Nursing Interventions in the Enhanced Recovery After Surgery<sup>®</sup>: Scoping Review

Mendes, Diana Isabel Arvelos; Ferrito, Candida Rosa de Almeida Clemente; Gonçalves, Maria Isabel Rodrigues

doi:10.1590/0034-7167-2018-0436

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 71 (suppl 6) • 2018 • https://doi.org/10.1590/0034-7167-2018-0436 copy

Nursing Interventions in the Enhanced Recovery After Surgery^®: Scoping Review

Intervenciones de Enfermería en el Programa Enhanced Recovery After Surgery^®: Scoping Review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the Nursing interventions, described in literature, in the ERAS^® program.

Method:

We defined a scoping review based on the recommendations of The Institute Joanna Brigs (JBI) and on research in electronic databases. We chose the studies through flow diagrams "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)" and presented them in a chart.

Results:

We found 306 articles published between 2010 and 2018 and included 14 of them. The main results were: the crucial role nurses play throughout the surgical process, which begins at the preoperative nursing consultation; goes to post-operative care, such as early giving food to patients, effective management of pain or early mobilization; and ends in telephone follow-up.

Conclusion:

The introduction of the surgical program ERAS^® may be an opportunity for nurses to play a more influential role in the surgical path, directly involving with their clients' results.

Descriptors:
Perioperative Nursing; Nursing; Recovery; Preoperative Nursing; Nursing Care

