute; O is the one-dimensional attribute

Quadrant diagram of perioperative nursing service needs for patients with cervical spondylosis

Taking the satisfaction/better coefficient as the vertical axis and the importance/worse coefficient as the horizontal axis, the satisfaction‒importance matrix can be obtained. The quadrant chart shows that 22 items (84.6%) of the requirements are located in the competitive advantage zone, specifically numbered 1, 2, 4 to 7, 10 to 24, and 26; 1 item (3.8%) is in the need for improvement zone, numbered 3; 1 item (3.8%) is in the secondary improvement zone, numbered 25; and 2 items (7.7%) are in the maintenance zone, specifically numbered 8 and 9 (see Fig. 1).

Fig. 1.

Importance-Satisfaction Matrix analysis model of perioperative nursing service needs for patients with cervical spondylosis

Discussion

The current status of Kano model requirements for patients with cervical spondylosis during the perioperative period

This study surveyed 181 patients with cervical spondylosis during the perioperative period, and the results showed that patients with cervical spondylosis had strong needs in 12 aspects, such as pain assessment, wound management, swallowing function, functional exercise, neck posture, and brace wearing, accounting for more than 50%. This shows that the overall level of perioperative nursing needs of patients with cervical spondylosis is high, and most of them are in postoperative nursing management. Among them, the need for pain management and functional exercise is strong, which is consistent with Yan’s research [26]. In addition, the need for rehabilitation, position care, diet and nutrition guidance, and disease- and surgery-related knowledge guidance is also more urgent, which is consistent with the results of researchers such as Sun et al. [27]. Studies have shown that patients with cervical spondylosis pay high attention to disease prognosis perioperatively. This high degree of attention may be due to the fact that although patients’ cervical spine function has been improved to some extent after surgical treatment, complications such as recurrent laryngeal nerve injury and incision infection will occur after surgery, which will affect postoperative neck function rehabilitation [10]. In addition, patients may lack the knowledge of disease and rehabilitation, so they express a strong demand for nursing services.It is suggested that medical staff should pay attention to the needs of cervical spondylosis patients for perioperative nursing services, and actively explore the relevant factors of patients’ needs for perioperative nursing services.

Analysis of the Kano model for the perioperative nursing service needs of patients with cervical spondylosis

One-dimensional attributes

Previous studies have shown that patient satisfaction is linearly related to expected attributes, and when such needs are met, patient satisfaction tends to increase rapidly [21]. There are 20 one-dimensional attributes in the research, accounting for 76.9% of the sample, indicating that patients with cervical spondylosis have a strong demand for perioperative nursing services. Among them, the one-dimensional quality attributes of pain care account for the highest proportion, accounting for 61.3%, Because pain has severely affected patients’ medical experiences and their quality of life, and improper treatment may lead to long-term chronic pain, which can greatly negatively affect their quality of life and psychology. Jenkins [28] conducted a retrospective review of the prospectively maintained registry for cervical surgeries between May 2013 and August 2019.The results suggest that the enhanced multimodal analgesic(MMA)protocol will help improve disability scores while keeping a lower likelihood of postoperative complications. Therefore, nursing staff should detect and evaluate the pain of patients in a timely manner, explain what may cause pain, adopt multimodal analgesia, and apply music therapy [29], mindfulness techniques [30], and other methods to effectively reduce postoperative pain on the basis of the reasonable and standardized use of analgesics to improve patient satisfaction. Second, the one-dimensional quality attributes of cervical spine postoperative wound and drainage tube care services accounted for a relatively high proportion, accounting for 60.2% and 50.3%, respectively. It has been reported that hematoma caused by drainage tube blockage after cervical spine surgery can cause respiratory distress [31]. Therefore, after the operation, the nursing staff should closely observe the patient’s wound and drainage tube; check whether there is bleeding or exudation on the surface of the dressing; ensure that the drainage tube is unobstructed; and avoid the occurrence of infection, hematoma and other complications caused by poor drainage. The demand for swallowing and respiratory care accounted for 52.5% and 51.4%, respectively, which accounted for a relatively high proportion of the demand. This is because dysphagia is a common complication after cervical spine surgery that can reduce the quality of life of patients after anterior cervical spine surgery, and in severe cases, it can lead to death [32, 33]. Therefore, it is particularly important to identify the risk factors for dysphagia after anterior cervical surgery as early as possible. Respiratory management is closely related to swallowing function. Studies have shown that smoking can lead to postoperative complications, including dysphagia, neck pain, and wound infection [34]. Therefore, we can guide patients to quit smoking before surgery, develop healthy eating habits, guide patients to perform tracheal displacement training before surgery, and guide patients to perform effective deep breathing, coughing, and sputum practice to reduce postoperative pharyngeal pain and soft tissue swelling. Finally, rehabilitation and position care play important roles in patient recovery. Wang [35] conducted a randomized controlled trial of 60 patients who received anterior cervical discectomy and fusion༈ACDF༉between September 2019 and September 2020.The results suggest that thecervical functional exercise could decrease cervical pain and improve postoperative function in patients after ACDF. It was a safe and effective treatment for postoperative rehabilitation. Therefore, nursing staff should carry out functional exercise and rehabilitation guidance for patients in a timely, effective and accurate manner, stimulate the knowledge and initiative of patients and their families, and improve the compliance of patients with exercise. At present, rehabilitation therapists have applied VR (virtual reality) to cervical spine rehabilitation and have shown good results [36]. Studies have shown that early ambulation is considered a key factor in improving recovery after spinal surgery [37]. Wearing a brace as an auxiliary means of recovery after cervical spine surgery can increase the postoperative fusion rate, improve postoperative pain, and provide patients with a subjective sense of security [38, 39].Therefore, nursing staff should comprehensively and thoroughly guide patients and their families on the correct method of wearing a neck brace, daily care, activity restrictions, and measures to address possible abnormal conditions to ensure that patients can use the neck brace safely and effectively. Early ambulation should also be based on the individual situation and needs of patients to form personalized exercise guidance programs, pay attention to the safety of patients getting out of bed, and promote the achievement of rehabilitation training goals [40].

