Surgical Nurses' Role in Preventing Postoperative Delirium in Elderly Patients Undergoing Surgery
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Background: Postoperative delirium (POD) commonly affects elderly patients (>65 years), leading to longer hospital stays, increased mortality, and higher healthcare costs. While surgical nurses play a vital role in POD prevention through risk assessment, non-pharmacological strategies, and environmental improvements, their efforts are often limited by inadequate training and resources.
Aim: This study aimed to assess surgical nurses’ knowledge, attitudes, and practices regarding POD prevention in elderly patients and examine the relationship between protocol adherence and POD incidence.
Methodology: A descriptive quantitative study was conducted at a tertiary hospital in Swat. Sixty surgical nurses completed structured questionnaires, and medical records of 100 elderly surgical patients were reviewed using the confusion assessment method (CAM). Data were analyzed using statistical package for the social sciences (SPSS) v27, including descriptive statistics and chi-square tests.
Results: Ninety percent of nurses recognized sedation reduction as helpful, and 85% supported early mobilization. However, only 60% routinely implemented cognitive orientation strategies. Although 92% had positive attitudes, only 40% felt adequately trained. The overall POD incidence was 20%. Notably, nurses with high adherence to preventive protocols had significantly lower POD rates (only 8%).
Conclusion: Surgical nurses possess good knowledge and strong motivation to prevent POD, but gaps in consistent practice remain. Strengthening training, especially in cognitive orientation and reinforcing adherence to evidence-based protocols are essential for improving outcomes in elderly postoperative patients.
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- Journal: 3065-9884 (ISSN)
Dates
- Accepted
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2025-06-24
References
- 1. Ho MH, Nealon J, Igwe E, et al. Postoperative delirium in older patients: a systematic review of assessment and incidence of postoperative delirium. Worldviews Evid Based Nurs. 2021;18(5):290-301. doi:10.1111/wvn.12536 PubMed | Crossref | Google Scholar
- 2. Igwe EO, Nealon J, O'Shaughnessy P, et al. Incidence of postoperative delirium in older adults undergoing surgical procedures: a systematic literature review and meta‐analysis. Worldviews Evid Based Nurs. 2023;20(3):220-237. doi:10.1111/wvn.12599 PubMed | Crossref | Google Scholar
- 3. Damluji AA, Forman DE, Wang TY, et al. Management of acute coronary syndrome in the older adult population: a scientific statement from the American Heart Association. Circulation. 2023;147(3):e93-e621. doi:10.1161/CIR.0000000000001123 PubMed | Crossref | Google Scholar
- 4. Russell CD, Lone NI, Baillie JK. Comorbidities, multimorbidity, and COVID-19. Nat Med. 2023;29(2):334-343. doi:10.1038/s41591-022-02156-9 PubMed | Crossref | Google Scholar
- 5. Yang Y, Zhao X, Gao L, et al. Incidence and associated factors of delirium after orthopedic surgery in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res. 2021;33:1493-1506. doi:10.1007/s40520-020-01674-1 PubMed | Crossref | Google Scholar
- 6. Pal N, Abernathy JH III, Taylor MA, et al. Dexmedetomidine, delirium, and adverse outcomes: analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2021;112(6):1886-1892. doi:10.1016/j.athoracsur.2021.03.056 Crossref | Google Scholar
- 7. Hussain AK, Kakakhel MM, Ashraf MF, et al. Innovative approaches to safe surgery: a narrative synthesis of best practices. Cureus. 2023;15(11):e48387. doi:10.7759/cureus.48387 PubMed | Crossref | Google Scholar
- 8. Dilmen OK, Meco BC, Evered LA, Radtke FM. Postoperative neurocognitive disorders: a clinical guide. J Clin Anesth. 2024;92:111320. doi:10.1016/j.jclinane.2023.111320 PubMed | Crossref | Google Scholar
- 9. Kleinfelder LD. Implementation of Evidenced Based Practice Guidelines for Reducing Emergence Delirium in Elderly Patients Undergoing a Total Hip Replacement. Doctor of Nursing Practice Scholarly Project. Otterbein University; 2026. Implementation of Evidenced Based Practice Guidelines for Reducing Emergence Delirium in Elderly Patients Undergoing a Total Hip Replacement
