Effect of Comprehensive Nursing on the Recovery of Gastrointestinal Function in Patients Undergoing Abdominal Operation.

Objective: The objective is to explore the effect of comprehensive nursing on the recovery of gastrointestinal function in patients undergoing an abdominal operation. Methods: Sixty patients undergoing abdominal surgery in our hospital from January 2019 to April 2021 were enrolled. The patients were arbitrarily assigned into control group and research group. The former group received routine nursing and the latter group received comprehensive nursing. Nursing satisfaction, gastrointestinal function, POMS-SF score, nutrition risk score, incidence of adverse reactions, and quality of life scores were compared. Results: The nursing satisfaction of the research group was higher than that of the control group, and the difference between the groups was statistically significant (P < 0.05). In terms of gastrointestinal function, the anal exhaust time eating time defecation time and bowel sound recovery time in the research group were significantly lower than those in the control group, and the difference between the groups was statistically significant (P < 0.05). In terms of POMS-SF score, the scores of tension-anxiety, depression-depression, fatigue-dullness, anger-hostility, and confusion-confusion in the research group were lower than those in the control group, while the energy-vitality score was higher than that in the control group, and the difference between the groups was statistically significant (P < 0.05). There was no significant difference in nutritional risk score among patients before nursing (P > 0.05); after nursing, the nutritional risk score decreased. Compared between the two groups, the nutritional risk score of the research group was lower when compared to the control group at 3 days, 5 days, and 7 days after nursing, and the difference between the groups was statistically significant (P < 0.05). In terms of the incidence of adverse reactions, the incidence of adverse reactions such as incision effusion, incision infection, incision dehiscence, and anastomotic leakage in the research group was lower when compared to the control group, and the difference between the groups was statistically significant (P < 0.05). Regarding quality of life scores, before nursing, there exhibited no significant difference of patients (P > 0.05); after nursing, the quality of life scores of patients decreased. Compared with the two groups, the physical function, psychological function, social function, and healthy self-cognition scores of the research group were all lower compared to the control group, and the difference between the groups was statistically significant (P < 0.05). Conclusion: Abdominal surgery patients received comprehensive care, which improved their mental health, reduced anxiety and depression levels, relieved fatigue and dullness, improved energy and vitality, and enhanced their overall mood. Meanwhile, it can also promote the recovery of gastrointestinal function in patients and reduce the incidence of adverse reactions.

Implementing Enhanced Recovery After Surgery (ERAS) Program on a Specialty Nursing Unit.

Implementing Enhanced Recovery After Surgery (ERAS) guidelines is an effective method to standardize patient care, improve patient outcomes, and develop quality improvement projects. Completing the required ERAS Implementation Program provided by the International ERAS Society enabled the hepatopancreaticobiliary surgery team at Carolinas HealthCare System to successfully implement evidence-based practice changes for pancreaticoduodenectomy patients on an acuity-adjustable unit resulting in improved care and cost reduction.

Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery programme.

AIMS AND OBJECTIVES: To investigate the effects of a standardised care protocol as part of an enhanced recovery after surgery programme on the management of patients who underwent open colon surgery at the University Hospital, South Korea. BACKGROUND: Patients who undergo open colon surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. DESIGN: A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after surgery programme with a care protocol. METHODS: Records of 219 patients who underwent open colon surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. RESULTS: Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. CONCLUSION: The findings can be used to facilitate the implementation of an enhanced recovery after surgery programme with a care protocol following open colon surgery. RELEVANCE TO CLINICAL PRACTICE: We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open colon surgery. This care protocol empowers long-term patient self-care capacity, which contributes to increasing the effectiveness of clinical nursing care.

The impact of an enhanced recovery pathway on nursing workload: A retrospective cohort study.

BACKGROUND & AIMS: The importance of nursing for surgical patients has been frequently underestimated. The success of enhanced recovery programs after surgery (ERAS) depends on preferably complete fulfillment of the protocol and nurses are an important part of it. Due to the additional nursing action required, such protocols are suspected to increase the nursing workload. The aim of the present study was to observe and measure objectively nursing workload before, during and after systematic implementation of a comprehensive enhanced recovery pathway in colorectal surgery. METHODS: The program ERAS was introduced systematically in our tertiary academic centre 2011, since then our experience is based on more than 1500 ERAS patients. Nursing workload was prospectively assessed for all patients on a routine basis by means of a standardized and validated point system (PRN). In a retrospective cohort study, we compared nursing workload based on prospective data before, during and after ERAS implementation and correlated nursing workload to the compliance with the ERAS protocol. RESULTS: The study cohort included 50 patients before ERAS implementation (2010) and 69 (2011) and 148 (2012) consecutive patients after implementation; the baseline characteristics of the 3 groups were similar. Mean PRN values were 61.2 ± 19.7 per day in 2010 and decreased to 52.3 ± 13.7 (P = 0.005) and 51.6 ± 18.6 (P < 0.002) in 2011 and 2012, respectively. Increasing compliance with the ERAS protocol was significantly correlated to decreasing nursing workload (ρ = -0.42; P < 0.001). CONCLUSIONS: Nursing workload is--against a common belief--decreased by systematic implementation of enhance recovery protocol. The higher the compliance with the pathway, the lower the burden for the nurses!

