Experiences of Cardiovascular Surgery Intensive Care Nurses in the Care of Patients With Postoperative Cognitive Dysfunction: A Qualitative Study

Abstract

Postoperative cognitive dysfunction (POCD) is the development of cognitive decline following anesthesia and surgery. The incidence of POCD is more pronounced in patients undergoing cardiac surgery than in patients undergoing non-cardiac surgery. This study aims to evaluate the experiences, knowledge status, and clinical practice interventions of nurses caring for patients diagnosed with POCD. Ten nurses working in the intensive care unit of cardiovascular surgery participated in this study, which used a phenomenological design, one of the qualitative research types. We collected the data face-to-face between January and March 2023 using the individual in-depth interview method. The data were analyzed by the researcher using thematic analysis. The study identified 13 main themes: cognitive, behavioral, emotional problems, occupational difficulties, increasing duration, age, premorbid period, psychological resilience, effective coping skills, interaction, restraint, external support systems, and cognitive structuring. After cardiovascular surgery, patients should be evaluated not only for cardiac but also for cognitive, emotional, and behavioral factors. In addition, the risk factors that cause POCD, the difficulties faced by nurses, and their coping skills are the effects that shape the patient care process of POCD.

Keywords

postoperative cognitive complications coping skills cardiac surgical procedures cognitive dysfunction intensive care units

Highlight

●To manage and prevent POCD, healthcare professionals should assess the patient’s cognitive function in the preoperative period and follow the patient not only cardiacally but also cognitively, emotionally, and behaviorally during the postoperative recovery period.

●Cognitive, behavioral, and emotional problems may occur in POCD after cardiovascular surgery.

●Factors that emerge from the experience of clinicians and affect the development of POCD include increased length of stay in intensive care, age, patients‘ experiences in the premorbid period, patients’ psychological resilience, and clinicians’ coping methods in the patient care process.

Introduction

Postoperative cognitive dysfunction (POCD) is the development of cognitive decline following anesthesia and surgery.¹ POCD is characterized by a range of symptoms, including memory problems, reduced attention span, language skills, and difficulty with problem solving.² POCD is a source of concern for patients undergoing surgical intervention, as it will affect their postoperative recovery process and quality of life.³

The incidence of POCD in patients undergoing cardiac surgery is more pronounced than in patients undergoing non-cardiac surgery.⁴ According to the results of a retrospective study.⁵ POCD was the most common problem after cardiac surgery, with an incidence of 37.6% on the seventh postoperative day and 20.8% in the third postoperative month. Another study found that 40% to 80% of patients undergoing coronary artery bypass graft surgery experienced a decline in mental abilities, including impaired concentration, decreased attention, short-term memory loss, and decreased cognitive speed. While most of these cognitive impairments vanished within a few months, 35% of the patients continued to experience them even a year after surgery.⁶

The favorable outcome of cardiovascular surgery depends on the surgical technique successfully applied and the postoperative nursing care provided. The aim of patient care after cardiovascular surgery is not only to stabilize cardiovascular functions and ensure the patient’s recovery, but also to detect and prevent postoperative mental problems and thus contribute to the treatment of cognitive dysfunction.⁷

The International Classification of Diseases still does not classify POCD, and a clear, uniform definition is lacking. Diagnosis is based on neuropsychiatric tests, but there is no consensus on which tests are more sensitive and specific to use. Experts believe that this reason also causes deficiencies in care for patients with POCD. It is thought that qualitative research on the problems experienced by patients with POCD and the experiences of healthcare professionals will resolve this uncertainty. In this study, nurse experiences were included in order to create awareness of the deficiencies in the literature and clinic. The study aimed to associate the problems experienced in the care of patients with POCD, factors causing problems, and experiences related to coping skills with the literature. It is thought that this study will contribute to the care protocols of patients with POCD and guide nurses.

Methods

Study Design and Setting

This study on the experiences of nurses in the care of patients with POCD after open heart surgery was planned in a phenomenological design, one of the qualitative research types, based on the 32-item Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ), which is a guide for qualitative studies.⁸ The study was conducted in the 8-bed cardiovascular surgery intensive care unit of Van Training and Research Hospital, a tertiary-level training and research hospital, between December 2022 and January 2023.

