Postoperative mobilisation as an indicator for the quality of surgical nursing care
Postoperative mobilisation is an important part of fundamental care. Increased mobilisation has positive effect on recovery, but immobilisation is still a challenge in postoperative care.
To report how the establishment of a national nursing database was used to measure postoperative mobilisation in patients undergoing surgery for ovarian cancer.
‘Mobilisation’ was defined as at least 3 hours out of bed on postoperative day 1, with the goal set at achieving this in 60% of patients. Data entry was performed by clinical nurses on 4400 patients with ovarian cancer.
46.7% of patients met the goal for mobilisation on the first postoperative day, but variations in duration and type of mobilisation were observed. Of those mobilised, 51.8% had been walking in the hallway.
A national nursing database creates opportunities to optimise fundamental care. By comparing nursing data with oncological, surgical and pathology data it became possible to study mobilisation in relation to cancer stage, comorbidity, treatment and extent of surgery.
Postoperative mobilisation is an important aspect of fundamental postoperative care. The effect and importance of mobilisation is well documented in the literature (Kehlet and Wilmore, 2008;Van der Leeden et al, 2016), but inadequate mobilisation still represents a challenge for daily practice in surgical departments. In this article the authors describe how the establishment of a national nursing database was used to measure and define sufficient postoperative mobilisation in patients undergoing ovarian cancer surgery. The discussion will primarily focus on postoperative mobilisation, because there is evidence of the positive impact of early enforced mobilisation on postoperative patient recovery (Henriksen et al, 2002; Kehlet, 2011). Despite this evidence, postoperative mobilisation is still an area that patients and nurses in surgical units struggle with, and where clinical audits demonstrate problems (Ahmed et al, 2012; Fiore et al, 2017). Some of the reasons for this are organisational, such as lack of care plans for mobilisation and staffing levels. Furthermore, staff members must be dedicated to mobilisation and, in addition, clinical issues such as pain, hypotension and fatigue may have a negative impact on patients' mobilisation. Therefore, insufficient postoperative mobilisation demonstrates multifactorial challenges in fundamental care, which must be focused on and improved in future clinical practice as well as in clinical guidelines.
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