[Nursing care in perioperative period in patients with intenstinal stomia exposure]. / Opieka pielegniarska w okresie okolooperacyjnym nad pacjentem z wyloniona stomia jelitowa.

Despite of enormous advance in minimally invasive surgery which is almost scarless nowadays, there is still very important emotional issue for patients connected with each surgical procedure. One of the most stressful surgical procedures for patients is the one which ends up with stomia exposure. The main objective of this article is to point out very the important factor which leads to decrease the number of complications, speeds up recovery and acceptation of the stomia by patients. This factor is known as a professional nursing care. It consists of physical and psychical preoperative preparation and postoperative care for patients. Special care in early postoperative 24h is crucial for preventing from development of any complications. That is why the nursing personnel is obliged to monitor vital signs very carefully. Complex preparation and postoperative care leads to diminish significantly the number of complications, facilitates cooperation with patients and also influences the increase of sense of safety and trust to medical personnel. Patients with stomia who were under professional nursing staff supervision achieve full recovery and higher quality of life considerably earlier.

[Educational role of a nurse in medical care of patients with outer intestinal stoma]. / Pielegniarka jako edukator pacjentów z wyloniona stomia jelitowa.

Nurse staff plays an important role in a process of professional nursing of patients suffering from intestinal stoma. Those functions are aimed at fast adaptation to life with the illness. The first important stage for a patient is to agree for artificial anus. At this time nurse supports patient and his family in a psychological way, giving tips and advice at the same time. It is crucial for patient's cognitive, motivating and information sphere. It helps patient to accept his body after changes, with unusual place of expelling a stool. That stage is the beginning for the patient to learn how to care for soma, which is a necessity to continue active career, family and social life. Patient is given information in range of stoma care and use of stoma equipment. Nursing staff provides patient with necessary knowledge about proper lifestyle, diet, clinics, supporting groups, stoma equpment refund and how to prevent distension. It is very crucial to involve whole family of a patient in educational process. Recovery strictly depends on the quality of information that patient and his family receive. Education is a fundamental condition to keep satisfactory level of fitness, independence and ability to deal with problems caused by stoma. It also has direct impact on life standard of a patient.

Introducing a patient-focused care map in colorectal surgery: a pilot qualitative study of patients' and surgical oncology nurses' experiences.

Care maps for patient care have been around for many years. Key stakeholders at our institution developed and implemented a care map for patients undergoing surgery for colorectal cancer. The purpose of this descriptive, qualitative pilot study was twofold. First was to understand the lived experience of patients being cared for under a newly-implemented care map utilizing patient diaries and interviews. The second goal was to describe the experiences of surgical oncology nurses caring for these patients using a focus group technique. The results of our small study indicated that patients appreciated having a document that outlines daily activities and goals, and were anxious to get home, but were disappointed in the discharge planning process. Nurses were positive about the care map overall, but felt they could have contributed more in the development and planning stages of the care map. Overall, the implementation of our patient-centred care map was a success.

Inpatient surgical bowel preps: making them work.

This article will describe the evidence-based approach our hospital developed to best prepare children for abdominal surgery. Our evidence-based interdisciplinary approach was based on the work of [McCallin, A. (2001). Interdisciplinary practice--A matter of teamwork: An integrated literature review. Journal of Clinical Nursing, 10, 419-428], [Melnyk, B. M. (2002). Evidence-based practice. Strategies for overcoming barriers in implementing evidence-based practice. Pediatric Nursing, 28, 159-161], [Melnyk, B. M., & Fineout-Overholt, E. (2002). Evidence-based practice. Key steps in implementing evidence-based practice: Asking compelling, searchable questions and searching for the best evidence. Pediatric Nursing, 28, 262-266], [Sierchio, G. P. (2003). A multidisciplinary approach for improving outcomes. Journal of Infusion Nursing, 26, 34-43], and [Wojner, A. W. (1996). Outcomes management: An interdisciplinary search for best practice. AACN Clinical Issues, 7, 133-145]. At our hospital, a leading children's hospital in an eastern urban setting, we surgically manage children, from newborns to young adults, with a variety of diagnoses. These diagnoses include the following: inflammatory bowel diseases, such as Crohn's disease and UC, imperforate anus, necrotizing enterocolitis, and abdominal tumors. The bowel prep is an integral part of these children's surgical preparation.

Evolución y cuidados del trasplante intestinal en el postoperatorio inmediato / Course and cares of intestinal transplant in immediate post-operative period

Objetivo. Describir la evolución y cuidados del postoperatorio inmediato en pacientes con trasplante intestinal. Material y métodos. Estudio descriptivo prospectivo realizado en la Unidad de Cuidados Intensivos Polivalente de un hospital terciario durante un año. Variables analizadas durante las primeras 48 horas del postoperatorio: constantes vitales, saturación O2, tiempo de destete, diuresis, glucemia, catéteres, drenajes, ileostomía, gastrostomía, TISS, NEMS, cuidados de enfermería, APACHE II y SAPS II al ingreso. Análisis estadístico con SPSS 11.0. Resultados. Cuatro pacientes. Mujeres 50%, edad media 42 ± 8 años. Motivo trasplante intestinal: 75% poliposis adenomatosa familiar con tumor desmoides y 25% obstrucción arteria mesentérica. Recibieron alemtuzumab y tacrólimus. Todos los pacientes eran portadores de catéter venoso central, arterial y drenajes abdominales Jackson Pratt (50% dos, 50% tres). Tiempo intubación (mediana) 15 horas. APACHE II 10 ± 6 y SAPS II 16 ± 4. Medias primer y segundo día de: tensión arterial sistólica/diastólica 132 ± 23/73 ± 11; 130 ± 25/74 ± 13 mmHg; glucemia 136 ± 26/119 ± 25 mg/dl; diuresis 95 ± 34/125 ± 30 cc/hora; TISS28 49 ± 4/38 ± 11 y NEMS 27 ± 0/25 ± 10, respectivamente. Una reintervención por shock hemorrágico. Mediana de estancia en Unidad de Cuidados Intensivos 4 días. Conclusiones. 1) Son pacientes hemodinámicamente estables; con destete corto; no portan muchos catéteres; ileostomía funcionante desde el primer día y con TISS28 y NEMS en la media del rango. 2) Los cuidados más específicos del trasplante intestinal son: herida quirúrgica, drenajes, ileostomía, gastrostomía. 3) La necesidad de intensa inmunosupresión implica aislamiento estricto y una ratio de enfermería:paciente 1:1

Objective. Describe the course and immediate post-operative care in patients with intestinal transplant. Material and methods. Descriptive, prospective study conducted in the Polyvalent Intensive Care Unit of a tertiary hospital for one year. Variables analyzed during the first 48 hours of the post-operative period: vital signs, O2 saturation, weaning time, diuresis, glycemia, catheters, drains, ileostomy, gastrostomy, TISS, NEMS, nursing cares, APACHE II and SAPS II on admission. Statistical analysis with SPSS 11.0. Results. Four patients, 50% women, mean age 42 ± 8 years. Reason for intestinal transplant: 75% familial adenomatous polyposis with desmoid tumor and 25% mesenteric artery obstruction. They were administered alemtuzumab and tacrolimus. All the patients were carrier of central and arterial venous catheters, and Jackson Pratt abdominal drains (50% two, 50% three). Intubation time (median) 15 hours. APACHE II 10 ± 6 y SAPS II 16 ± 4. Means on first and second day of: systolic/diastolic blood pressure 132 ± 23/73 ± 11; 130 ± 25/74 ± 13 mmHg; glycemia 136 ± 26/119 ± 25 mg/dl; diuresis 95 ± 34/125 ± 30 cc/hour; TISS28 49 ± 4/38 ± 11 and NEMS 27 ± 0/25 ± 10, respectively. One re-operation due to hemorrhagic shock. Median study in Intensive Care Unit of 4 days. Conclusions. 1) They are hemodynamically stable patients with short weaning. They do not have many catheters, functioning ileostomy since the first day and TISS28 and NEMS in the middle of the range. 2) The most specific cares of the intestinal transplant are: surgical wound, drains, ileostomy, gastrostomy. 3) The need for intense immunosuppression implies strict isolation and nursing:patient ratio of 1:1

The provision of nursing care for gay men with GI issues.

The holistic nursing care of the individual is a hallmark of high-quality care; this holistic approach means that the nurse will also have to take the sexuality of the person being cared for into account. This article promotes the notion of holism and, in particular, the care of one group of patients -- homosexual men. In this article the needs of the gay patient who has undergone GI surgery are discussed in respect to their sexuality. Key terms and concepts are considered. A therapeutic nurse-patient relationship can only be achieved if the needs of the patient are taken into account; the term that the patient chooses to use when identifying his individual sexuality must be respected. Stigma, discrimination and prejudice are unwanted results of a failure to respect an individual and should be avoided. There are several instances where stereotyping and myth may occur concerning the gay patient who has undergone GI surgery, and erroneous assumptions made about the patient can thwart the unique nurse-patient bond.

