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.

Integrating corporate responsbility into investor relations. Sustainability report as a part of investor relations.

Corporate responsibility is a question that many stakeholders are interested in. These stakeholders can be e.g. company’s employees, partners, clients, media or investors. Especially for listed companies, investors are one of the most important stakeholders. It is essential for a company to maintain the trust of current investors and gain the trust of potential investors. Investors cannot be divided only into two groups, individual and institutional investors. Investors differ a lot, especially when it comes to investment decisions. Investors can make their investment decisions based on many things, and strong financial performance is not necessarily good enough a reason. Socially responsible investors value responsibility and sustainability related factors when making investment decisions. These things can be divided into three dimensions: environmental, social and economic responsibility. Many companies disclose a sustainability report in order to be able to answer to the needs of different stakeholders, including investors. The purpose of this thesis was to study how companies integrate corporate responsibility into investor relations, and how sustainability report can be used in investor relations. Furthermore, this thesis examined the key elements of sustainability reports. The research was made by a qualitative study in two phases. In the first phase five representatives of two Finnish listed companies, KONE and Kesko were interviewed. The interviewees are professionals within investor relations and corporate responsibility communications. In the second phase of the study the sustainability reports of these two companies were analyzed with content analysis. The existing theory and the interviews created the base for the content analysis. This study suggests that there is a connection between corporate responsibility and investor relations, and those should be integrated. Socially responsible investors are an important target group for companies, and companies should be able to respond to their and other stakeholders’ needs. Sustainability report can be used as a tool both within the company and in external communication for these purposes.