The current and future role of nurses within enhanced recovery after surgery pathways

Abstract

Background: Enhanced recovery after surgery (ERAS) pathways have been proven to expedite recovery after many procedures and reduce lengths of stay in hospital and surgical complications. However, improvements are still needed, especially in postoperative ERAS components delivered by nurses such as early mobilisation and oral feeding. This article summarises the current and possible future role of nurses within ERAS, and recommends areas for future research. Discussion: Nurses are the professionals who spend the most time with patients throughout the perioperative pathway and are known to play a vital role in delivering many components of an ERAS pathway. They frequently co-ordinate care across disciplines and ensure continuity of care. However, there is a paucity of ERAS research specific to nurses compared to other professional groups. Continual training on ERAS will be required to ensure nurses are highly educated and for the best possible ERAS implementation. In certain types of surgery, nurses may fulfil extended roles in the postoperative period, such as taking over responsibility and leadership for co-ordinating pain management, mobilisation and discharge. However, this requires a well-defined care programme, a clear definition of nursing responsibilities from surgeons, agreed discharge criteria and highly qualified nurses, along with the collection and analysis of data to test safety and efficacy. Conclusion: Increasing nurse involvement in ERAS research is vital to drive improvements in care and to develop nursing roles. Nurses should have a major role in the preoperative clinic, the early postoperative phase and the follow-up post-discharge period, where the benefits of ERAS need to be further documented.

CE: Overcoming Movement-Evoked Pain to Facilitate Postoperative Recovery

“…operative preparation, and to improve analgesia, nutrition, hydration, and early mobilization. 11 Adopting MEP as a standard part of pain assessment and reassessment and as a basis for daily treatment is an important component of recovery. Alternate approaches for those not achieving pain control or hitting functional benchmarks at defined intervals should also be discussed by the team to facilitate refinement of treatment plans if first-line therapies fail.…”

“…Protocols typically start with preoperative prehabilitation (exercise), nutritional, education, and counseling efforts using motivational interviewing techniques to improve physical and mental preparation before surgery. 11 Perioperative preemptive multimodal analgesia, with early postoperative mobilization, sleep hygiene, and oral intake, has also been shown to have better outcomes than traditional restrictive approaches. 28 Early mobilization is considered one of the most important components of ERAS protocols.…”

“…Nurses should intervene to enhance pain tolerability and relief as well as engagement in activities required for optimal recovery 9. Nurses are in a key position to implement and evaluate safe, effective pain treatment plans while also considering functional benchmarks, discharge criteria, and patient-specific factors 10, 11. Establishing a plan based on realistic, measurable goals will help maximize pain reduction and functional improvement while avoiding treatment-related harm.…”

“…9 Nurses are in a key position to implement and evaluate safe, effective pain treatment plans while also considering functional benchmarks, discharge criteria, and patient-specific factors. 10,11 Establishing a plan based on realistic, measurable goals will help maximize pain reduction and functional improvement while avoiding treatmentrelated harm. Nurses can work collaboratively with patients, the health care team, and caregivers to develop and implement a multifaceted plan of care to…”

The Comparison of enhanced recovery after surgery versus traditional pathway in early-onset scoliosis surgery

“…Kehlet first proposed enhanced recovery after surgery (ERAS) in 1997 as a multidisciplinary and multi-modal method to improve the perioperative prognosis and rehabilitation of inpatients, enhanced recovery after surgery (ERAS) was first proposed by Kehlet in 1997 [11][12]. ERAS is a comprehensive system that combines medical, therapeutic, and psychological approaches to accelerate postoperative patient recovery [13].…”