Organization Factors in the ERAS Bladder Cancer Pathway: The Multifarious Role of the ERAS Nurse, Why and What Is Important?

Objective: This paper provides an overview of the multifarious role of nursing in enhanced recovery after surgery (ERAS) in advanced bladder cancer surgery with procedure-specific recommendations in radical cystectomy pathways. Data Sources: Electronic databases including PubMed and CINAHL. Conclusion: The growing evidence of preoperative, perioperative, and postoperative interventions and the concept of reacting proactively in ERAS, has led to the paradigm shift in the surgical pathway with establishment of nurse-led multi-professional prehabilitation academies. Moreover, although most patients will recover in real-life at home, there is a need for a change in postoperative and discharge management. Thus, a highly skilled discharge nurse is required to secure a comprehensive, safe discharge plan adjusted to the patient's needs in close cooperation with the primary care setting, family, and survivorship clinic if needed. Limited efforts have been made to evaluate rational principles and goals for rehabilitation after radical cystectomy; an important issue with major patient and perhaps socioeconomic consequences, wherein the ERAS nurse may take the future lead. Implication for Nursing Practice: It has become a governmental demand in many countries to involve the patient and family in treatment decisions and care by using shared decision tools, and to educate and inform each family in concordance with the patient's needs and preferences, and the health care systems must react accordingly. However, to provide person-centeredness care within advanced surgical pathways, there remains a need for thought-leaders, strategic planners, managers, and decision-makers to anchor the process of change and stop we do it anyway arguments to defend organizational cultures that are not conducing the evidence-recommend practice. (c) 2020 Elsevier Inc. All rights reserved.

Automated summary

This paper provides an overview of the multifaceted role of nursing in enhanced recovery after surgery, with specific recommendations for radical cystectomy pathways in advanced bladder cancer surgery. The establishment of nurse-led multi-professional prehabilitation academies is a key trend in surgical pathways. Postoperative and discharge management need to be changed, with highly skilled discharge nurses required to develop comprehensive and safe discharge plans. Limited efforts have been made to evaluate rational principles and goals for rehabilitation after radical cystectomy, highlighting the potential for ERAS nurses to take a leadership role in the future.