Aim
The use of care packages has positive effects on patient satisfaction and quality of care. The study aims to review the effectiveness of care packages in experimental postgraduate theses conducted with care packages in the nursing field in Turkey and to examine the data obtained from systematically.
Method
The universe of the study consists of postgraduate theses accessed from the database of the Council of Higher Education Thesis Center (YÖKTEZ) in Türkiye between 24 November 2023 and 6 December 2023. In the review, master’s and doctoral theses that evaluated the effects of care package applications in nursing care on outcomes, published in Turkish, research design randomized controlled, quasi-experimental and experimental, open access, and containing the keywords “care package”, “care protocol”, “nursing care” and “postgraduate thesis studies” were selected. Six postgraduate theses that met the research criteria constituted the sample of the systematic review.
Results
Of the graduate theses included in the study, 66.6% were quasi-experimental, 16.6% were experimental, and 16.6% were experimental. PRISMA-P was used as the protocol for the systematic review and writing of the article. As a result of the six theses included in the study, it was found that all the care packages used had positive effects on the examined parameters (100%).
Conclusion
It is seen that care package applications made in line with evidence-based approaches reduce complications and provide benefits in infection control and prevention. In this direction, it is recommended that care packages be disseminated
Ballantyne H. Beyond the nursing care plan: an
introduction to care bundles. Veterinary Nursing
Journal. 2016;31(2):43-46.
Blot S, Ruppé E, Harbarth S, Asehnoune K, Poulakou
G, Luyt CE, et al. Healthcare-associated
infections in adult intensive care unit patients:
Changes in epidemiology, diagnosis, prevention
and contributions of new technologies. Intensive
and Critical Care Nursing. 2022;70:103227.
Borgert M, Binnekade J, Paulus F, Goossens
A, Dongelmans D. A flowchart for building evidence-
based care bundles in intensive care:
based on a systematic review. International Journal
for Quality in Health Care. 2017;29(2):163-
175.
Lavallée JF, Gray TA, Dumville J, Russell W, Cullum
N. The effects of care bundles on patient
outcomes: A systematic review and meta-analysis.
Implementation Science. 2017;12(1):1-13.
Resar R, Griffin FA, Haraden C, Nolan TW. Using
care bundles to improve health care quality. IHI
innovation series white paper. Cambridge (MA):
Institute for Healthcare Improvement.2012.
Fulbrook P, Mooney S. Care bundles in critical
care: a practical approach to evidence‐based
practice. Nursing in Critical Care. 2003;8(6):249-
255.
Devlin JW, O’Neal Jr, HR, Thomas C, Daly MAB,
Stollings JL, Janz DR, Lin JC. Strategies to optimize
ICU liberation (A to F) bundle performance
in critically ill adults with coronavirus disease
2019. Critical Care Explorations. 2020;2(6).
Candaş B, Gürsoy A. Time to take action for nurses:
from evidence-based practices to care packages.
Journal of Education & Research in Nursing.
2017;14(3).
Chaboyer W, Bucknall T, Webster J, McInnes
E, Gillespiea BM, Banks M, et al. The effect of
a patient centred care bundle intervention on
pressure ulcer incidence (INTACT): A cluster randomised
trial. International Journal of Nursing
Studies. 2016; 64:63-71.
Sayın Y. What is a care package? 10th National
Turkish Surgical and Operating Room Nursing
Congress Congress Book. November. 2015;12-
16:110-112.
Skaggs MKD, Daniels JF, Hodge AJ, DeCamp VL.
Using the evidence-based practice service nursing
bundle to increase patient satisfaction. Journal
of emergency Nursing. 2018;44(1):37-45.
http://www.ihi.org Accessed on: 6 December
2023.
Weiser MR, Gonen M, Usiak S, Pottinger T, Samedy
P, Patel D, et al. Effectiveness of a multidisciplinary
patient care bundle for reducing surgical-
site infections. Journal of British Surgery.