- 10. Moody E, McDougall H, Weeks LE, et al. Nursing interventions to improve care of people living with dementia in hospital: a mixed methods systematic review. Int J Nurs Stud. 2024;104838. doi:10.1016/j.ijnurstu.2024.104838 PubMed | Crossref | Google Scholar
- 11. Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med. 2021;47(10):1089-1103. doi:10.1007/s00134-021-06503-1 PubMed | Crossref | Google Scholar
- 12. Bellelli G, Brathwaite JS, Mazzola P. Delirium: a marker of vulnerability in older people. Front Aging Neurosci. 2021;13:626127. doi:10.3389/fnagi.2021.626127 PubMed | Crossref | Google Scholar
- 13. Mart MF, Roberson SW, Salas B, Pandharipande PP, Ely EW. Prevention and management of delirium in the intensive care unit. In: Semin Respir Crit Care Med. 2021;42(1):112-126. doi:10.1055/s-0040-1710572 PubMed | Crossref | Google Scholar
- 14. Krupa S, Friganović A, Oomen B, Benko S, Mędrzycka-Dąbrowska W. Nurses' knowledge about delirium in the group of intensive care units patients. Int J Environ Res Public Health. 2022;19(5):2758. doi:10.3390/ijerph19052758 PubMed | Crossref | Google Scholar
- 15. Eagles D, Cheung WJ, Avlijas T, et al. Barriers and facilitators to nursing delirium screening in older emergency patients: a qualitative study using the theoretical domains framework. Age Ageing. 2022;51(1):afab256. doi:10.1093/ageing/afab256 PubMed | Crossref | Google Scholar
- 16. Swarbrick CJ, Partridge JS. Evidence‐based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia. 2022;77:92-101. doi:10.1111/anae.15584 PubMed | Crossref | Google Scholar
- 17. Liang S, Chau JP, Lo SH, Zhao J, Liu W. Non-pharmacological delirium prevention practices among critical care nurses: a qualitative study. BMC Nurs. 2022;21(1):235. doi:10.1186/s12912-022-01019-5 PubMed | Crossref | Google Scholar
- 18. Alanazi FK, Sim J, Lapkin S. Systematic review: Nurses' safety attitudes and their impact on patient outcomes in acute‐care hospitals. Nurs Open. 2022;9(1):30-43. doi:10.1002/nop2.1043 PubMed | Crossref | Google Scholar
- 19. Richemond RP. An Educational Intervention to Promote a Shift in Attitude in Using Dexmedetomidine to Prevent Pediatric Emergence Delirium. DNP Project. Florida International University; 2021. An Educational Intervention to Promote a Shift in Attitude in Using Dexmedetomidine to Prevent Pediatric Emergence Delirium
- 20. Bellido D, García-García C, Talluri A, Lukaski HC, García-Almeida JM. Future lines of research on phase angle: strengths and limitations. Rev Endocr Metab Disord. 2023;24(3):563-583. doi:10.1007/s11154-023-09803-7 PubMed | Crossref | Google Scholar
- 21. Liang S, Chau JP, Lo SH, Zhao J, Liu W. Non-pharmacological delirium prevention practices among critical care nurses: a qualitative study. BMC Nurs. 2022;21(1):235. doi:10.1186/s12912-022-01019-5 PubMed | Crossref | Google Scholar
- 22. Hwang DY, Oczkowski SJ, Lewis K, et al. Society of Critical Care Medicine guidelines on family-centered care for adult ICUs: 2024. Crit Care Med. 2025;53(2):e465-e482. doi:10.1097/CCM.0000000000006286 PubMed | Crossref | Google Scholar
- 23. Hakvoort L, Dikken J, van der Wel M, Derks C, Schuurmans M. Minimizing the knowledge-to-action gap: identification of interventions to change nurses' behavior regarding fall prevention, a mixed method study. BMC Nurs. 2021;20(1):1-3. doi:10.1186/s12912-021-00598-z PubMed | Crossref | Google Scholar
- 24. Van Dierendonck D, Lam H. Interventions to enhance eudaemonic psychological well‐being: a meta‐analytic review with Ryff's Scales of Psychological Well‐Being. Appl Psychol Health Well Being. 2023;15(2):594-610. doi:10.1111/aphw.12429 PubMed | Crossref | Google Scholar
- 25. Ho MH, Nealon J, Igwe E, et al. Postoperative delirium in older patients: a systematic review of assessment and incidence of postoperative delirium. Worldviews Evid Based Nurs. 2021;18(5):290-301. doi:10.1111/wvn.12536 PubMed | Crossref | Google Scholar
- 26. Cortés-Beringola A, Vicent L, Martín-Asenjo R, et al. Diagnosis, prevention, and management of delirium in the intensive cardiac care unit. Am Heart J. 2021;232:164-176. doi:10.1016/j.ahj.2020.11.009 PubMed Crossref | Google Scholar