Verbeterd hersteltraject (ERP) bij slokdarmresecties voor kanker: verpleegkundige perspectieven

SUMMARY The prologue of this thesis outlines the design and implementation of an Enhanced Recovery Protocol (ERP) for esophagectomy, emphasizing the vital role of nurses and allied health professionals in transforming traditional surgical care into an interprofessional, patient-centered approach. Drawing inspiration from international best practices and firsthand observations at Virginia Mason Hospital, the team restructured perioperative care around five key pillars: active patient and family involvement, optimized pain management, early mobilization, avoidance of catheters, and a shift from parenteral to enteral nutrition. The chapter highlights the collaborative development process. From the introduction onward, rigorous outcome tracking and process evaluation are implemented to assess the ERP's potential. In Part 1, the Foundation of Enhanced Recovery Protocols (ERP) is described in detail. Chapter 1 examines the clinical impact of our institution-specific ERP, compares it with traditional care, and demonstrates the ERP's clinical effectiveness in improving outcomes for patients with esophageal cancer. Chapter 2 focuses on patient satisfaction and the delivery of personalized care. Patients expressed high satisfaction with ERP-driven care, emphasizing the importance of clear communication and tailored approaches. Chapter 3 describes the process analysis of postoperative nursing care and shows that adherence to ERP nursing components directly influences clinical outcomes. This chapter emphasizes the importance of regular audits, interprofessional training, and adaptive strategies as essential components for maintaining consistency and quality in an ERP. Part 2 addresses two specific issues in postoperative nursing care. Chapter 4 discusses the currently used Early Warning Score (EWS) and its limitations in clinical judgment, while Chapter 5 elaborates on the challenges encountered with the routine use of Feeding Jejunostomy (FJ). Part 3 delves deeper into the human element in ERP success. Chapter 6 highlights nurses' perspectives on ERP and staffing realities. Adequate nurse staffing emerges as a key factor for ERP success, leading to improved outcomes and higher patient satisfaction. This thesis confirms the hypothesis that a structured, interprofessional ERP improves both clinical outcomes and patient satisfaction in esophagectomy for cancer. The research journey, from protocol implementation and patient experience to nursing processes, monitoring tools, nutritional strategies, and staffing, demonstrates ERP's transformative potential when nurses and allied health professionals are empowered as central contributors.