The Effect Of Clinical Nursing Pathway Of Enhanced Recovery After Surgery In Colorectal Cancer Patients During The Perioperative Period

Objectives:Based on the consensus of experts in ERAS,the perioperative clinical nursing pathway(CNP)of ERAS for colorectal cancer patients was preliminarily constructed to meet the clinical needs,and the clinical verification was carried out to provide reference for the improvement of overall nursing quality and the rehabilitation of patients' prognosis.Methods:1.To establish perioperative CNP of ERAS for colorectal cancer patients: The draft of CNP was designed through literature analysis,chart review and medical order data collation,and optimized by expert meeting.Three rounds of pre-tests were taken to verify and modify the CNP(including the CNP for nurses and the CNP for patients).2.Application and effect evaluation of perioperative CNP in ERAS for with colorectal cancer patients:This is a quasi-experimental study.From March 2018 to November 2018,we used convenience sampling method,and collected a total of 110 perioperative colorectal cancer patients who met the inclusion and exclusion criteria in colorectal anus surgery at a Grade 3A hospital in Shanxi province.According to the time of admission,55 patients hospitalized from March 2018 to June 2018 were the control group,received general nursing care without clinical nursing path management;55 patients hospitalized from July2018 to November 2018 were the intervention group,received nursing according to the Clinical Nursing Path Table of ERAS for Colorectal Cancer Patients.Both groups were used the concept of ERAS.The time of first flatus,the completion rate of getting out of bed 12 hours after operation,the rates of complication,pain score and satisfaction with pain control,length of stay and the hospital expenses,the values of serum total protein and serum albumin on the fifth day after operation were compared between the two groups.3.Statistical methods:All the collected data were analyzed by SPSS22.0 statistical software.The measurement data in the general data are described by the mean±standard deviation,and analyzed by two independent samples t test and repeated measurement of variance analysis;And the counting data are described by the frequency and the composition ratio,analyzed by tested using the chi-square test or Fisher method.P values less than 0.05 were considered significant.Results:1.The CNP of ERAS for colorectal cancer was constructed to meet the clinical needs and conform to the Department development.The standard length of hospital stay of the CNP was 11 days,including 4 days for preoperative preparation and 7 days for post-operative recovery.The CNP consists of two parts: the nurse and the patient.The CNP for nurses takes nursing diagnosis and treatment items as vertical axis and time as horizontal axis,forming 6 CNP forms :the first day of admission,from the second day of admission to the preoperative stage,preoperative preparation,return to the ward after operation,from the first day to the third day after operation,and from the fourth day to the discharge stage.The patient part takes the above six stages as the horizontal axis,and checks ?diets ?activities and nursing guidance as the vertical axis to formulate tables.Nurses strictly implement the contents of the CNP table in accordance with the time sequence and mark as “?” and signed.2.No significant difference was found between two groups in gender,age,educational level,basic blood pressure value,operation method and preoperative total protein and albumin values(P>0.05);Rehabilitation index:The time of first flatus in experimental group were shorter than that in control group,and the completion rate of getting out of bed 12 hours after operation in experimental group were higher than that in control group,and the difference was statistically significant(P<0.01);There were no significant differences in the rate of postoperative complication between two groups(P>0.05).Benefit Indicators:The length of stay(LOS),LOS after operation and LOS before operation,the hospital expenses in experimental group were shorter than those in control group,and the difference was statistically significant(P<0.05).The results of repeated analysis of variance showed that:There were significant differences in time and group of pain scores between the experimental group and the control group(P<0.01),and there was interaction between time and group.And the average satisfaction of pain control in the observation group was 8.4 points higher than that in the control group,and the difference was statistically significant(P < 0.01).Laboratory indicators: Total protein(TP)and albumin(ALB)in the experimental group were significantly higher than those in the control group on the third day after operation,and the difference was statistically significant(P<0.01).Conclusion:CNP designed and generated for ERAS can improve the outcome of patients after operation,reduce stress response,improve the implementation rate of nursing work and patient satisfaction,and promote the recovery of patients after operation.