Participants

In qualitat -98520ive research, the quality rather than the quantity of the sample is important. In qualitative research, the sample size should be determined according to the amount of rich information to be obtained from the sample. The ideal sample size is the point at which the data reach saturation and the data begin to be repeated with each participant. The sample of the individual interviews, in which the qualitative data of the research were collected, was obtained through criterion sampling. In criterion sampling, situations that are suitable for the purpose of the research and contain a set of criteria predetermined by the researcher are investigated.^9,10 In this study, the study was completed with 10 nurses based on sample size, data saturation, and cyclic data repetition.

The study’s sample consisted of 10 nurses who agreed to participate, cared for POCD patients, and wanted to share their experiences. We conducted face-to-face, individual, in-depth interviews with the selected sample group. This study included participants who worked as nurses in the Cardiovascular Surgery Intensive Care Unit, provided care to patients diagnosed with POCD, were open to communication, and voluntarily agreed to participate. The study’s exclusion criteria included never having cared for a patient with POCD, not working as a nurse in the Cardiovascular Surgery Intensive Care Unit, and not voluntarily agreeing to participate.

In individual, in-depth interviews, it is essential to reach data saturation in order to finalize the data collection process. We collected data from 10 nurses, reaching data saturation when the participants’ perspectives began to mirror each other. The participants’ age range is between 24 and 32 years, and their years of employment are between 1 and 14 years (Table 1).

Table 1.

Demographic Data of Participants.

Participants	Age	Gender	Working years in the profession
H1	24	Female	1 y
H2	29	Female	7 y
H3	32	Male	8 y
H4	32	Male	14 y
H5	29	Male	4 y
H6	32	Male	8 y
H7	30	Male	8 y
H8	32	Female	10 y
H9	30	Female	6 y
H10	27	Male	10 y

Research Team and Reflexivity

The researcher is a faculty member (PhD, assistant professor) in the Department of Surgical Nursing, Faculty of Health Sciences, a university. In the past, she worked as a surgical clinic nurse in a hospital. The 37-year-old female researcher, who is a faculty member, was trained in qualitative research. The researcher did not know the participants before. At the same time, the data of this study were controlled by a faculty member who was trained in qualitative research and had experience in a cardiovascular surgical intensive care unit.

Data Collection

The semi-structured interview form used to collect data in the study was created in accordance with the literature, taking into account the study’s aims and objectives. For the interview form, the opinions of 2 doctor working in cardiovascular surgery, 2 nurses with a master’s degree in surgery, and 1 mental health master’s degree graduate expert were consulted. The study was approved by the Van Yüzüncü Yıl University Non-Interventional Clinical Research Ethics Committee on 18.11.2022 (approval no. 2022/11-22). Before the interview, the participants were informed that they would be asked questions about their experiences in the care of patients with POCD after open heart surgery. All participants gave written informed consent to the researcher before participating in the study. At the same time, the 1975 Declaration of Helsinki, revised in 2024, was adhered to. The selected sample group was interviewed individually using an interview form, and the interviews lasted an average of 30 minutes (Table 2). With the explicit consent of the participants, the interviews were audio-recorded and transferred to a password-protected laptop computer by the researcher. To maintain confidentiality, each participant received a random code (code formula: H + participant number; example: H9). The interview guide was created by considering the aims and objectives of the research, and the questions asked were ensured to best match the intended objectives of the research. No participant refused to participate in the study.

Table 2.

Semi-Structured Interview Form.

Interview questions
1-What kind of situations do you encounter in patients who develop POCD, and what is the -most challenging situation for you in the care process?
2-What do you think are the factors affecting POCD?
3-How do you cope with the difficulties you encounter in the care process of the patient who develops POCD?

Note. (Semi-structured interview form developed within the scope of literature).

Data Analysis

The researcher transcribed the audio-recorded interviews in their original languages to prevent mistranslation. After transcribing the voice recordings, we checked the consistency between the recordings and transcriptions. Braun and Clarke'’s theme analysis standards were used to analyze the interview data.¹¹ The stages of the thematic analysis are given below: the researcher’s familiarity with the data, creation of initial codes, searching for themes, review of themes, identification and naming of themes, report preparation. An experienced academician other than the researcher analyzed the collected themes and codes, and the results showed that they overlapped.

