Wickenbergh Evelina, Nilsson Lena, Bladh Marie, Kjølhede Preben, Wodlin Ninnie Borendal
Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Department of Anesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Eur J Obstet Gynecol Reprod Biol. 2020 Jul;250:216-223. doi: 10.1016/j.ejogrb.2020.04.014. Epub 2020 May 5.
The aim of the study was to evaluate the agreements between patients and nursing staff in perceived use of the principles of Enhanced Recovery After Surgery (ERAS) in a gynecological ward, both prior to and following an educational session on ERAS guidelines for the nursing staff.
This was a prospective observational study conducted in the in-patient gynecological section of the Department of Obstetrics and Gynecology at the University hospital of Linköping during spring 2017. The study groups comprised women scheduled for elective in-patient gynecological surgery due to benign or malignant diseases and the nursing staff at the gynecological ward. The study was performed in three parts with two structured questionnaire interviews of patients and nursing staff, and an intermediate educational session for the nursing staff regarding ERAS principles, conducted between the parts of the interview. Seventy-two patients were included in Interview part 1 and 68 patients in Interview part 2. The results are shown as the degree of inter-rater agreement and reliability of the responses between patients and nursing staff in numbers and percentages, along with the difference (Δ) in agreement between the interview parts, and its corresponding 95% confidence interval (CI). In addition, Cohen's kappa was used to validate the findings.
Inter-rater agreement in answers to the interview questions was high even before the educational session. The observed agreement was ≥ 70% in 34 out of 42 questions in Interview part 1, and in 38 out of 42 questions in Interview part 2. Thirty of the 42 items (71%) had positive Δ agreement (%) whereas 12 of the 42 (29%) had negative Δ agreement (%).
This study showed high inter-rater agreement in perceived adherence to ERAS principles between patients and nursing staff in a gynecological ward. This was further improved by an educational session for the staff concerning ERAS guidelines. This might indicate the importance of repeated educational sessions to maintain high compliance with ERAS principles.
本研究旨在评估妇科病房患者与护理人员在接受手术加速康复（ERAS）原则培训前后，对ERAS原则的认知一致性。
这是一项前瞻性观察性研究，于2017年春季在林雪平大学医院妇产科的住院妇科病房进行。研究组包括因良性或恶性疾病计划接受择期住院妇科手术的女性患者以及妇科病房的护理人员。该研究分三个部分进行，对患者和护理人员进行两次结构化问卷调查，并在两次调查之间为护理人员举办一次关于ERAS原则的中间教育课程。访谈第一部分纳入72例患者，访谈第二部分纳入68例患者。结果以患者与护理人员之间评分者间一致性程度和回答的可靠性以数字和百分比表示，以及访谈部分之间一致性的差异（Δ）及其相应的95%置信区间（CI）。此外，使用科恩kappa系数来验证研究结果。
即使在教育课程之前，访谈问题答案的评分者间一致性也很高。在访谈第一部分的42个问题中，34个问题（70%）的观察一致性≥70%，在访谈第二部分的42个问题中，38个问题（70%）的观察一致性≥70%。42项中的30项（71%）有正的Δ一致性（%），而42项中的12项（29%）有负的Δ一致性（%）。
本研究表明，妇科病房患者与护理人员在遵循ERAS原则方面具有较高的评分者间一致性。针对护理人员的ERAS指南教育课程进一步提高了这种一致性。这可能表明重复教育课程对于保持对ERAS原则的高度依从性很重要。
