Enhancing Recovery After
Colorectal Surgery
Theory Guiding Practice
Lorraine Babcock
UCF
Background
 The cognitive adult patient s/p colorectal surgery (with a
new stoma) present multifaceted challenges for nursing
 Enhanced recovery programs designed to reduce recovery
time are now in use
 High stress & anxiety hinder retention of patient
education, often delaying discharge
 The nurse must develop a plan of care with emphasis on
coping strategies & education
 Surgeons & patients rely on nursing for positive outcomes
Statement of the Problem
 Adult stoma patients with normal intellect experience
ineffective health maintenance related to impaired
knowledge regarding integration of stoma care into
their lifestyle
 The essence of this problem is motivation & changing
behavior
Significance of the Problem
 Inflammatory bowel disease (IBD) includes Crohn’s & ulcerative
colitis
 IBD causes pain, altered elimination, fatigue, & malnutrition
 IBD affects as many as 1.4 million people in the US
 Over 100,000 hospitalizations per year are due to IBD
 IBD has an overall healthcare cost of over $1.7 billion annually
 Patients usually require healthcare throughout their lifetime
 There is no medical cure, only symptom management & surgical
intervention (when medicine fails)
 Focus on education & coping is beneficial for patient recovery
Specific Aims
 Nursing has an opportunity to help improve patient outcomes by
applying a middle range theory to ready the patient for
discharge
 The Theory of Self-Efficacy will address the core problems of
motivation & changing behaviors
 The goal is to use the critical elements to design successful plans
of care for the stoma patient
 Shared decision making
 Teamwork
 Communication
 The patient, family, providers, & nursing should be involved
Theory of Self-Efficacy
 Definition of self-efficacy: the individual’s own recognition
of his or her ability to take action
 Theory of Self-Efficacy is based on the social cognitive
theory
 Two vital concepts of the theory
 Self-efficacy expectations
 Outcome expectations
 The environment & interactions with others are also
influential
 The individual must believe they are capable of causing a
certain outcome
Application of Theory to Practice
 To apply the theory, the nurse should focus on each of the
theory’s informational sources
 Enactive attainment
 Ex: set goal for patient to return demonstrate self-care of stoma by
postoperative day 2
 Vicarious experience
 Ex: visualize others performing the desired behavior
 Verbal persuasion
 Ex: nursing & providers give verbal encouragement & support the
patient’s efforts
 Physiological feedback during a behavior
 Ex: maintain pain at an acceptable level through use of relaxation
techniques & non-opioid medications
Summary and Conclusions
 Adult stoma patients with normal intellect often have
difficulty incorporating self-care into their lifestyle after
discharge
 Stress & anxiety may hinder knowledge retention
 Problems with ineffective coping, motivation, & changing
behavior are common
 Enhanced recovery discharge objectives are often hard to
meet without focused nursing interventions
 Through application of the Theory of Self-Efficacy, the
nurse can effect positive outcomes, where the patient is
motivated & able to change behaviors
References

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