Results

The study analyzed nurse experiences in caring for patients with POCD after open heart surgery, yielding 13 main themes and 22 sub-themes (Figure 1).

Figure 1.

Key factors affecting the care of patients with POCD (Code Cloud).

Nurses’ Experiences About the Situations Encountered in Patients With POCD and Difficulties in the Care Process

According to the participant statements, the main themes related to the experiences of nurses regarding the situations encountered in patients with POCD and the difficulties experienced in the care process were “cognitive problems seen in patients,” “behavioral problems seen in patients,” “emotional problems seen in patients” and “professional difficulties.” The majority of nurse participants reported that cognitive problems were more common in patients during the care process, followed by behavioral problems, emotional problems, and professional difficulties, respectively. The most frequently reported cognitive problem is “derealization,” the most frequently reported behavioral problem is “self-harm of the patient,” the most frequently reported emotional problem is “fear,” and the most frequently reported professional difficulty is “inadequacy in coping with patients.”

Cognitive Problems Seen in the Patient

The main theme of the cognitive problems seen in patients is divided into 3 sub-themes: “derealization,” “adjustment problem,” and “confusion.”

Derealization

In the case of POCD, patients often do not recognize where they are, the time zone, their relatives, or anyone else, and sometimes react in a very meaningless way. . . .(H3)

Adjustment Problem

. . .not harmonising. . .(H1)

. . .The most difficult situation for me is that the patient does not adapt to anything. . . .(H8)

Confusion

The patient with POCD develops a cloud of consciousness. . . .(H7)

Behavioral Problems Seen in the Patient

The main theme of the behavioral problems seen in the patient is divided into 4 sub-themes: “communication problem,” “self-harm of the patient,” “aggression” and “non-compliance with treatment.”

Communication Problem

We find it very difficult to communicate with these patients. . . .(H3)

Self-Harm of the Patient

. . .At the same time, these patients are self-harming (such as pulling out urinary catheters or arterial catheters). . . .(H2)

Aggression

We observe problems such as irritability, aggressiveness, questioning life, and irritability in patients who develop POCD. . . .(H4)

Non-compliance With Treatment

Patients with POCD frequently defy us and refuse treatment. . . .(H9)

Emotional Problems Seen in the Patient

The main theme of the emotional problems seen in the patient is divided into 3 sub-themes: “insecurity,” “fear” and “anxiety.”

Insecurity

. . . The patient thinks we’ll do him more harm than good. . . .(H2)

Fear

. . . They also have a fear of death. . . .(H7)

Anxiety

The patient develops anxiety, disharmony, worry, and fear. . . .(H8)

Professional Difficulties

The main theme of the professional difficulties is divided into 2 sub-themes: “disruption in the work of nurses” and “inadequacy in coping with patients.”

Disruption in the Work of Nurses

. . .Clinic work was disrupted. Unfortunately, the care of other patients was disrupted in the energy and time I spent on that patient. . . .(H1)

İnadequacy in Coping with Patients

. . . The most challenging scenario for me involves the inability to limit the patient’s movements. Typically, these patients resist our attempts to approach them. . . .(H6)

. . . I’m tired of not being able to intervene. The patient doesn’t understand me. . . .(H8)

Nurses’ Views on the Factors Affecting POCD

The main themes regarding the nurses’ views on the factors affecting POCD development were determined as “increasing duration,” “age,” “premorbid period,” “psychological resilience,” “effective coping skills.” The majority of the participating nurses reported that “age.”

