Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Denmark.
J Clin Nurs. 2023 Jul;32(13-14):4037-4048. doi: 10.1111/jocn.16555. Epub 2022 Oct 24.
To gain insight into nursing in an enhanced recovery after surgery program for lung cancer, we explored its meaning for nurses in a thoracic surgery unit.
Since nurses play a key role in overcoming implementation barriers in enhanced recovery after surgery programs, successful implementation depends on their care approach during the surgery pathway.
Qualitative focus group study.
A hermeneutic approach inspired by Gadamer guided the research. Sixteen thoracic surgery nurses participated in focus group interviews. Benner and Wrubel's primacy of caring theory enhanced understanding of the findings. COREQ guidelines were followed.
The thoracic surgery nurses compared the streamlined trajectory in the program to working in a factory. Shifting focus away from a dialogue-based, situated care practice compromised their professional nursing identity. The program made combining scientific evidence with patients' lifeworld perspectives challenging. Although the nurses recognised that the physiological processes and positive outcomes promoted recovery, they felt each patient's life situation was not sufficiently considered. To meet the program's professional nursing responsibilities and provide comprehensive care, specialised thoracic nursing should continue after discharge to allow professional care while meaningfully engaging with the patient's situatedness and lifeworld.
Primacy of caring risks being compromised if accelerated treatment is implemented uncritically. If care is based on the dominant rational justifications underpinning surgical nursing, living conditions and patient values might be overlooked, affecting how disease, illness and health are managed.
Our findings focus on obvious unintended consequences of enhanced recovery after surgery programs. To avoid dehumanising patients, surgical lung cancer programs must adopt a humanistic attitude in a caring practice guided by the moral art and ethics of care and responsibility.
To reminding us of what matters and helping us think differently, we discussed the results of the study with organisational stakeholders.
为深入了解肺癌术后加速康复外科护理的内涵，本研究聚焦于胸外科病房护士。
护士在克服加速康复外科实施障碍方面发挥着关键作用，成功实施取决于他们在手术路径中的护理方法。
定性焦点小组研究。
受伽达默尔启发的解释学方法指导了本研究。16 名胸外科护士参与了焦点小组访谈。本研究以 Benner 和 Wrubel 的关怀优先理论为基础，以加深对研究结果的理解。
胸外科护士将该项目中的简化流程与工厂工作进行了比较。将重点从基于对话的、情境化的护理实践转移，会损害他们的专业护理身份。该项目使得将科学证据与患者的生活世界观点相结合具有挑战性。尽管护士们认识到生理过程和积极的结果促进了康复，但他们认为每个患者的生活状况都没有得到充分考虑。为了满足该项目的专业护理责任并提供全面护理，应该在出院后继续进行专门的胸科护理，以允许提供专业护理，同时有意义地参与到患者的情境和生活世界中。
如果不加批判地实施加速治疗，关怀优先可能会受到损害。如果护理是基于支撑外科护理的主要理性依据，那么生活条件和患者价值观可能会被忽视，从而影响疾病、患病和健康的管理方式。
我们的研究结果聚焦于加速康复外科项目的明显意外后果。为了避免对患者的人性化待遇，肺癌手术项目必须在关怀实践中采取人文态度，该实践以关怀和责任的道德艺术和伦理为指导。
通过提醒我们什么是重要的，帮助我们以不同的方式思考，我们与组织利益相关者讨论了研究结果。