	Article	Year	Objective of the study	Population/ sample	Design of the study	Main conclusions
A1	Ward nurses' experience of enhanced recovery after surgery: a grounded theory approach⁽¹¹11 Jeff A, Taylor C. Ward nurses' experience of enhanced recovery after surgery: a grounded theory approach. Gastrointestinal Nurs[Internet]. 2014[cited 2018 May 01];12(4):23-31. Available from: https://www.magonlinelibrary.com/doi/abs/10.12968/gasn.2014.12.4.23 https://www.magonlinelibrary.com/doi/abs... ⁾	2014	Explore and describe the experiences of nurses involved in the ERAS^® program.	8 nurses	Qualitative study - Semi-structured interviews	We found 4 main categories: believe in the program; introduce the program; identify the role of nurses in the program; adapt the path of clients' recovery.
A2	The impact of the enhanced recovery after surgery (ERAS ^® ) programme on community nursing⁽¹²12 Bernard H, Foss M. The impact of the enhanced recovery after surgery (ERAS) programme on community nursing. Brit J Community Nurs[Internet]. 2014[cited 2018 May 01];19(4):184-8. Available from: https://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2014.19.4.184 https://www.magonlinelibrary.com/doi/abs... ⁾	2014	Know clients' point of view to use their experience in improving future practice.	Clients of the ERAS^® program	Qualitative study - Semi-structured interviews	Clients need supervision when returning earlier to home; telephone follow-up is very well received by clients; the training of nurses is vital to the success of the program.
A3	Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions´ experiences⁽¹³13 Conn LG, McKenzie M, Pearsall EA, McLeod RS. Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions' experiences. Implement Sci[Internet]. 2015[cited 2018 May 01];10(1):99. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0289-y https://implementationscience.biomedcent... ⁾	2015	Know the impact of introducing the ERAS^® program.	58 Health professionals	Qualitative study - Semi-structured interviews	Nurses can keep up with their clients' situation throughout their surgical experience, which helps nurses to improve their practice continuously.
A4	Optimising patient management before and after surgery⁽¹⁴14 Roberts J, Fenech T. Optimising patient management before and after surgery. Nurs Manag[Internet]. 2010[cited 2018 May 01];17(6):22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21137703 https://www.ncbi.nlm.nih.gov/pubmed/2113... ⁾	2010	Explain the program and discuss some of its benefits.	-	Literature review	Nurses' approach is divided into 4 main moments: preoperative evaluation; admission; postoperative and follow-up. It highlights the concept of clients as partners in care.
A5	Enhanced recovery after surgery - the importance of the perianesthesia nurse on program success⁽¹⁵15 Crosson JA. Enhanced recovery after surgery: the importance of the perianesthesia nurse on program success. J PeriAnesthesia Nurs[Internet]. 2017[cited 2018 May 01]. Available from: https://www.sciencedirect.com/science/article/pii/S1089947217300400 https://www.sciencedirect.com/science/ar... ⁾	2017	Discuss the importance of perioperative nurses in the introduction of the ERAS^® program.	-	Literature review	Strong effect of the multidisciplinary team in the ERAS ^® program; preoperative training and active involvement clients as primary intervention; nurses have a highly valuable contribution to care.
A6	Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: a provider and patient perspective⁽¹⁶16 Alawadi ZM, Leal I, Phatak UR, Flores-Gonzalez JR, Holihan JL, Karanjawala BE, et al. Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: a provider and patient perspective. Surg[Internet]. 2016[cited 2018 May 01];159(3):700-12. Available from: https://www.surgjournal.com/article/S0039-6060(15)00681-9/fulltext https://www.surgjournal.com/article/S003... ⁾	2015	Identify barriers and facilitating aspects to the introduction of an ERAS^® program.	19 Health professionals18 clients	Qualitative study - Semi-structured interviews	3 major categories: factors related to professionals; factors related to clients; and factors related to the institution. Barriers and events facilitating the introduction of the program were identified.
A7	Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery program⁽¹⁷17 Kim B, Park S, Park K, Ryoo S. Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery programme. J Clin Nurs[Internet]. 2017[cited 2018 May 01];26(21-22):3336-44. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.13682 https://onlinelibrary.wiley.com/doi/full... ⁾	2016	Assess the effects of introducing an ERAS^® care protocol.	219 clients	Comparative retrospective study	We analyzed aspects such as recovery of gastrointestinal function, pain control, recovery time and postoperative complications. We emphasize the role of nurses so that clients achieve positive results.
A8	An integrative review of postoperative accelerated recovery protocols⁽¹⁸18 Oliveira RA, Silva GMGB, Peniche ADCG, Costa ALS, Poveda VB. An integrative review of postoperative accelerated recovery protocols. AORN J[Internet]. 2017[cited 2018 May 01];106(4):324-30. Available from: https://aornjournal.onlinelibrary.wiley.com/doi/full/10.1016/j.aorn.2017.08.005 https://aornjournal.onlinelibrary.wiley.... ⁾	2017	Review published evidence regarding perioperative Nursing care for clients that are part of the enhanced recovery protocols.	13 articles	Integrative literature review	It divides the Nursing approach into two great moments: pre and intraoperative and postoperative periods. It emphasizes the importance of Nursing intervention for the success of the protocol - client's outcomes and the importance of specialized nurses dedicated to care.