Increasing Duration in Intensive Care

. . .In some patients, this condition may develop when they stay in intensive care for one week or more. In the first three days, it develops very rarely. When the patient stays too long, this condition can occur immediately. . . .(H3)

Age

This is a situation that may vary for each patient. The patient’s age and psychological state are very important. . . .(H5)

The age of the patient affects this situation . . .(H10)

Premorbid Period

. . .It also depends on the patient’s previous traumatic situations or the level of happiness in his or her life. . . .(H4)

Psychological Resilience

This is a situation that may vary for each patient. The patient’s age and psychological state are very important. The patient is significantly impacted by their psychological state prior to the operation. . . .(H5)

Effective Coping Skills

. . .Some people are grateful and have strong coping mechanisms. These patients are usually unaffected. . . .(H4)

Nurses’ Experiences About Coping With the Difficulties They Face in the Care Process of Patients With POCD

According to the participant statements, nurses’ experiences in coping with the difficulties they encountered in the care process of patients with POCD were divided into 4 main themes: “interaction,” “restriction,” “external support systems” and “ cognitive configuration .” Participants reported that the coping method they most frequently used in the difficulties they encountered in the care process was “restriction.” In the interaction theme, participants reported that they frequently used the “communication” method, in the restriction theme, they used the “pharmacological support-medical restriction” method, in the external support systems, they used the “providing support from the doctor” and “providing social support” methods, and in the cognitive configuration process, they used the “focus shifting” and “guidance” methods.

Interaction

The main theme of the “interaction” is divided into 3 sub-themes: “communication,” “empathy” and “emotional support.”

Communication

I approach the patient more moderately, in line with the ethical rules required by our profession, in a way that makes the patient feel safe, and I try to communicate. . . .(H4)

Empathy

I try to understand the patient’s psychology. I try to establish contact with the patient and have him/her meet his/her relatives. I try to convince the patient that this condition is not permanent. I try to answer his or her questions.(H6)

Emotional Support

. . .For example, I talk to the patient to find out what would make the patient happy. It is very difficult to identify what will make the patient happy. Sometimes the patient wants to wear his watch, that watch can make him happy. Or he wants my daughter to come to see me instead of my son. I try to fulfil their wishes as much as possible. . . .(H4)

Restriction

The main theme of the “Restriction” is divided into 2 sub-themes: “pharmacological support-medical restriction” and “physical restriction.”

Pharmacological Support-Medical Restriction

. . .Every patient I administer sedation medication to calms down, but if I think there is still a possibility of a negative outcome, I resort to restraining the patient so that he does not harm himself. . . .(H8)

Physical Restriction

I first try to calm the patient down. I explain clearly, one by one, so that the patient understands me. Unfortunately, this usually does not lead to a positive result. In this case, I have to restrain the patient (tie their hands to the bed). . . .(H1)

. . .I’m tying his hands and feet because he’s trying to pull CVP and arterial catheters or drains. . . .(H7)

External Support Systems

The main theme of the “external support systems” into 3 sub-themes: “providing support from the doctor,” “providing social support” and “referral to the clinic”

Providing Support From the Doctor

. . .In consultation with the doctor, I administer sedation medication based on his or her recommendation. I also administer painkillers and antipsychotic medication. . . .(H9)

Providing Social Support

I try to understand the patient’s psychology. I try to establish communication with the patient and have him/her meet his/her relatives. I try to convince the patient that this condition is not permanent. I try to answer his or her questions. . . .(H6)

. . .I take the patient’s relatives with me. I communicate with the patient’s relatives first. I suggest the patient’s relatives chat with the patient, say something about the patient’s life before the operation, and talk about his or her children. I usually let them make a video call. . . .(H10)

Referral to the Clinic

. . .The intensive care environment, the patient’s lack of perception of time and space, and his or her inability to see his or her relatives and the outside aggravate the POCD picture. Therefore, I try to get the patient to the ward quickly. . . .(H1)

Cognitive Configuration

The main theme of the “cognitive configuration” into 2 sub-themes: “changing the focus” and “orienting.”

Changing the Focus

. . .I have daily conversations to divert the patient’s attention. . . .(H2)

Orienting

. . .Following their relatives, some patients may recover within 1-2 days, while others may recover within hours. . . .(H3)

Discussion

Ten nurses participated in this study, which aimed to examine the experiences of nurses in the care of patients undergoing open heart surgery and POCD, and 13 main themes and 22 sub-themes were obtained.

