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Nurses’ perspectives on the influence of Enhanced Recovery After Surgery (ERAS) protocols on postoperative recovery after emergency laparotomy: a qualitative study

Year: 2026

Type: article

Abstract: 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.

Source: BMC Nursing

DOI: 10.1186/s12912-026-04861-z

Authors: Fatmah Ahmed Alamoudi, Mohammed Nasser Albarqi, Mohammed Yousef Almulhim, Mai Adel Albana

Institutions: Prince Sultan Military College of Health Sciences, King Faisal University, Cairo University

Language: English

Topic: Enhanced Recovery After Surgery

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090