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

doi:10.1097/jnr.0000000000000610

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

J Nurs Res. 2024 May 10. doi: 10.1097/jnr.0000000000000610. Online ahead of print.

Authors

Jieman Hu¹, Xiuling Zhang², Jianan Sun³, Haiyan Hu⁴, Chulei Tang¹, Lei Ba⁵, Qin Xu⁶

Affiliations

¹ PhD, RN, Lecturer, School of Nursing, Nanjing Medical University, Nanjing, China.
² BSN, RN, Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
³ MS, RN, Department of Gastrointestinal Colorectal and Anal Surgery, The First Hospital of Jilin University, Changchun, China.
⁴ BSN, RN, Head Nurse, Department of Gastrointestinal Colorectal and Anal Surgery, The First Hospital of Jilin University, Changchun, China.
⁵ PhD, Associate Professor, National Health Commission Contraceptives Adverse Reaction Surveillance Center, Jiangsu Health Development Research Center, Nanjing, China.
⁶ MS, RN, Professor, School of Nursing, Nanjing Medical University, Nanjing, China.

PMID: 38727228
DOI: 10.1097/jnr.0000000000000610

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.