In our study, the participants reported that they encountered cognitive problems in patients in the form of derealization, adjustment problems, and confusion. According to reports, changes in brain oxygenation during open heart surgery may cause physiological changes that lead to cognitive issues.^4,12 In a study of 101 patients, Ghaffary et al found cognitive decline in 65 patients following cardiac surgery.¹³ Five out of 19 studies using a control group in a systematic review by Paredes et al reported cognitive dysfunction.¹⁴ Analyzing studies with similar groups on nurses’ experiences caring for patients with POCD revealed results similar to those of the current study. These findings suggest that open heart surgery has an impact not only on physical health but also on mental health as it affects cognitive aspects. Therefore, it is thought that POCD is an important problem arising in patient care and the effects of surgical interventions on cognitive aspects should be carefully evaluated. In this process, perioperative cognitive tests can be applied to patients. With the tests applied, it can be determined whether the patients are cognitively at risk or not, and specific care can be planned for patients at risk. Considering whether the effects on cognitive aspects are related to factors such as pain, fear, and anxiety, specific prophylactic steps can be planned for each patient.

We found in this study, participants reported that patients had communication problems, self-harm, and behavioral problems such as aggressive behavior and non-compliance with treatment. In a study, it was observed that the commonly used nursing diagnoses in patients after cardiac surgery were self-harm, risk of self-harm, and risk of injury, and nursing diagnoses were created for behavioral problems.^15,16 At the same time, establishing and maintaining communication with patients who develop POCD after open heart surgery can be challenging. Reports indicate that these patients often refuse care or display disruptive behaviors like shouting and physically attacking the nurses.^17
-20 For this reason, it is thought that it will be beneficial to make short and understandable sentences while communicating with patients, to speak slowly and clearly without shouting, to call the patient by name, to pay attention to pronunciation, not to be in a hurry for the answer, to tell the patient what he or she is asked to do, not what he or she should do, and to make the sentences clear.

In our study, it was reported that patients experienced many adverse events, such as CVP, arterial and urinary catheters and drains, and jumping out of bed. The presence of cognitive impairments in patients with POCD leads to the perception that the intensive care environment is threatening and causes behavioral problems such as self-harm. The literature highlights that patients’ changing emotional states lead to dissatisfaction with their treatment, leading them to engage in risky behaviors related to self-harm, such as removing their catheters and turning off the monitor. At the same time, it is emphasized that these patients may use materials such as hand sanitizer, towels, glasses, plates, and forks in the room for suicidal purposes.^21,22 The results of this study align with those of similar studies in the literature. These findings suggest that it is important to ensure and maintain environmental safety for patients with POCD. It is thought that a sense of trust and correct communication with patients will be effective for self-harming patients. If the clinician cannot cope with the self-harm of the patient, it is thought that external support, psychiatry and neurology consultations, and pharmacological support will be effective. These findings suggest that it is important to ensure and maintain environmental safety in patients with POCD.

In this study, participants reported that patients developed emotional problems such as insecurity, fear, and anxiety. Patients state that the information and training they will receive about the postoperative process will be useful in terms of the emotional problems experienced.²³ Butz et al evaluated whether cognitive training was effective in preventing postoperative cognitive decline and improving health-related quality of life in patients undergoing cardiac surgery, and the patients were followed up for 12 months. Twelve months after the training, the training group showed improvements in quality of life, especially in role limitations related to physical health, role limitations related to emotional problems, physical component summary, and mental component summary compared to the control group. At the same time, the incidence of POCD in these patients was found to be 22% in the control group and 11% in the training group.²⁴ When the findings of this study are evaluated together with those in the literature, it is thought that emotional problems that occur in the postoperative period in patients undergoing cardiac surgery negatively affect physical and psychological recovery and challenge nurses in the care process. In this process, it is believed that educating and informing patients about the postoperative period will help eliminate the emotional problems they may experience. In addition, explanatory and clear answers should be given to the curiosity and questions of the patients about their diseases and the surgical intervention they will undergo in the preoperative period. It is thought that providing necessary psychological support to patients with anxiety and fears about the surgery and their diseases will make the postoperative process easier.

