Postoperative Bowel Function and Related Factors in Enhanced Recovery Protocol with Patients Undergoing Hepatectomy

Patients’ bowel dysfunction is a major factor that weakens the results of surgical care as it can cause pain and weaken patients’ rehabilitation. Bowel dysfunction is a common postoperative problem, yet most incidents remain undocumented. The nursing profession has a significant role in enhancing the bowel function postoperatively. However, studies of postoperative bowel function after hepatectomy are scarce and somewhat incongruous. Enhanced recovery protocols are innovative models of care aiming for better outcomes of surgical care. Enhanced recovery protocols can improve gastrointestinal function after surgery, yet patients are also known to be satisfied with their care. The aim was to investigate if postoperative bowel function day varies between patients in terms of age, gender, ASA score, type of surgery, histology, patients’ experienced pain and experienced satisfaction three days after discharge and three months after operation in patients undergoing hepatectomy. The goal was to produce information for basis of scientific research, to give nurses in clinical setting more tools to work with hepatectomy patients undergoing enhanced recovery protocol and to produce information to nurse managers to use in process management of patients undergoing enhanced recovery protocol. The design of this study is descriptive. Data was collected retrospectively from hepatectomy patients (n = 134) undergoing enhanced recovery protocol within the first year of enhanced recovery protocol implementation. The data was based on registers and analyzed statistically. Mean age of patients was 62 years and mean day of discharge was 4. Main (n = 72) histology of the patients was colorectal liver metastases. Mean bowel function day was 3. Most of the patients were very satisfied or satisfied with the care three days after discharge (99%) and three months (90%) after operation. Most of the patients (72%) experienced moderate pain three days after discharge, but three months after operation 47% of the patients did not experience pain and 48% experienced moderate pain. There were no statistically significant differences in bowel function between different age groups, genders, ASA score groups or histologies. Neither were there statistically significant differences in postoperative bowel function in terms of experienced satisfaction or pain. There were statistically significant differences in postoperative bowel function between different types of surgery (p < 0.01). Nurses should take into consideration hepatectomy patients’ type of surgery and pay special attention in supporting major open hepatectomy patients’ postoperative bowel function. Nurses should educate patients undergoing major open hepatectomy about prolonged postoperative bowel function.

To be a woman here is to be invisible: in search of the dispossessed femininity in Middle-earth

In my thesis I examine J.R.R. Tolkien’s The Lord of the Rings (1954-55), the fantasy epic written on the basis of a fictional universe created by Tolkien, complete with elves, dwarves and other mystical creatures – with languages, alphabets and grammar created for all. While rich linguistically, Tolkien writes a decidedly male description of his world, often neglecting any acknowledgement of female existence. Tolkien’s monolithic stature amongst other fantasy authors made me conduct a feminist reading of The Lord of the Rings, with an eye for the way female experience is marginalized to the point of omission. Tolkien’s linguistic accomplishments have overshadowed the illogical aspects of his work, namely the omission of genders, societal classes and features of society necessary for the fictional universe to retain its cohesion. This cohesion suffers from a totally male experience in the novel which is willfully blind to these features I listed. My theoretical framework is built on ideas in Toril Moi’s Sex, Gender and the Body (2005) and bell hook’s Feminism is For Everybody (2000). Michel Foucault’s ideas of power and hidden histories assist in performing a close reading of the source text and interpreting the results. My thesis focuses on the transformation that the values associated with the concept of equality have undergone. This is best illustrated in the treatment of the few female characters in the novel – Galadriel, Éowyn and Arwen – as their beauty and existence interferes with the ordering of the male-dominated world.