2018;105(12):1680-1687.
Yazıcı G, Bulut H, Kahraman BB, Palteki T. Analysis
of the efficiency and cost of a care bundle for
prevention of common infections in an intensive
care unit: A quasi-experimental pretest-posttest
design study. Konuralp Medical Journal.
2022;14(2):398-405.
Gel KT, Yaşacak A, Yorgun S. Nurses’ views on
care package practices. Anatolian Journal of
Nursing and Health Sciences. 2020;23(3):383-
388.
Zuo XL, Meng FJ. A care bundle for pressure ulcer
treatment in intensive care units. International
Journal of Nursing Sciences. 2015;2(4):340-
347.
Anderson M, Guthrie PF, Kraft W, Reicks P,
Skay C, Beal AL. Universal pressure ulcer prevention
bundle with WOC nurse support. Journal
of Wound Ostomy & Continence Nursing.
2015;42(3):217-225. https://doi.org/10.1097/
WON.0000000000000109.
Şen S, Uğur E, Afacan S, Sönmezoğlu M. Use
of care packages in the prevention of intensive
care infections. Journal of Intensive Care Nursing.
2019;23(1):27-35.
Kaya K. The Determination of The Effect of A
Constipation Prevention Care Package on Postoperative
Constipation Severity in Patients Undergoing
Orthopedic Surgery, Gaziantep, Hasan
Kalyoncu University Graduate School of Education,
Master’s Thesis. 2023.
Yılmaz Y. Investigation of The Effect of Care
Bundle Implementation on Recovery Process in
Open Heart Surgery Patients, Gaziantep, Hasan
Kalyoncu University Graduate Education Institute,
Doctoral Thesis. 2022.
Altaş G. Evaluation of Pressure Injury Prevention
Care Bundle Application in Intensive Care
Unit Patients Diagnosed with Internal Diseases,
Istanbul, University of Health Sciences, Hamidiye
Institute of Health Sciences, Master’s Thesis.
2022.
Eğilmez H. Investigation of the Effect of Pressure
Wound Care Package in Reducing the Development
of Pressure Wound in the Operating
Room in Orthopedic Surgery Patients, Gaziantep,
Hasan Kalyoncu University Graduate School of
Education, Doctoral Thesis. 2022.
Ongün P. Effect of A Preoperative Care Package
on Recovery in Patients Undergoing Cardiac Surgery,
Istanbul, Istanbul University-Cerrahpaşa
Institute of Postgraduate Education, Doctoral
Thesis. 2021.
Kutluğ S. The Evaluation of The Effect of Care
Package Application on Urinary Catheter-Related
Infection and Incontinence of Female Patients in
Intensive Care Unit, Sakarya, Sakarya University
Graduate School of Health Sciences, Master’s
Thesis. 2021.
Alcan AO, Korkmaz FD. Prevention of ventilator-
associated pneumonia: A care package approach.
Izmir University Medical Journal. 2015;
3:38-47.
Irmak B, Bulut H. Use of non-pharmacologic
methods to improve bowel function after abdominal
surgery: What does the evidence say?
Istanbul Gelişim University Journal of Health Sciences.
2021;(14):336-350.
Hodges LA, Hughes A, Targett D, Durcan MJ.
Does a hot drink provide faster absorption of
paracetamol than a tablet? A pharmacoscintigraphic
study in healthy male volunteers. Pharm
Res. 2014;31(8):2078-2085.
Mcnıchol L, Mackey D, Watts C, Zuecca N. Choosing
a support surface for pressure injury prevention
and treatment. Nursing. 2020;50(2).
Dale CM, Rose L, Carbone S, Pinto R, Smith
OM, Burry L, et al. Effect of oral chlorhexidine
de-adoption and implementation of an oral care
bundle on mortality for mechanically ventilated
patients in the intensive care unit (CHORAL): a
multi-center stepped wedge cluster-randomized
controlled trial. Intensive Care Medicine. 2021;
47:1295-1302.