Combining topical negative pressure and a Bogota bag for managing a difficult laparostomy.

A patient with a severe intra-abdominal infection required a laparostomy. A Bogota bag was combined with topical negative pressure therapy, saving nursing time and enabling successful management of wound fluid.

Robotics and general surgery.

Robotics are now being used in all surgical fields, including general surgery. By increasing intra-abdominal articulations while operating through small incisions, robotics are increasingly being used for a large number of visceral and solid organ operations, including those for the gallbladder, esophagus, stomach, intestines, colon, and rectum, as well as for the endocrine organs. Robotics and general surgery are blending for the first time in history and as a specialty field should continue to grow for many years to come. We continuously demand solutions to questions and limitations that are experienced in our daily work. Laparoscopy is laden with limitations such as fixed axis points at the trocar insertion sites, two-dimensional video monitors, limited dexterity at the instrument tips, lack of haptic sensation, and in some cases poor ergonomics. The creation of a surgical robot system with 3D visual capacity seems to deal with most of these limitations. Although some in the surgical community continue to test the feasibility of these surgical robots and to question the necessity of such an expensive venture, others are already postulating how to improve the next generation of telemanipulators, and in so doing are looking beyond today's horizon to find simpler solutions. As the robotic era enters the world of the general surgeon, more and more complex procedures will be able to be approached through small incisions. As technology catches up with our imaginations, robotic instruments (as opposed to robots) and 3D monitoring will become routine and continue to improve patient care by providing surgeons with the most precise, least traumatic ways of treating surgical disease.

Third-space fluid shift in elderly patients undergoing gastrointestinal surgery: Part 1: Pathophysiological mechanisms.

Third-space fluid shift, the movement of body fluid to a non-functional space, is a frequently occurring and potentially fatal clinical phenomenon. Little published research exists however in medical or nursing journals concerning its incidence, significance and ramifications in elderly patients undergoing major gastrointestinal surgery. This initial article, part I, explores fluid movement between fluid compartments and uses these principles to discuss the pathophysiology of the two distinct phases of third-space fluid shift. Part II will examine the criteria nurses could use in the clinical assessment of patients in both first and second phases third-space fluid shift and discuss the clinical reliability of these criteria.

The role of the RNSA in colorectal and general surgery.

More nurses are taking on the role of Surgical Assistant. In this article, Jill Biggins reports on her own experience of becoming a Registered Nurse Surgical Assistant in colorectal and general surgery. Jill explains how the role was developed, its tasks and responsibilities, the response of other perioperative practitioners to the role and how further development of the role might be achieved.

Dispositivos en ostomías digestiva y urológica / Instruments for us in digestive tract and urologic osteomas

Se realiza un breve recorrido histórico analizando los estomas intestinales y la evolución de técnicas y dispositivos utilizados. Se habla de las características que condicionan la elección del dispositivo, de cuáles son sus requisitos básicos, y de los tipos de dispositivos existentes en el mercado. Las bolsas y los accesorios son otros de los apartados de este artículo (AU)

Clinical decision making by nurses when faced with third-space fluid shift. How well do they fare?

Nurses' use of knowledge, the connection of this knowledge to treatment decisions and information actually used to reach such decisions, delineates nurses' level of expertise. Previous research has shown that nurses in their clinical decision-making use the hypothetico-deductive method and intuitive judgment or pattern recognition. This interpretive study explored experienced critical care nurses' (n = 5) and gastrointestinal surgical nurses' (n = 5) clinical decision-making processes through ascertaining their knowledge and understanding of third-space fluid shift in elderly patients undergoing major gastrointestinal surgery. Both groups of nurses, because of their experience with elderly patients undergoing gastrointestinal surgery, were assumed to be experts. Data collection techniques included semi-structured interviews and the use of think aloud protocol for clinical scenario analysis. The findings demonstrated that the gastrointestinal surgical nurses used the hypothetico-deductive method to recognize critical cues and the existence of a problem but could not name the problem. The critical care nurses, on the other hand, used a combination of the hypothetico-deductive method and pattern recognition as a basis for identification of critical cues. The critical care nurses also possessed in depth knowledge of third-space fluid shift and were able to use pivotal cues to identify the actual phenomenon. Ultimately, it would appear that the structure of critical care nurses' work, their increased educational qualifications and the culture of the critical care unit promote a more proactive approach to reasoning in the physiological domain. The findings have implications for the development of practice guidelines and curriculum development in both tertiary and continuing nurse education.