Enhanced recovery after surgery and its effects on nurses' clinical decision-making: A case study in quality of care

Beskrivelse

Introduction: This presentation discusses the effect that enhanced recovery after surgery (ERAS) (1) has on nurses’ agency and clinical decision-making. As its starting point, it uses data collected at an emergency surgical ward; this data investigated nurses’ ability to involve patients in their treatment at the emergency ward, as opposed to the surgical ward, and overall patient satisfaction with the treatment they received.
Background: Patients’ perception of being involved in their treatment and care plan improves the quality of the former (1-3). A quality development project implemented in 2018 at the surgical and emergency wards of a Copenhagen hospital, aiming to boost patient involvement, increased overall patient satisfaction with emergency ward care. However, satisfaction with surgical ward care remained unaffected, even though the same nurses worked in both places.
Methods: Single case study of a quality development project at a surgical and emergency ward. The data included documents such as qualitative reports, operation pathway programs, governmental reports and guidelines, focus interviews with nurses, and informal conversations with the ward nurse and other head nurses.
Results: The data reveals that the nurses know how to involve patients and make appropriate clinical decisions. However, in cases where the nurses expected the patient involvement process to be time-consuming (e.g. language barrier, social complexity), they complied with administrative goals (number of patients discharged), rather than quality of care. The results highlight the double standard of quality that emerges in these two settings and ultimately question what constitutes quality care in ERAS (4-5).

Keywords: Enhanced recovery, clinical decision-making, patient involvement, double standards

References:
1. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017;152(3):292–298. doi:10.1001/jamasurg.2016.4952.

2. Archer, S., Montague, J., & Bali, A. (2014). Exploring the experience of an enhanced recovery programme for gynaecological cancer patients: a qualitative study. Perioperative Medicine, 3(1), 1-8

3. Specht, K., Kjaersgaard‐Andersen, P., & Pedersen, B. D. (2016). Patient experience in fast‐track hip and knee arthroplasty–a qualitative study. Journal of Clinical Nursing, 25(5-6), 836-845.

Periode	30 jun. 2021
Begivenhedstitel	COMET 2021: INTERNATIONAL AND INTERDISCIPLINARY CONFERENCE ON COMMUNICATION, MEDICINE AND ETHICS
Begivenhedstype	Konference
Konferencenummer	19
Placering	Como, ItalienVis på kort
Grad af anerkendelse	International