Dennison C, Prasad M, Lloyd A, Bhattacharyya
SK, Dhawan R, Coyne K. The health-related quality
of life and economic burden of constipation.
Pharmacoeconomics. 2005; 23:461-476.
Pérez-Granda MJ, Barrio JM, Muñoz P, Hortal
J, Rincón C, Bouza E. Impact of four sequential
measures on the prevention of ventilator-associated
pneumonia in cardiac surgery patients. Crit
Care. 2014;18(2):1-8.
Fischer MO, Brotons F, Briant AR, Suehiro K, Gozdzik
W, Sponholz C, et al. Postoperative pulmonary
complications after cardiac surgery: the
VENICE international cohort study. Journal of
Cardiothoracic and Vascular Anesthesia. 2022;
36:23442-351.
Strobel RJ, Harrington SD, Hill C, Thompson
MP, Cabrera L, Theurer P, et al. Evaluating the
impact of pneumonia prevention recommendations
after cardiac surgery. Ann Thorac Surg.
2020;110(3):903-910.
Fleming IO, Garratt C, Guha R, Desai J, Chaubey
S, Wang Y, et al. Aggregation of marginal gains
in cardiac surgery – feasibility of a perioperative
care bundle for enhanced recovery in cardiac
surgical patients, Journal of Cardiothoracic and
Vascular Anesthesia. 2016;30(3):665-670.
Yılmazer T. Current approach in the prevention of
pressure sores; care package approach. Nursing
and Innovation Izmir: Güven Plus A.Ş. Publications.
2018;280-298.
Al-Otaibi YK, Al-Nowaiser N, Rahman A. Reducing
hospital-acquired pressure injuries. BMJ
Open Quality. 2019;8(1):e000464.
Lavallée JF, Gray TA, Dumville J, Cullum N. Preventing
pressure ulcers in nursing homes using
a care bundle: a feasibility study. Health & Social
Care in The Community. 2019;27(4):e417-e427.
Tayyib N, Coyer F, Lewisa PA. Implementing a
pressure ulcer prevention bundle in an adult intensive
care. Intensive and Critical Care Nursing.
2016; 37:27-36.
Tschannen D, Bates O, Talsma A, Guo Y. Patient‐
Specific and Surgical Characteristics in The Development
Of Pressure Ulcers. American Journal
of Critical Care. 2012;21(2):116‐124.
Roberts S, McInnes E, Bucknall T, Wallis M,
Banks M, Chaboyer W. Process evaluation of a
cluster-randomised trial testing a pressure ulcer
prevention care bundle: a mixed-methods study.
Implementation Science. 2017; 12:1-9.
Şahin G, Başak T. Intraoperative pressure injury
risk assessment of patients over 65 years of age
undergoing orthopedic surgery. SBÜ Journal of
Nursing. 2020;2(2):55-62.
Shafipour V, Ramezanpour E, Gorji MA, Moosazadeh
M. Prevalence of postoperative pressure
ulcer: A systematic review and meta-analysis.
Electron Physician. 2016;8(11):3170-3176.
Gilhooly D, Green SA, McCann C, Black N, Moonesinghe
SR. Barriers and facilitators to the
successful development, implementation and
evaluation of care bundles in acute care in hospital:
a scoping review. Implementation Science.
2019;14(1):1-12.
Clark K, Curry T, Byfieldt N. The effect of a care
bundle on nursing staff when caring for the dying.
International Journal of Palliative Nursing.
2015;21(8):392-398.
Clarkson DM. The role of ‘care bundles’ in healthcare.
British Journal of Healthcare Management.
2013;19(2):63-68.
Conway A, Gow J, Ralph N, Duff J, Edward KL,
Alexander K, et al. Implementing a thermal care
bundle for inadvertent perioperative hypothermia:
A cost-effectiveness analysis. International
Journal of Nursing Studies. 2019; 97:21-27.
