Effects of Nursing Process–Based Care on Postoperative Complications, Length of Hospital Stay, Discharge Readiness, and Patient Satisfaction Among Patients Undergoing Major Open Abdominal Surgery
Keywords:
Nursing process, Laparotomy, Readiness for discharge, Patient satisfactionAbstract
Background: Patients undergoing open abdominal surgery are at high risk of postoperative complications. This study aimed to examine the effects of applying the nursing process on postoperative complications, length of hospital stay, discharge readiness, and patient satisfaction.
Methods: This quasi-experimental study employed a non-equivalent control group design. The participants were 60 patients undergoing open abdominal surgery. Thirty patients in the control group received standard nursing care, whereas 30 patients in the experimental group received care based on the developed nursing process–based guideline. Data were analyzed using descriptive statistics, the chi-square test, Fisher’s exact test, multiple logistic regression, analysis of covariance, and the independent-samples t-test.
Results: After controlling for age, body mass index, and comorbidities, the experimental group had a significantly lower overall postoperative complication rate than the control group (23.33% vs. 70.00%; p < 0.001; adjusted OR = 0.11; 95% CI = 0.03–0.37). In particular, the incidence of postoperative ileus was significantly lower in the experimental group (16.67% vs. 50.00%; p = 0.007; adjusted OR = 0.18; 95% CI = 0.05–0.62). The length of hospital stay did not differ significantly between the groups (p = 0.598). However, the experimental group had significantly higher discharge readiness and satisfaction scores than the control group (p < 0.001).
Conclusion: The application of the nursing process reduced postoperative complications and improved discharge readiness and satisfaction among patients undergoing open abdominal surgery. Therefore, this approach should be promoted in the postoperative care of patients undergoing open abdominal surgery.
References
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1. Ljungqvist O, de Boer HD, Balfour A, et al. Opportunities and challenges for the next phase of enhanced recovery after surgery: a review. JAMA Surg. 2021;156(8):775–84.
2. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2019;43(3):659–95.
3. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91.
4. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224(1):59–74.
5. Downey CL, Bainbridge J, Jayne DG, Meads DM. Impact of in-hospital postoperative complications on quality of life up to 12 months after major abdominal surgery. Br J Surg. 2023;110(9):1206-12.
6. Healy GL, Stuart CM, Dyas AR, Bronsert MR, Meguid RA, Anioke T, et al. Association between postoperative complications and hospital length of stay: a large-scale observational study of 4,495,582 patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry. Patient Saf Surg. 2024;18:29.
7. Potter PA, Perry AG, Stockert P, Hall A. Fundamentals of nursing. 10th ed. St. Louis (MO): Elsevier; 2021.
8. Hinkle JL, Cheever KH. Brunner & Suddarth's textbook of medical-surgical nursing. 15th ed. Philadelphia: Wolters Kluwer; 2022.
9. Chalanuwat J, Kinhom S, Phonsaen N. Effects of developing a patient care system using a systematic nursing process on complications and clinical outcomes in a community hospital. Kuakarun J Nurs. 2022;29(2):45-57.
10. World Health Organization. WHO guidelines on hand hygiene in health care. Geneva: WHO; 2009.
11.Carpenito LJ. Nursing diagnosis: application to clinical practice. 15th ed. Philadelphia: Wolters Kluwer; 2017.
12. Ackley BJ, Ladwig GB, Makic MBF, Martinez-Kratz MR, Zanotti M. Nursing diagnosis handbook: An evidence-based guide to planning care. 13th ed. St. Louis, MO: Elsevier; 2023.
13. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates; 1988.
14. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.
15. Rothrock JC. Alexander's care of the patient in surgery. 16th ed. St. Louis (MO): Elsevier; 2019.
16. Work Group of the Clinical Practice Guidelines on Perioperative Care in Major Abdominal Surgery. Clinical practice guidelines on perioperative care in major abdominal surgery. Madrid: Ministry of Health, Social Services and Equality; 2016.
17. Spruce L. Infection prevention: a perioperative nurse's guide to preventing surgical site infections. AORN. 2024.
18. Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: Royal College of Physicians; 2017.
19. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52.
20. National Institute for Health and Care Excellence. Perioperative care in adults. NICE guideline NG180. London: NICE; 2020.
21. Association of Perioperative Registered Nurses. Guidelines for perioperative practice. Denver (CO): AORN; 2022.
22. Gonçalves-Bradley DC, Lannin NA, Clemson L, Cameron ID, Shepperd S. Discharge planning from hospital. Cochrane Database Syst Rev. 2022;2(2):CD000313.
23. Naylor MD, Shaid EC, Carpenter D, Gass B, Levine C, Li J, et al. Components of comprehensive and effective transitional care. J Am Geriatr Soc. 2017;65(6):1119-25.
24. Moonesinghe SR, Harris S, Mythen MG, et al. Survival after postoperative morbidity: a longitudinal observational cohort study. Br J Anaesth. 2014;113(6):977-84.
25. Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016;40(9):2065-83.
26. Jain SN. Enhanced recovery after surgery: exploring the advances and clinical outcomes. J Clin Med. 2023;12(5):1678.
27. Sauro KM, Smith C, Ibadin S, Thomas A, Ganshorn H, Bakunda L, et al. Enhanced Recovery After Surgery guidelines and hospital length of stay, readmission, complications, and mortality: a meta-analysis of randomized clinical trials. JAMA Netw Open. 2024;7(6):e2417310.
28. Kannan V, Ullah N, Geddada S, Ibrahiam A, Al-Qassab ZMS, Ahmed O, et al. Impact of enhanced recovery after surgery (ERAS) protocols vs traditional perioperative care on patient outcomes after colorectal surgery: a systematic review. Patient Saf Surg. 2025;19:4.
29. World Health Organization. Framework on integrated people-centred health services. Geneva: WHO; 2016.
30. Kwame A, Petrucka PM. Communication in nurse-patient interaction in healthcare settings in sub-Saharan Africa: A scoping review. Int J Afr Nurs Sci. 2020;12:100198.
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