In our study, participants reported that they had difficulties in the care process due to disruptions in their work and their inability to cope with patients. In a qualitative study by Sturm et al, general practitioners reported that they almost never saw patients with postoperative delirium or POCD, whereas nurses, especially in the intensive care unit, reported that they encountered delusional patients every day.²³ They also claim that doctors frequently fail to recognize patients with acute or subacute delirium. These results show that physicians do not deal with this problem very often, and nurses have more responsibility in the care of patients with POCD.

The participants in this study reported that factors such as the increased duration of hospitalization in intensive care, age (older), experiences in the premorbid period, coping style, and psychological resilience were associated with influencing the development of POCD after cardiovascular surgery. The studies’ data indicate that POCD may be a transient condition, with a high rate observed in the early postoperative period but a decrease in the late postoperative period. This suggests that it may be possible to improve the cognitive health of patients with long-term follow-up and support. In the study by Larson et al, it was found that an improvement in cognitive performance occurred in the first 6 to 12 months after discharge.²⁵ In a systematic review by Arefayne et al, the shortest period of time that patients were followed (observed) until they developed POCD was found to be the first days of the first week and the longest period was found to be 12 months. It is thought that this may be a reason for the variation in the incidence of POCD.²⁶ At the same time, a review by Caza et al reported that POCD decreased a few days or weeks after surgery.²⁷ According to reports, the perioperative process, anesthesia, age, prolonged stays in the intensive care unit, educational status, preoperative cognitive status, and comorbidities all play a significant role in the pathogenesis of POCD.^14,28
-30 This study’s results support similar studies in the literature. These findings reveal the necessity of considering emotional and psychological needs as well as physical needs in patient care. Simultaneously, preoperative patient preparation for patients undergoing open heart surgery should address the psychological preparation stage more comprehensively. This approach suggests examining risk factors for POCD development by spending more time with patients during history taking, and planning interventions to prevent POCD development by assessing psychological and physical findings.

Participants reported that interaction with the patient is important in coping with the difficulties encountered in the care process of patients with POCD and that effective communication with patients, an empathic approach, and emotional support for the patient are effective in achieving this. The literature states that effective communication and empathic skills between the nurse and the patient improve patient care.^31
-33 In a qualitative study by Babaii et al, the majority of participating nurses expressed that they empathized with patients to comprehend their needs and foster intimate, friendly communication. At the same time, they stated that they spoke to patients with humility, in a pleasant and sincere tone of voice, and answered patients’ questions in kind and understandable language. Participants in the study by Babaii et al stated that when they paid attention to the appearance and behavior of patients and gave feedback to patients regarding changes in these issues, patients understood that they were important to nurses and felt closer to nurses.³⁴ When the results of this study are evaluated together with the results of similar studies in the literature, it shows that nurses’ adopting an effective communication style, trying to understand patients, and supporting them while caring for patients with POCD have an important place in coping with the difficulties experienced by nurses.

We found in this study, participants reported that they occasionally restrained agitated patients pharmacologically and physically. Studies have reported the application of physical restraints to prevent self-harm and to ensure patient safety. For example, physical restraint applications are frequently used to prevent the unplanned removal of life-supporting medical devices.^35,36 However, in the study by Kawai et al, it is a question mark that this strategy may increase cognitive problems.³⁶ At this point, safety precautions in patient care need to be carefully evaluated to prevent damage to the patient’s cognitive health. The study by McPherson et al found that cognitive impairment was higher in patients with physical restraint after cardiac surgery.³⁵ When the results of this study are evaluated together with the results of similar studies, it is seen that physical restraint is a coping method used by nurses to prevent the patient’s damaging behaviors in patients with POCD, but the literature indicates that physical restraint has potential risks to cognitive health. Therefore, it is critical to consider the patient’s cognitive health as well as the effective implementation of safety measures in patient care. In order to provide better patient care and cope with POCD, a balance between patient safety and cognitive health is considered necessary.

