Key result
ERAS in emergency laparotomy relies on nurses' clinical judgment and advocacy over rigid checklist compliance.
Why the study?
Enhanced Recovery After Surgery protocols improve outcomes in elective surgery, but implementation in emergency settings remains complex, and limited evidence explores how nurses perceive and operationalize them in high-acuity contexts.
ERAS implementation in emergency laparotomy is perceived by nurses as an adaptive, context-dependent process requiring nursing leadership and interdisciplinary collaboration rather than a strict checklist.
Nurses' perceptions support flexible, judgment-driven ERAS use in emergency laparotomy; leaves open impact on outcomes in prospective trials.
BACKGROUND: Emergency laparotomy carries high postoperative morbidity and mortality, requiring coordinated perioperative care to optimize recovery. Enhanced Recovery After Surgery (ERAS) protocols improve outcomes in elective surgery; however, their implementation in emergency settings remains complex. Limited evidence explores how nurses perceive and operationalize ERAS in high-acuity contexts. This study aimed to examine nurses' perspectives on the influence of ERAS protocols on postoperative recovery following emergency laparotomy in tertiary care. METHODS: A qualitative descriptive design was employed, grounded in a constructivist-informed, descriptive epistemological orientation. Twenty registered nurses from surgical wards, intensive care units [ICU], high-dependency units [HDU], and post-anesthesia care units [PACU] in two tertiary government teaching hospitals in the Al-Ahsa region, Saudi Arabia, participated in semi-structured interviews. Participants had direct experience caring for patients undergoing emergency laparotomy and exposure to ERAS related practices. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. The study adhered to SRQR guidelines. Ethical approval was obtained from the Institutional Review Board of King Faisal University. RESULTS: Four interrelated themes were identified: (1) ERAS as a structured recovery roadmap providing measurable milestones; (2) balancing protocol and patient instability through adaptive modification; (3) nursing advocacy and clinical judgment as central mediators of implementation; and (4) system constraints, including staffing and institutional variability, shaping consistency. These findings informed the Adaptive ERAS Implementation Model, conceptualizing ERAS enactment as a dynamic, nurse-mediated and context-dependent process. CONCLUSIONS: ERAS implementation in emergency laparotomy is adaptive rather than checklist-driven. Its effectiveness depends on nursing leadership, interdisciplinary collaboration, and organizational support. Strengthening these elements may enhance sustainable recovery pathways in high-acuity surgical settings. CLINICAL TRIAL NUMBER: Not applicable.
No takes yet. Share an insight, caveat, or question.
Alamoudi et al. (2026) studied Emergency laparotomy (n=20). Enhanced Recovery After Surgery (ERAS) protocols was evaluated on Nurses' perspectives on the influence of ERAS protocols on postoperative recovery. Enhanced Recovery After Surgery (ERAS) implementation in emergency laparotomy is perceived by nurses as an adaptive, context-dependent process that relies on clinical judgment and advocacy rather than rigid checklist compliance.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: