Barriers and facilitators to the implementation of ERAS protocols according to nurses experience: a mixed method study.

Background: The Enhanced Recovery After Surgery (ERAS) protocols are designed to expedite patient recovery after major surgeries. Aim: This study explores barriers and facilitators to implementing these protocols from the perspective of nurses in surgical care settings at Piacenza Hospital, Italy. Methology: Authors employed an explanatory sequential mixed-methods research design. This began with a quantitative observational phase, using a survey aligned with the STROBE 2019 Transversal Studies Guidelines. Following this, a qualitative phase included two focus groups to delve deeper into the findings from the initial survey. This phase adhered to the COREQ criteria for qualitative research reporting. Results: Thirty nurses took part in the study on a voluntary basis. Survey results showed that the most valued aspect of the ERAS protocols was their importance in patient care, scoring an average of 3.4 out of 5 on the Likert scale. The benefits for patient outcomes and treatment effectiveness both scored 3.3. However, Guttman’s Scalogram analysis identified significant barriers, including low patient compliance and insufficient nurse training. The thematic analysis using Van Kaam’s method revealed a primary domain named "context elements," supported by four dimensions: team characteristics, doctor’s role, operational organization, and care relationship. Discussion: The integration of the quantitative and qualitative results highlights the critical need for effective communication, continuous training, and staff updates. It also emphasizes the importance of a multidisciplinary approach, including the integration of psychologists into the healthcare team to improve overall implementation of the ERAS protocols.