Good preparation for an operation starts weeks in advance

Good preparation for an operation starts weeks in advance

How it can go: you broke your hip, but tonight you don’t get the turn for the operation. The next morning you are first on the schedule, but there is an emergency in between. By the time you go into the operating room, you’ve been fasted all day. In addition to stress and pain, you are now also hungry and thirsty, which makes you feel even worse. And then the operation has yet to begin. For example, Harm van Noort, a nursing researcher at Radboudumc, can give more examples of patients who do not eat and drink much longer than necessary prior to an operation.

An empty stomach prevents stomach contents from entering the lungs during surgery. With this knowledge, doctors had their patients fast before they went under sail in the nineteenth century. Before the operation, do not eat for six hours and do not drink for two hours: that has been the guideline since the nineties. It has greatly increased the chance of safe anesthesia, but the sober policy is now biting itself on the tail. 90 percent of patients remain sober for too long for solid food, 67 percent do not drink for too long. “That you have to do something before an operation to leave, is well established,” says Van Noort. “It’s good to do something doing – continue to eat and drink as long as possible – is less well known.” Van Noort obtained his doctorate on December 14 on nursing nutritional care before surgery.

It sounds logical to look at the role of nurses, but they often remain out of the picture in research. This while Florence Nightingale already knew how important nutrition is for patients, writes Van Noort in his thesis. Van Noort studied what happens if nurses inform patients better about staying sober. It turned out that patients spent less time on an empty stomach. Three hours shorter on average for solid foods and five hours for clear liquids. “Eating at night when you have surgery in the morning is difficult, but continuing to drink up to two hours before the operation is quite feasible.”

Shorter fasting makes the patient more ‘comfortable’ before the operation, as it is called in the hospital. According to Van Noort, the fasting period for solid food with a light snack could be reduced to four hours. “Liquids pass even faster through the stomach. At the UMC Utrecht, patients are now given clear liquids to drink, such as lemonade, until the operation. That would be a good guideline.”

Photo Dieuwertje Bravenboer
Photo Dieuwertje Bravenboer
Photo Dieuwertje Bravenboer
Photo Dieuwertje Bravenboer

malnourished patients

Sober policy is one side of the story. It is also becoming increasingly clear that those who are fit for the operation recover better and can go home faster. Especially frail elderly people and patients with pain, loss of appetite and weight loss often go into surgery malnourished without knowing it. Good preparation starts weeks in advance, with a diary in which patients keep track of what they eat and how much they weigh, and possibly receive protein shakes to make up for deficiencies. Here too, Van Noort saw that nurses can mean a lot: malnourished patients who were supervised by nurses went into surgery better nourished.

You may wonder whether nurses should also take care of patient nutrition, in addition to all the other work they have to do in less and less time – admissions are getting shorter and shorter. Van Noort believes that nurses have a pre-eminent role to play here. “Of course we work with dietitians, but they cannot see all patients. As a nurse you are constantly standing next to the patient and you watch everything.” This way you can also better tackle the causes of malnutrition. “If you can relieve the pain with better medication, the appetite can also increase again.”

Researcher ‘in white’

Harm van Noort was selected by lottery for medicine after his pre-university education and then decided to study nursing at a higher vocational level. He entered research through a master’s degree in nursing science. He always stayed at the bedside a few days a week, in recent years in the oncological surgery department at Radboud university medical center. Everyday practice helps him in his research, he says. For example, an experiment is now underway in the hospital with an innovative sensor that nurses can use to view measurements of vital functions at any time, such as oxygen saturation in the blood. Being able to act faster results in fewer IC admissions. “Because I am at the bedside myself, I immediately see the impact such an innovation has on our work.” A researcher ‘in white’ will also always look at the applicability and feasibility of innovations and policy.

About thirty nurses are now conducting scientific research at Radboudumc. It gives them a better career perspective, says Van Noort. “And knowledge helps nurses to have more say in the hospital. If you are well prepared, as a nurse you are a more equal discussion partner with doctors and you can improve care together. Our input matters.”

Van Noort’s research into nursing nutrition care not only shows how patient care can be improved, you can also read it as a plea for more nursing scientists with job-sharing: “In this way we can take back control of our profession.”


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