Chan JL, Miller JG, Murphy M, et al. A multidisciplinary
protocol driven approach to improve
extubation times following cardiac surgery. Ann
Thorac Surg. 2018;(18):S0003-4975.
Markham T, Wegner R, Hernandez N, Lee JW,
Choi W, Eltzschig HK, et al. Assessment of a
multimodal analgesia protocol to allow the implementation
of enhanced recovery after cardiac
surgery: retrospective analysis of patient
outcomes. Journal of Clinical Anesthesia. 2019;
54:76-80.
Eastwood D, Manson N, Bigney E, Darling M,
Richardson E, Paixao R, et al. Improving postoperative
patient reported benefits and satisfaction
following spinal fusion with a single preoperative
education session. The Spine Journal.
2019;19(5):840-845.
Gustafsson UO, Scott MJ, Hubner M, Nygren J,
Demartines N, Francis N, et al. Guidelines for
perioperative care in elective colorectal surgery:
Enhanced Recovery After Surgery (ERAS®) Society
recommendations: World Journal of Surgery.
2019; 43:659-695.
Türkiye’de Hemşirelik Alanında Bakım Paketleri ile Yapılmış Deneysel Lisansüstü Tez Çalışmalarının İncelenmesi: Sistematik Derleme
Year 2025,
Volume: 4 Issue: 1, 39 - 50, 18.04.2025
Amaç
Bakım paketi kullanımı hasta memnuniyeti ve bakım kalitesi üzerinde olumlu etkilere sahiptir. Çalışmanın amacı, Türkiye’de hemşirelik alanında bakım paketleri ile yürütülen deneysel lisansüstü tez çalışmalarında bakım paketlerinin etkinliğini gözden geçirmek ve bu çalışmalardan elde edilen verileri sistematik olarak incelemektir.
Yöntem
Çalışmanın evrenini Türkiye’deki Yükseköğretim Kurulu Tez Merkezi (YÖKTEZ) veri tabanından 24 Kasım 2023 ve 6 Aralık 2023 tarihleri arasında erişilen lisansüstü tez çalışmaları oluşturmaktadır. İncelemede, hemşirelik bakımında bakım paketi uygulamalarının çıktılara etkisinin değerlendirildiği, yayın dili Türkçe, araştırma tasarımı randomize kontrollü, yarı deneysel ve deneysel olan, açık erişime sahip, “bakım paketi”, “bakım protokolü”, “hemşirelik bakımı” ve “lisansüstü tez çalışmaları” anahtar kelimelerini içeren yüksek lisans ve doktora tezleri seçilmiştir. Bu tezler arasından araştırma kriterlerini karşılayan altı lisansüstü tez çalışması sistematik incelemenin örneklemini oluşturmuştur.
Bulgular
Çalışmaya dahil edilen lisansüstü tezlerin %66,6’ sı yarı deneysel, %16,6’sı deneysel ve %16,6’sı da deneysel çalışma türündedir. Sistematik incelemenin protokolü ve makalenin yazımı için PRISMA-P kullanılmıştır. Çalışmaya dahil edilen altı tez sonucunda kullanılan bakım paketlerinin tümünde incelenen parametreler üzerinde olumlu etkileri olduğu bulunmuştur (%100).
Sonuç
Bu derleme ile kanıt temelli yaklaşımlar doğrultusunda yapılan bakım paketi uygulamalarının komplikasyonları azalttığı, enfeksiyon kontrol ve önlenmesinde yarar sağladığı görülmektedir. Bu doğrultuda bakım paketlerinin yaygınlaştırılması önerilmektedir
Ballantyne H. Beyond the nursing care plan: an
introduction to care bundles. Veterinary Nursing
Journal. 2016;31(2):43-46.
