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Emergence delirium (ED), also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors following general anesthesia. The incidence of ED is 3 to 8 times higher in children 5 years of age or less. There is no standard of nursing practice for managing ED symptoms in the pediatric surgical population. The purpose of this quality improvement project was to address a gap in knowledge needed to inform clinical decision-making when managing ED in the postoperative setting. Using an educational presentation for post anesthesia care unit (PACU) nurses, this project introduced the use of non-pharmacological interventions to mitigate symptoms of ED in the pediatric population as inspired by The Green Star Initiative, an Army program at Fort Carson. The project aim was to describe the effectiveness of ED-specific interventions from the nursing perspective. Using tenets of the Iowa model, this quality improvement project included a needs assessment survey, PowerPoint presentation, parent education leaflet, ED cheat sheet, and a post-intervention survey. Applying the context, input, process, product model for evaluation, this project increased knowledge of ED-specific interventions used by nurses that demonstrates a change in clinical decision-making. PACU nurses rated the interventions 43% effective on pediatric patients. This project addressed the gap in practice by providing structured education on ED, inspiring the use of ED-specific interventions, and promoting readiness to care for the pediatric surgical population. Outcomes add to the nursing literature by introducing ED-specific interventions to manage pediatric ED in facilities nationwide. A social implication of this project is to improve the care of pediatric surgical patients.

Background: Emergence delirium is a transient change in mental function and is a common complication in the postoperative period. The condition is characterized by emotional disturbances, lack of ability to think clearly, disorientation and hallucinations. Emergence delirium is associated with both suffering for the patient and a longer period of care. Method: Literature review with a qualitative approach and a descriptive design. The result is based on ten scientific qualitative original articles. All articles have been quality reviewed using SBU's (2022a) review template and the content has been analyzed through Forsberg and Wengström's (2016) content analysis. Aim: The aim was to investigate patients' experiences of postoperative confusion in hospital departments. Results: Three themes emerged in the results; the experience of being in emergence delirium, interaction with staff and environmental impact. Emotional experiences and feelings of a distorted picture of reality emerged. The environment in the care department was perceived to have a negative impact on the disease state. Suffering was a major factor that was experienced as burdensome. A minority described a positive picture of their experience. The condition made communication and interaction with healthcare staff complicated. Patients experienced obstacles in conveying their will, and healthcare professionals were therefore unable to provide the person-centred care that every patient is entitled to. Conclusion: Emergence delirium caused problems in the care of patients. The experience of a distorted picture of reality together with the emotional strain was suffering. Difficulty with communication created a disturbed interaction with healthcare staff, which led to problems in the care of patients. The nurse's way of meeting the patient in suffering contributed to the patient's experience. / Bakgrund: Akut konfusion är en övergående förändring i den mentala funktionen och är en vanlig komplikation i det postoperativa skedet. Tillståndet kännetecknas av känslomässiga störningar, bristande förmåga att tänka klart, desorientering samt hallucinationer. Akut konfusion är associerat med både lidande för patienten och en längre vårdtid. Metod: Litteraturöversikt med kvalitativ ansats och en beskrivande design. Resultatet grundar sig på tio vetenskapliga kvalitativa originalartiklar. Samtliga artiklar har kvalitetsgranskats med SBU:s (2022a) granskningsmall och innehållet har analyserats genom Forsberg och Wengströms (2016) innehållsanalys. Syfte: Syftet var att undersöka patienters upplevelser av postoperativ konfusion på vårdavdelning.  Resultat: I resultatet framkom tre teman; upplevelsen att befinna sig i akut konfusion, interaktion med personal och miljöpåverkan. Det framkom emotionella upplevelser och känslor av en förvrängd verklighetsbild. Miljön på vårdavdelningen upplevdes ha en negativ inverkan på sjukdomstillståndet. Lidande var en stor faktor som upplevdes betungande. En minoritet beskrev en positiv bild av sin upplevelse. Tillståndet gjorde kommunikation och interaktion med vårdpersonal komplicerad. Patienter upplevde hinder i att förmedla sin vilja och vårdpersonal kunde därför inte ge en personcentrerad vård som varje patient har rätt till. Slutsats: Akut konfusion medförde problematik i vårdandet av patienter. Upplevelsen av en förvrängd verklighetsbild tillsammans med den emotionella påfrestningen var ett lidande. Svårighet med kommunikation skapade en störd interaktion med vårdpersonal, vilket medförde problematik i vårdandet av patienter. Sjuksköterskans sätt att möta patienten i lidande bidrog till patientens upplevelse.