Nurses' perspectives on the influence of Enhanced Recovery After Surgery (ERAS) protocols on postoperative recovery...

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.

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.

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.

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.

Not applicable.