Objective: To explore the effect of narrative nursing combined with positive reinforcement nursing intervention on the psychological state of patients with gynecological cancer chemotherapy. Methods: From January 2022 to December 2023, 99 cancer patients with postoperative chemotherapy admitted to the Department of Gynecology in the author’s Class ⅲ Grade A hospital were selected as the research objects, and they were divided into the control group (49 cases) and the observation group (50 cases) by random number method. The control group was intervened by the nursing model based on positive reinforcement theory, while the observation group received narrative nursing intervention measures on this basis. The self-rating Anxiety scale (SAS), self-rating depression scale (SDS), distress thermometer (DT), Pittsburgh sleep quality index (PSQI), and General Self-Efficacy Scale (GSES) were used to evaluate and compare the changes of various indicators between the two groups after intervention. Results: There were no significant differences in the scores of SAS, SDS, DT, PSQI, and GSES between the two groups at the time of intervention (P > 0.05). After chemotherapy, the SAS, SDS, and DT scores of the observation group were significantly lower than those of the control group (P < 0.05), and the PSQI and GSES scores were significantly better than those of the control group (P < 0.01). Conclusion: Compared with the simple positive reinforcement nursing model, narrative nursing combined with positive reinforcement nursing intervention has more advantages in improving the mental health status of patients with gynecological cancer chemotherapy. It can significantly relieve the negative emotions, such as anxiety and depression of patients, effectively improve their self-efficacy level, optimize their sleep quality, and provide more comprehensive support for the physical and mental rehabilitation of patients.