Blot S, Ruppé E, Harbarth S, Asehnoune K, Poulakou
G, Luyt CE, et al. Healthcare-associated
infections in adult intensive care unit patients:
Changes in epidemiology, diagnosis, prevention
and contributions of new technologies. Intensive
and Critical Care Nursing. 2022;70:103227.
Borgert M, Binnekade J, Paulus F, Goossens
A, Dongelmans D. A flowchart for building evidence-
based care bundles in intensive care:
based on a systematic review. International Journal
for Quality in Health Care. 2017;29(2):163-
175.
Lavallée JF, Gray TA, Dumville J, Russell W, Cullum
N. The effects of care bundles on patient
outcomes: A systematic review and meta-analysis.
Implementation Science. 2017;12(1):1-13.
Resar R, Griffin FA, Haraden C, Nolan TW. Using
care bundles to improve health care quality. IHI
innovation series white paper. Cambridge (MA):
Institute for Healthcare Improvement.2012.
Fulbrook P, Mooney S. Care bundles in critical
care: a practical approach to evidence‐based
practice. Nursing in Critical Care. 2003;8(6):249-
255.
Devlin JW, O’Neal Jr, HR, Thomas C, Daly MAB,
Stollings JL, Janz DR, Lin JC. Strategies to optimize
ICU liberation (A to F) bundle performance
in critically ill adults with coronavirus disease
2019. Critical Care Explorations. 2020;2(6).
Candaş B, Gürsoy A. Time to take action for nurses:
from evidence-based practices to care packages.
Journal of Education & Research in Nursing.
2017;14(3).
Chaboyer W, Bucknall T, Webster J, McInnes
E, Gillespiea BM, Banks M, et al. The effect of
a patient centred care bundle intervention on
pressure ulcer incidence (INTACT): A cluster randomised
trial. International Journal of Nursing
Studies. 2016; 64:63-71.
Sayın Y. What is a care package? 10th National
Turkish Surgical and Operating Room Nursing
Congress Congress Book. November. 2015;12-
16:110-112.
Skaggs MKD, Daniels JF, Hodge AJ, DeCamp VL.
Using the evidence-based practice service nursing
bundle to increase patient satisfaction. Journal
of emergency Nursing. 2018;44(1):37-45.
http://www.ihi.org Accessed on: 6 December
2023.
Weiser MR, Gonen M, Usiak S, Pottinger T, Samedy
P, Patel D, et al. Effectiveness of a multidisciplinary
patient care bundle for reducing surgical-
site infections. Journal of British Surgery.
2018;105(12):1680-1687.
Yazıcı G, Bulut H, Kahraman BB, Palteki T. Analysis
of the efficiency and cost of a care bundle for
prevention of common infections in an intensive
care unit: A quasi-experimental pretest-posttest
design study. Konuralp Medical Journal.
2022;14(2):398-405.
Gel KT, Yaşacak A, Yorgun S. Nurses’ views on
care package practices. Anatolian Journal of
Nursing and Health Sciences. 2020;23(3):383-
388.
Zuo XL, Meng FJ. A care bundle for pressure ulcer
treatment in intensive care units. International
Journal of Nursing Sciences. 2015;2(4):340-
347.
Anderson M, Guthrie PF, Kraft W, Reicks P,
Skay C, Beal AL. Universal pressure ulcer prevention
bundle with WOC nurse support. Journal
of Wound Ostomy & Continence Nursing.
2015;42(3):217-225. https://doi.org/10.1097/
WON.0000000000000109.
Şen S, Uğur E, Afacan S, Sönmezoğlu M. Use
of care packages in the prevention of intensive
care infections. Journal of Intensive Care Nursing.
2019;23(1):27-35.
Kaya K. The Determination of The Effect of A
Constipation Prevention Care Package on Postoperative
Constipation Severity in Patients Undergoing
Orthopedic Surgery, Gaziantep, Hasan
Kalyoncu University Graduate School of Education,
Master’s Thesis. 2023.