In this study, the participants reported that external support systems were another way of coping with the difficulties they encountered in the care process of the patient who developed POCD, and in this direction, they evaluated the patient with the support of the physician and requested psychiatry or neurology consultations, provided social support from patient relatives, and referred patients from intensive care to clinics. During postoperative POCD, nurses should intervene by managing environmental stressors that may accelerate symptoms. These interventions include providing vision and hearing aids to people with visual or hearing impairments, limiting high levels of light and noise, providing appropriate sleep hygiene, avoiding physical and pharmacological control measures through treatment, and changing the environment. After 72 hours, the nurse should thoroughly assess the patient for mild cognitive changes, and if requested, a therapist should also assess the patient before discharge. Specialists should evaluate patients with moderate neurocognitive disorders. With the support of the patient’s relatives, the patient should be informed that if stress, insomnia, and mood disorders persist for more than 3 months, support from a doctor and a neuropsychiatry specialist should be sought. Today, the establishment of social support groups and the participation of patients and their families in treatment are among the popular practices that contribute to recovery.³⁷ These findings highlight the importance of a multidisciplinary approach in patient care. Simultaneously, the adoption of a holistic approach in coping with POCD, through the establishment of social support groups and the involvement of patients and their families in treatment, facilitates the easier resolution of challenges in nursing care.

Nevertheless, POCD is an important health problem, and its management and prevention can be addressed through government, community, and public health education programs. At the governmental level, the Ministry of Health’s policies for the health of the elderly and quality standards for care services can provide guidance for the prevention and management of POCD. At the community level, local health institutions and non-governmental organizations can organize programs to support the cognitive function of elderly individuals before and after surgery. Public health education programs can raise awareness about POCD and inform both health professionals and patients and their relatives. This multifaceted approach may be effective in reducing the effects of POCD.^38,39

Limitations

Nurses who met the sample selection criteria, worked in the cardiovascular surgery intensive care unit, and experienced patient outcomes after cardiovascular surgery participated in this study, which took place in a single center. Therefore, the findings cannot be generalized to all patients. Patients’ diseases, medical histories, patient-nurse experiences, and differences in care all reveal the study’s limitations. Despite these limitations, the results of this study suggest the need for further research on POCD care for patients undergoing surgery. At the same time, although this study provided descriptive data on participants’ years of professional experience, the potential impact of this on their perspectives was not specifically analyzed. Future studies could focus on how different levels of experience shape nurses’ approaches to POCD care.

Conclusion

There is currently no clear uniform definition of POCD, which is not classified in the International Classification of Diseases. Diagnosis is based on the use of neuropsychiatric tests, but there is no consensus yet on which tests are more sensitive and specific for use. It is thought that the deficiencies seen in the care given to patients who develop POCD are also due to this reason. This study revealed that nurses encounter several common themes when caring for patients with POCD. Based on the study findings, specific education and training programs for nurses focusing on POCD recognition, assessment, and management strategies are needed to improve the care of patients with POCD. These programs should also address the psychological and emotional aspects of care. Nurses should evaluate the presence of risk factors that may lead to the development of POCD in the preoperative period. If there is a possible risk, patients and their relatives should be informed about what the patients will encounter in the POCD picture that may develop in the postoperative period. Healthcare organizations should invest in the development and implementation of guidelines and protocols specific to the care of patients with POCD. These guidelines should emphasize interdisciplinary collaboration and standardized approaches to improve patient outcomes. It is thought that by establishing special care protocols and standardized approaches for these patients, the healing process of patients will be supported and the quality of care will increase by helping healthcare professionals to provide better service.

Supplemental Material

sj-pdf-1-inq-10.1177_00469580251332061 – Supplemental material for Experiences of Cardiovascular Surgery Intensive Care Nurses in the Care of Patients With Postoperative Cognitive Dysfunction: A Qualitative Study

Supplemental material, sj-pdf-1-inq-10.1177_00469580251332061 for Experiences of Cardiovascular Surgery Intensive Care Nurses in the Care of Patients With Postoperative Cognitive Dysfunction: A Qualitative Study by Hatice Azizoğlu in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Footnotes

Acknowledgements

I would like to thank the faculty members of Van Yüzüncü Yıl University, Faculty of Health Sciences, Department of Psychiatric Nursing and Zeynep GÜRKAN for their contributions and suggestions.

ORCID iD

Hatice Azizoğlu

Statements and Declarations

Supplemental Material

Supplemental material for this article is available online.

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