ND correction surgery can induce significant physical and psychological discomfort5,6. The KCT-ERAS nursing protocol has been effective in enhancing physical comfort, expediting recovery, and improving emotional well-being34. However, there is a notable gap in high-quality, systematic KCT-ERAS nursing plans for perioperative ND care. To bridge this gap, we have developed the first systematic KCT-ERAS nursing model for ND surgery's perioperative period. This model includes personalized shared SDM plan, health education, psychological support, environmental adjustments, dietary management, and pain control, providing a comprehensive and individualized care approach.
Gaining insight into the patient's psychospiritual and sociocultural perspectives is crucial for optimal care. SDM, a collaborative approach integrating medical evidence with the patient’s circumstances and values, has shown positive outcomes in thyroid and nasal surgery, reducing anxiety and improving recovery confidence and satisfaction35,36. The application of SDM in ND patients is particularly pertinent, considering both anatomical and aesthetic factors that are closely linked to the patient’s subjective experiences.
Environmental quality is increasingly valued, with the sensory environment of the ward being a key component of patient comfort. Positive environmental modifications, like art and music, can reduce anxiety, shorten hospital stays, and improve sleep quality37, while reducing stressors such as light and noise19. The KCT-ERAS program tailors environmental adjustments to enhance physical comfort and satisfaction.
Dietary management is pivotal in perioperative care. Shortened fasting periods and early resumption of diet, as shown in research38., have beneficial effects such as reduced surgical stress response and improved gastrointestinal function. Our protocol adopts these principles, significantly improving patient comfort during the perioperative period.
Effective pain management, transitioning from traditional postoperative pain focus to preemptive analgesia with NSAIDs, has shown to greatly improve comfort and hasten recovery. This proactive approach addresses pain before it begins, enhancing patient comfort and overall recovery outcomes.
Special nursing measures tailored to ND’s perioperative period, like preoperative adaptation training, can prevent issues like dry mouth and aid in adapting to postoperative changes, thereby reducing depressive emotions post-surgery 22. Additionally, nasal cold compresses and moist masks can alleviate facial swelling, pain, and dry mouth symptoms.
Combining comfort care theory with ERAS concepts for ND perioperative care is innovative, addressing physiological, psychological, social, and environmental discomfort factors through targeted measures. This multidisciplinary, multimodal nursing process aims to improve care quality, benefiting both medical practitioners and patients. However, the study has limitations, such as the lack of a scientific Delphi survey in expert consultations, and the possibility of more comprehensive care details. Future research should refine the ND-specific nursing program and further assess the KCT-ERAS model’s specific effects.
Strengths and Limitations of This Study
Strengths:
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The protocol effectively monitors and regulates environmental factors such as light, noise, and temperature to create a comfortable setting for patients.
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Patient stress is significantly reduced through shared decision-making, shortened fasting periods, and proactive pain management strategies.
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Preoperative behavioral training is implemented to enhance patients' adaptability to nasal packing, improving their postoperative experience.
Limitations:
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The expert consultation process lacked the robustness of a scientific Delphi survey, potentially impacting the scientific validity of the intervention measures.
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The care details provided in this study could have been more comprehensive. Incorporating additional adjunctive strategies might have further optimized the effectiveness of patient care.