Yılmaz Y. Investigation of The Effect of Care
Bundle Implementation on Recovery Process in
Open Heart Surgery Patients, Gaziantep, Hasan
Kalyoncu University Graduate Education Institute,
Doctoral Thesis. 2022.
Altaş G. Evaluation of Pressure Injury Prevention
Care Bundle Application in Intensive Care
Unit Patients Diagnosed with Internal Diseases,
Istanbul, University of Health Sciences, Hamidiye
Institute of Health Sciences, Master’s Thesis.
2022.
Eğilmez H. Investigation of the Effect of Pressure
Wound Care Package in Reducing the Development
of Pressure Wound in the Operating
Room in Orthopedic Surgery Patients, Gaziantep,
Hasan Kalyoncu University Graduate School of
Education, Doctoral Thesis. 2022.
Ongün P. Effect of A Preoperative Care Package
on Recovery in Patients Undergoing Cardiac Surgery,
Istanbul, Istanbul University-Cerrahpaşa
Institute of Postgraduate Education, Doctoral
Thesis. 2021.
Kutluğ S. The Evaluation of The Effect of Care
Package Application on Urinary Catheter-Related
Infection and Incontinence of Female Patients in
Intensive Care Unit, Sakarya, Sakarya University
Graduate School of Health Sciences, Master’s
Thesis. 2021.
Alcan AO, Korkmaz FD. Prevention of ventilator-
associated pneumonia: A care package approach.
Izmir University Medical Journal. 2015;
3:38-47.
Irmak B, Bulut H. Use of non-pharmacologic
methods to improve bowel function after abdominal
surgery: What does the evidence say?
Istanbul Gelişim University Journal of Health Sciences.
2021;(14):336-350.
Hodges LA, Hughes A, Targett D, Durcan MJ.
Does a hot drink provide faster absorption of
paracetamol than a tablet? A pharmacoscintigraphic
study in healthy male volunteers. Pharm
Res. 2014;31(8):2078-2085.
Mcnıchol L, Mackey D, Watts C, Zuecca N. Choosing
a support surface for pressure injury prevention
and treatment. Nursing. 2020;50(2).
Dale CM, Rose L, Carbone S, Pinto R, Smith
OM, Burry L, et al. Effect of oral chlorhexidine
de-adoption and implementation of an oral care
bundle on mortality for mechanically ventilated
patients in the intensive care unit (CHORAL): a
multi-center stepped wedge cluster-randomized
controlled trial. Intensive Care Medicine. 2021;
47:1295-1302.
Dennison C, Prasad M, Lloyd A, Bhattacharyya
SK, Dhawan R, Coyne K. The health-related quality
of life and economic burden of constipation.
Pharmacoeconomics. 2005; 23:461-476.
Pérez-Granda MJ, Barrio JM, Muñoz P, Hortal
J, Rincón C, Bouza E. Impact of four sequential
measures on the prevention of ventilator-associated
pneumonia in cardiac surgery patients. Crit
Care. 2014;18(2):1-8.
Fischer MO, Brotons F, Briant AR, Suehiro K, Gozdzik
W, Sponholz C, et al. Postoperative pulmonary
complications after cardiac surgery: the
VENICE international cohort study. Journal of
Cardiothoracic and Vascular Anesthesia. 2022;
36:23442-351.
Strobel RJ, Harrington SD, Hill C, Thompson
MP, Cabrera L, Theurer P, et al. Evaluating the
impact of pneumonia prevention recommendations
after cardiac surgery. Ann Thorac Surg.
2020;110(3):903-910.
Fleming IO, Garratt C, Guha R, Desai J, Chaubey
S, Wang Y, et al. Aggregation of marginal gains
in cardiac surgery – feasibility of a perioperative
care bundle for enhanced recovery in cardiac
surgical patients, Journal of Cardiothoracic and
Vascular Anesthesia. 2016;30(3):665-670.
