Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Candice Falls

Clinical Mentor

Dr. Mansi Shah-Jadeja

Committee Member

Dr. Karen Butler



Background: Minimally invasive esophagectomy surgery is commonly performed by thoracic surgeons on patients with esophageal cancer. The post-operative care of these patients is meticulous and follows a protocol developed by the thoracic surgeons at the University of Kentucky. At UK Chandler Medical Center, concerns have been raised regarding nurses’ lack of education of the protocol, and therefore decreased implementation. Increasing nursing knowledge pertaining to this protocol by performing educational in-services periodically and standardizing and implementing formal education as part of nursing orientation will decrease the knowledge gap and improve patient outcomes and increase utilization of the post-operative protocol.

Purpose: The purpose of this project was to increase nurses’ knowledge, help bridge the knowledge gap between providers and nurses caring for esophagectomy patients and therefore increase compliance with the post-operative care protocol for minimally invasive esophagectomy patients. This practice change was accomplished via an educational in-service for nursing staff.

Design: This was a quasi-experimental study.

Methods: This study was performed at the University of Kentucky in the Cardiothoracic ICU. Retrospective chart reviews were performed in the Fall of 2023 and prospective chart reviews were performed in the Spring of 2024. These chart reviews focused on obtaining demographic data as well as four objectives to assess compliance to the post-operative esophagectomy protocol: documentation of nasogastric tube to low wall suction, number of times the patient ambulated per day, post-operative day of foley catheter removal, and initiation and advancement of enteral tube feeds. The outcome of an anastomotic leak was also tracked.

In addition, the Cardiothoracic ICU bedside nurses were invited to attend an educational in-service. Participants performed a pre-test in which they identified their baseline knowledge of post-esophagectomy care. After the in-service, they completed a post-test questionnaire to identify any change in knowledge.

Results: There were 5 participants for pre- and post-test surveys. Statistically significant increases in knowledge (n = 5, p = .003) and confidence ratings (n = 5, p = .005) were found after the in-service. In the chart reviews, there was one statistically significant finding, an improvement in the frequency of ambulation on post-operative day two, in which ambulation frequency increased from 1.13 before in-service to 2.45 after in-service (p-value = .02). Identifying the improvement in ambulation could indicate increased compliance with the post-operative protocol.

Conclusion: Further research is needed regarding various methods for nursing education and the effects on patient outcomes. This study shows that educating nurses on post-operative protocols can make a statistically significant improvement in post-operative care, but the impact of this could be better investigated with a larger sample size of participants in an educational in-service, as well as a larger cohort of patients.