Development and pilot evaluation of a nurse-led Hydration, Early mobilisation, Active breathing and Limb Assessment checklist to support postoperative recovery after abdominal surgery.

Abstract

Background: Postoperative nursing assessment plays an important role in helping detect any possible complication and enabling functional rehabilitation following the operation due to the risk associated with fluid imbalance, decreased mobility, respiratory problems, and leg complications such as deep vein thrombosis and pulmonary embolism.

Aim: The aim of the study was to design and test the piloted Hydration, Early mobilisation, Active breathing and Limb Assessment Monitoring checklist developed in collaboration with the local nursing team. The study evaluated the validity and reliability of this tool.

Methods: Development of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist involved conducting a focused narrative review of postoperative care literature and routine practice of nurses working in the clinical context of postoperative abdominal surgical units. The face and content validities of the items were analysed by seven experts from various professional disciplines rating the relevance and clarity of the items; content validity indices at item level and at scale level were determined according to conventional methodology. The face validity and feasibility of the checklist were tested by the clinical nurses practicing postoperative abdominal surgical care. Piloting was conducted on adult patients undergoing elective abdominal surgery. Two trained nurses independently completed the checklist for each patient. Inter-rater reliability was estimated using kappa coefficients and intraclass correlation coefficients.

Results: There were high levels of agreement among experts regarding the relevance and comprehensibility of items, with high content validity indices at the scale level confirming the content validity of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist. Nurses who are currently practicing reported that the checklist is comprehensible, clinically relevant, and easy to conduct in the context of routine care delivery. The checklist generated an intraclass correlation coefficient of 0.88, with kappa coefficients at the item level falling between 0.76 and 0.91, reflecting moderate to high inter-rater reliability.

Conclusion: This pilot study provides initial evidence supporting the use of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist as a valid, reliable and practicable tool led by nurses for structured postoperative monitoring after abdominal surgery. There is a need for more multicentre studies that will focus on setting appropriate Hydration, Early mobilisation, Active breathing and Limb Assessment scores and developing the corresponding patient escalation protocol.