Yılmazer T. Current approach in the prevention of
pressure sores; care package approach. Nursing
and Innovation Izmir: Güven Plus A.Ş. Publications.
2018;280-298.
Al-Otaibi YK, Al-Nowaiser N, Rahman A. Reducing
hospital-acquired pressure injuries. BMJ
Open Quality. 2019;8(1):e000464.
Lavallée JF, Gray TA, Dumville J, Cullum N. Preventing
pressure ulcers in nursing homes using
a care bundle: a feasibility study. Health & Social
Care in The Community. 2019;27(4):e417-e427.
Tayyib N, Coyer F, Lewisa PA. Implementing a
pressure ulcer prevention bundle in an adult intensive
care. Intensive and Critical Care Nursing.
2016; 37:27-36.
Tschannen D, Bates O, Talsma A, Guo Y. Patient‐
Specific and Surgical Characteristics in The Development
Of Pressure Ulcers. American Journal
of Critical Care. 2012;21(2):116‐124.
Roberts S, McInnes E, Bucknall T, Wallis M,
Banks M, Chaboyer W. Process evaluation of a
cluster-randomised trial testing a pressure ulcer
prevention care bundle: a mixed-methods study.
Implementation Science. 2017; 12:1-9.
Şahin G, Başak T. Intraoperative pressure injury
risk assessment of patients over 65 years of age
undergoing orthopedic surgery. SBÜ Journal of
Nursing. 2020;2(2):55-62.
Shafipour V, Ramezanpour E, Gorji MA, Moosazadeh
M. Prevalence of postoperative pressure
ulcer: A systematic review and meta-analysis.
Electron Physician. 2016;8(11):3170-3176.
Gilhooly D, Green SA, McCann C, Black N, Moonesinghe
SR. Barriers and facilitators to the
successful development, implementation and
evaluation of care bundles in acute care in hospital:
a scoping review. Implementation Science.
2019;14(1):1-12.
Clark K, Curry T, Byfieldt N. The effect of a care
bundle on nursing staff when caring for the dying.
International Journal of Palliative Nursing.
2015;21(8):392-398.
Clarkson DM. The role of ‘care bundles’ in healthcare.
British Journal of Healthcare Management.
2013;19(2):63-68.
Conway A, Gow J, Ralph N, Duff J, Edward KL,
Alexander K, et al. Implementing a thermal care
bundle for inadvertent perioperative hypothermia:
A cost-effectiveness analysis. International
Journal of Nursing Studies. 2019; 97:21-27.
Chan JL, Miller JG, Murphy M, et al. A multidisciplinary
protocol driven approach to improve
extubation times following cardiac surgery. Ann
Thorac Surg. 2018;(18):S0003-4975.
Markham T, Wegner R, Hernandez N, Lee JW,
Choi W, Eltzschig HK, et al. Assessment of a
multimodal analgesia protocol to allow the implementation
of enhanced recovery after cardiac
surgery: retrospective analysis of patient
outcomes. Journal of Clinical Anesthesia. 2019;
54:76-80.
Eastwood D, Manson N, Bigney E, Darling M,
Richardson E, Paixao R, et al. Improving postoperative
patient reported benefits and satisfaction
following spinal fusion with a single preoperative
education session. The Spine Journal.
2019;19(5):840-845.
Gustafsson UO, Scott MJ, Hubner M, Nygren J,
Demartines N, Francis N, et al. Guidelines for
perioperative care in elective colorectal surgery:
Enhanced Recovery After Surgery (ERAS®) Society
recommendations: World Journal of Surgery.
2019; 43:659-695.
Dayan A, Terzi B. Examination of Experimental Postgraduate Thesis Studies Conducted with Care Bundles in The Field of Nursing in Türkiye: A Systematic Review. Akd Nurs J. 2025;4(1):39-50.