Navigating the New Frontier: Enhanced Recovery After Surgery (ERAS) Protocols in Gynecological Nursing Care

Abstract

Gynecological surgery procedures are responsible for millions of hospital admissions worldwide annually; however, the perioperative recovery protocols have always been based on conservative strategies, which are often paternalistic, based on the convenience of the surgeon and not the patient. Enhanced Recovery After Surgery (ERAS) protocols signify a paradigm shift, a coordinated, multimodal approach to surgery that undermines traditional practices of lengthy fasting, routine use of opioids, and delayed mobilization. Despite strong evidence of surgical impact, the crucial role of nursing in ERAS implementation has not been fully explored in the scholarly literature. This integrative review explores the current understanding of ERAS programs in gynecological surgical practice, focusing specifically on the nursing profession in the preoperative, operative, and postoperative phases. This paper also outlines the institutional challenges to the uptake of ERAS and suggests evidence-based strategies for its sustainable implementation. A systematic search of the PubMed, CINAHL, Cochrane Library, Embase, and MEDLINE databases was performed for literature published from 2017 to 2026. The Boolean search strategies included "ERAS," "enhanced recovery," "gynecological surgery," "perioperative nursing," "hysterectomy," and " The Critical Appraisal Skills Program (CASP) was used to critically appraise 47 studies that met the inclusion criteria. ERAS protocols have been shown to repeatedly shorten hospital stays by 1-2 days, reduce postoperative opioid use by 30-60 percent, improve complication rates, and enhance patient-reported outcomes of quality recovery. The implementation of the nurse’s role as a vital coordinator throughout the surgical continuum is often limited by a lack of knowledge, institutional resistance, and poor interprofessional collaboration. The adoption of ERAS becomes more standardized when it is integrated into gynecological nursing practice, which involves the investment of education through simulation, nurse champion models, and the design of protocols from an equity perspective. Future studies should focus on nursing-led randomized controlled trials and long-term patient outcome studies. Borrowed from Kolcaba's Theory of Comfort, this review emphasizes the patient-centered nursing role in the perioperative period, rather than that of a mere follower of surgical instructions.