Supportive Care Needs of Patients With Temporary Ostomy in Enhanced Recovery After Surgery: A Mixed-Methods Study.

Jieman Hu, Xiuling Zhang, Jianan Sun, Haiyan Hu, Chulei Tang, Lei Ba, Qin Xu
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Abstract

Background: Enhanced recovery after surgery (ERAS), a global surgical quality improvement initiative, reduces the length of stay in the hospital. Temporary stoma care for rectal cancer is complex, and patients require prolonged care services to adjust to the stoma. The shorter stay durations in the new model challenge the conventional care pathways and create new patient needs.

Purpose: This study was designed to explore the supportive care needs of patients under the new surgical model to provide a reference for the design of ERAS nursing care plans.

Methods: A convergent parallel mixed-methods design was used in this study. Patients with temporary stomas for rectal cancer were recruited using a convenience sampling method in gastrointestinal surgery wards and wound & stoma clinics in two public tertiary care hospitals in China. Standardized questionnaires were administered to 140 patients to collect quantitative data, and semistructured interviews were conducted individually with 13 patients to collect qualitative data. The questionnaire data were analyzed using descriptive statistics, and the interview data were analyzed using thematic analysis.

Results: "Health system and information needs" and "care and support needs" were identified in both the qualitative and quantitative analyses as the most significant unmet needs of the participants. In addition, the qualitative analysis identified receiving focused stoma care instructions and easily understandable information as essential to fulfilling health system and information needs. Care and support needs included access to continued postdischarge services and attention from medical professionals.

Conclusion/implications for practice: The participants in this study experienced a variety of unmet supportive care needs under the ERAS protocol, with gaps particularly notable in two categories: "health system and information needs" and "care and support needs." Increased perioperative care and shorter hospital stays under the ERAS protocol reduce opportunities for patients to receive targeted instruction and shift much of the ostomy education and care workload out of the hospital, requiring greater attention from clinical nurses to ensure quality of care.

临时造口术患者在术后康复中的支持性护理需求:混合方法研究
背景:加强术后恢复(ERAS)是一项全球性的外科质量改进计划,可缩短住院时间。直肠癌临时造口护理非常复杂,患者需要长时间的护理服务来适应造口。目的:本研究旨在探讨新手术模式下患者的支持性护理需求,为 ERAS 护理计划的设计提供参考:本研究采用收敛平行混合方法设计。方法:本研究采用聚合平行混合方法,在中国两家公立三级甲等医院的胃肠外科病房和伤口造口门诊采用便利抽样法招募直肠癌临时造口患者。对 140 名患者进行了标准化问卷调查以收集定量数据,并对 13 名患者进行了半结构化访谈以收集定性数据。问卷数据采用描述性统计进行分析,访谈数据采用主题分析进行分析:结果:在定性和定量分析中,"医疗系统和信息需求 "以及 "护理和支持需求 "被认为是参与者最重要的未满足需求。此外,定性分析还发现,接受有针对性的造口护理指导和易于理解的信息对于满足医疗系统和信息需求至关重要。护理和支持需求包括获得出院后的持续服务和医疗专业人员的关注:本研究的参与者在 ERAS 方案下经历了各种未得到满足的支持性护理需求,其中两类需求的差距尤为明显:"医疗系统和信息需求 "以及 "护理和支持需求"。ERAS 方案下围术期护理的增加和住院时间的缩短减少了患者接受有针对性指导的机会,并将大部分造口教育和护理工作量转移到了医院之外,这就需要临床护士给予更多关注,以确保护理质量。
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