Lorraine Babcock Theory of Self-Efficacy Colorectal Surgery Enhanced Recovery Pathway

What is Enhanced Recovery Pathway? An accelerated recovery program for colorectal surgical patients Standardized Interventions to: Decrease stress responses Decrease stress responses Decrease organ dysfunction Decrease organ dysfunction Improve post-op recovery Improve post-op recovery Focus on: Patient education Patient education Optimal pain control Optimal pain control Fluid balance Fluid balance Early nutrition Early nutrition Early ambulation Early ambulation Optimal Outcomes: INCREASED- Cardiopulmonary, muscle, & gut function Cardiopulmonary, muscle, & gut function Patient Satisfaction Patient SatisfactionDECREASED- Fatigue Fatigue Morbidity Morbidity Length of stay Length of stay Opioid use Opioid use Hospital costs Hospital costs

Helping patients recover faster Critical Elements Shared decision making Teamwork Communication Participants Patient & family Nursing staff Providers

Enactive Attainment performance of a behavior - patient & family can demonstrate care of the stoma or incision -patient & family participate in plan of care Vicarious Experience visualizing others perform the same behavior - patient & family are given resources (via networking and/or literature) with similar experiences Application of Theory of Self-Efficacy

Verbal Persuasion mentoring and motivating -nursing staff and providers support the patient’s efforts -nursing staff and providers give verbal encouragement Physiological Feedback establishing goals related to function -optimal pain control is achieved through relaxation techniques and non-opioid medication -patient follows walking schedule -patient follows early nutrition schedule -nursing staff maintains euvolemic fluid balance

-UCF library database -search limited to works published in the last 10 years -266 peer-reviewed relevant articles found -enhanced recovery pathways applied to: bariatric surgery, colorectal surgery, GI surgery, GYN surgery, orthopedic surgery -optimal outcomes observed when process and procedures are standardized for a particular diagnosis or patient population Literature search

References Smith, M. J., & Liehr, P. R. (2014). Middle Range Theory for Nursing (3rd ed.). New York: Springer Publishing Company.