Attractive attributes

The attractive attribute refers to the fact that patients do not expect services, but the additional satisfaction of their needs will surprise them. In this study, there were three needs for attractive attributes: improving the care capacity of family caregivers, providing multichannel medical information, and maintaining a good personal image during hospitalization. This may be because of the rapid development of enhanced recovery after surgery (ERAS), which has greatly reduced the length of hospital stay for cervical spine surgery, and more patients need home-based rehabilitation. Therefore, it is particularly important for patients to improve the ability of family members to care at home. A foreign study [41] revealed that family education intervention measures were taken to encourage family members to participate and carry out synchronous family education. By changing cognition, correcting misconceptions, improving care ability, and enhancing communication between family and patients, postoperative rehabilitation can be promoted. Second, nursing staff should strive to provide patients with diverse medical information channels. For example, they should actively build continuous nursing service platforms and make full use of diverse methods such as internet + medical platforms. This will maximize support and assistance for patients, ensuring that they can conveniently access the necessary medical information.Notably, maintaining a good personal image during hospitalization was one of the attractive attributes of this study. This is because the back part of the cervical spine is often covered by hair, so some patients need to shave their hair. Owing to the impact of surgery on aesthetics, some female patients are prone to anxiety, fear, and other negative emotions [42, 43]. Therefore, nursing staff should pay attention to the personal image needs of patients with cervical spondylosis so that patients can feel physical and mental comfort and pleasure throughout the entire treatment process. For example, patients are carefully styled before surgery to ensure that they remain clean and tidy after surgery or that they can choose to wear wigs that do not affect their appearance. This not only helps maintain patients’ personal image but, more importantly, can greatly improve patients’ self-efficacy so that they are more confident and positive in the face of disease and treatment.

Must-be attributes

Must-be attribute services are services that need to be routinely provided perioperatively for patients with cervical spondylosis. This study revealed two must-be attributes, namely, dietary and nutritional guidance and disease- and surgery-related knowledge guidance. The reason for this may be that these two services are important to the safety of patients’ surgery, and nursing staff should first ensure such needs. Previous studies have shown that by adjusting the texture and viscosity of food for cervical spine patients, raising the head of the bed, eating in one bite, and using long-handled spoons or straws, aspiration can be effectively avoided, and postoperative comfort can be improved [44]. Diversified health education can also help patients better understand the precautions before and after surgery [45, 46]. For example, preoperative education sheets can be made in the form of text and pictures, perioperative diet precautions and specific requirements can be shown through education videos, and various popular science videos can be made to help patients fully understand the operation situation, so that patients have a clear understanding of the whole operation process and make full preparations.

Indifferent attributes

The fulfillment of indifferent attributes has little correlation with patient satisfaction. This study revealed one indifferent attribute related to the maintenance of the cervical collar. This may be because the wearing time of the cervical spine in postoperative patients’ cervical collar is generally approximately 3 months [47], and most of the current cervical collar materials have enough service life to meet the needs of patients. Although this need is not urgent for the patients in this study, nurses should try to meet the needs of patients as much as possible according to the actual situation. For example, according to the size and material of the cervical collar, the patient should be guided to choose an appropriate wash agent for maintenance.

Better–worse two-dimensional matrix graph analysis

Figure 1 shows that most of the perioperative nursing service needs of patients with cervical spondylosis are concentrated in the first quadrant advantage area, with a total of 22 items. These items not only are critical but also, once satisfied, greatly improve patient satisfaction; thus, special attention should be given to these items. The second quadrant area for improvement has one entry (dietary and nutritional guidance), which is of high importance and low level of satisfaction and needs to be improved with emphasis. For these two quadrants of needs, such needs should be met and improved on the basis of continuous improvement. For example, nursing staff have developed a comprehensive perioperative service plan for patients with cervical spondylosis. This plan covers all aspects, from preoperative preparation to postoperative recovery, paying attention to the physiological and psychological conditions that may arise before and after surgery and making optimized adjustments. In clinical nursing, fully embodying humanistic care, providing emotional comfort to patients and creating a warm atmosphere are essential. In terms of diet and nutrition, nursing staff can cooperate with dietitians across disciplines to provide personalized dietary guidance for patients by assessing their health status, nutritional needs and food preferences or restrictions. The 1 item (maintenance of the cervical spine brace) in the secondary improvement area has a small better and worse value, indicating that the needs of this area have little impact on patient satisfaction and influence. It can be placed at the end for improvement but should not be used as an urgent item for improvement. For the two items located in the maintenance area (maintaining personal image and improving family care ability), although the importance of the area is not very high, it has a great impact on satisfaction. For this quadrant, nursing staff should consider increasing the maintenance of patients’ image needs and family empowerment programs on the basis of ensuring the advantages of the project, such as guiding patients to compile hair before surgery, carrying out nursing skills workshops, establishing family psychological support groups, etc., to meet patients’ needs to the greatest extent.

Limitation

The present study has the following limitations: (1) Firstly, this study used convenience sampling method and enrolled only 181 patients with cervical spondylosis in one hospital, which may lead to poor generalization of the results; (2) Secondly, this study investigates perioperative nursing service needs of cervical spondylosis patients using the Kano model, without analyzing differences in care services among patients with different demographic characteristics. We aim to further explore these disparities in subsequent research, develop tailored nursing management protocols, and conduct practical studies. (3) Thirdly, due to the change of nursing environment, patients are transferred from the ward to the operating room. Therefore, we did not study the intraoperative needs of patients, but focused on the preoperative and postoperative nursing needs. In the future, we will further explore the intraoperative nursing needs of patients. (4)Finally, the cervical spondylosis perioperative questionnaire scale was a self-made scale based on literature review, qualitative interview and expert group meeting. The content validity of the scale was evaluated, but no pretest was conducted, which may lead to bias in the results. In the future, we will further optimize and improve this Kano model questionnaire when carrying out larger-scale application. Nevertheless, this study provides a valuable analytical approach for assessing its needs.

Conclusions

On the basis of the Kano model, this study qualitatively classified the perioperative nursing service needs of patients with cervical spondylosis and identified the service items that should be vigorously developed and promoted for such patients. The one-dimensional and must-be attributes of the perioperative nursing service needs of patients with cervical spondylosis mainly focus on pain care, wound and drainage tube care, swallowing and respiratory care, rehabilitation and position care, diet and nutrition guidance, disease- and surgery-related knowledge guidance, etc. Attractive attributes include improving family care ability, providing multichannel medical information and maintaining patients’ personal image. It is suggested that medical institutions and medical staff continue to maintain and improve the supply of one-dimensional and must-be attribute services and develop attractive attribute services according to the actual clinical situation. In this study, cervical spondylosis patients were selected from a public tertiary hospital in Chongqing. The results may be biased. It is suggested that more hospitals of different regions, levels, and types should be included in the future. Moreover, the Kano model is only a qualitative analysis tool without establishing a quantifiable mechanism. Combining this method with quantitative tools is suggested in the future to make the results more scientific and convincing.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

LinLing Hu and Lei Wang: methodology, formal analysis, writing - original draft, and writing - review and editing. Yan Wang and Huang Jing: data collection, statistical analysis, and visualization. Chunmei Luo and Ping Dong: participated in the research idea, conceptualization, writing - review and editing, supervision, and validation.

Funding

There was no funding.

Data availability

The data and materials of the current study are not publicly available due to confidentiality reason but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Second Affiliated Hospital of the Army Medical University (2024-Research No.024 − 01). And this study was employed according to the principles of the Declaration of Helsinki and followed relevant guidelines and regulations. The confidentiality of the data were preserved. The patients signed consent to participate in the study prior to data collection was safeguarded. The participants were given the option to withdraw from the study at any time. Informed consent obtained from all the participants included in the study. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.