A9	Successful implementation of an enhanced recovery pathway: the nurse´s role⁽¹⁹19 Brady KM, Keller DS, Delaney CP. Successful implementation of an enhanced recovery pathway: the Nurse's role. AORN J[Internet]. 2015[cited 2018 May 01];102(5):469-81. Available from: https://aornjournal.onlinelibrary.wiley.com/doi/full/10.1016/j.aorn.2015.08.015 https://aornjournal.onlinelibrary.wiley.... ⁾	2015	Describe the role of nurses in the introduction of enhanced recovery programs.	18 clients in 2013 and 15 clients in 2014	Comparative retrospective study	Stresses the importance of pre-operative training made by nurses to clients and their family; importance of establishing a plan of care appropriate to the client and ensuring compliance with the planned surgical path.
A10	Patients as partners in enhanced recovery after surgery: a qualitative patient-led study⁽²⁰20 Gillis C, Gill M, Marlett N, MacKean G, GermAnn K, Gilmour L, et al. Patients as partners in Enhanced Recovery After Surgery: a qualitative patient-led study. BMJ Open[Internet]. 2017[cited 2018 May 01];7(6):e017002. Available from: http://bmjopen.bmj.com/content/7/6/e017002 http://bmjopen.bmj.com/content/7/6/e0170... ⁾	2017	Explore the experience of clients undergoing colorectal surgery with the ERAS^® program.	27 clients	Qualitative study: focus group (7 clients) and interview (20 clients)	One of the aspects pointed out in the study was how nurses introduce and encourage compliance with the ERAS^® protocol in pre-operative training - clients reveal that it was through the nurses they received the most important information.
A11	Enhanced recovery after surgery: implications for nurses⁽²¹21 Foss M, Bernard H. Enhanced recovery after surgery: implications for nurses. Brit J Nurs[Internet]. 2012[cited 2018 May 01];21(4):221-3. Available from: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2012.21.4.221?journalCode=bjon https://www.magonlinelibrary.com/doi/abs... ⁾	2012	Examine practical aspects of the ERAS^® program in relation to Nursing.	-	Article of opinion with theoretical foundation	The importance of Nursing begins in preoperative training and also the concern in the preparation for discharge. A large part of the responsibility for introducing the program is inherent in the role of nurses.
A12	Patient´s need for nursing telephone follow up after enhanced recovery⁽²²22 Burch J, Taylor C. Patients' need for nursing telephone follow-up after enhanced recovery. Gastrointestinal Nurs[Internet]. 2012[cited 2018 May 01];10(4):51-8. Available from: https://www.magonlinelibrary.com/doi/abs/10.12968/gasn.2012.10.4.51 https://www.magonlinelibrary.com/doi/abs... ⁾	2012	Identify clients' concerns and discuss their support needs in this program.	100 clients of the ERAS^® program	Comparative retrospective study	About 50% of clients were with the nurse after discharge from the hospital, for reasons such as: pain, stoma care, clarification of doubts, etc. Telephone follow-up is well received by clients and has a positive impact on their vigilance and confidence levels.
A13	Standardising fast-track surgical nursing care in Denmark⁽²³23 Jakobsen DH, Rud K, Kehlet H, Egerod I. Standardising fast-track surgical nursing care in Denmark. Brit J Nurs[Internet]. 2014[cited 2018 May 01];23(9):471-6. Available from: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2014.23.9.471 https://www.magonlinelibrary.com/doi/abs... ⁾	2014	Report the initiative of Denmark to increase the quality of surgical care by implementing measures of enhanced recovery programs.	Audit platform data from 6 countries	Comparative retrospective study.	Creation of a perioperative Nursing unit with well defined responsibilities. Recognition of nurses as agents of change and program auditors - promoting the creation of guidelines for care.
A14	The future of surgical nursing and enhanced recovery programme⁽⁴4 Mitchell M. The future of surgical nursing and enhanced recovery programmes. Brit J Nurs[Internet]. 2011[cited 2018 May 01];20(16):978-84. Available from: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2011.20.16.978 https://www.magonlinelibrary.com/doi/abs... ⁾	2011	Describe the principles of enhanced recovery and identify aspects of Nursing knowledge that can positively influence outcomes.	-	Article of opinion with theoretical foundation.	It reports the dynamic approach that nurses can have in the program ("accompanying the client" from preoperative to post-discharge periods). It reveals that Nursing should distance itself from purely physical care and include interventions coordinated from the preoperative to the early preparation for discharge. It is important to keep the focus on the quality of information transmitted to clients and to be aware of the management of anxiety caused by the surgical process in clients. Promote coordination with community nurses to ensure post-discharge Nursing care.

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[1] CORRESPONDING AUTHOR Diana Isabel Arvelos Mendes E-mail: diana.arvelos.mendes@gmail.com

Brasil

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Nursing Interventions in the Enhanced Recovery After Surgery®: Scoping Review

Intervenciones de Enfermería en el Programa Enhanced Recovery After Surgery®: Scoping Review

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Nursing Interventions in the Enhanced Recovery After Surgery^®: Scoping Review

Intervenciones de Enfermería en el Programa Enhanced Recovery After Surgery^®: Scoping Review