{"paper_id":"0b6af034-9373-402b-8b9d-d31d72b6c899","body_text":"the real experience and coping styles of emergence delirium in patients after radical lung cancer surgery: A qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article the real experience and coping styles of emergence delirium in patients after radical lung cancer surgery: A qualitative study Tongyang You, Qin Li, Yao Fu, Juan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6854883/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study employs a interpretative phenomenological approach to explore the real experience of emergence delirium (ED) in patients following radical lung cancer surgery, a common and complex postoperative complication in the post-anesthesia care unit.Despite the prevalence and impact of ED in this specific patient population, the real experience of ED has not been extensively explored. There is a paucity of research on the coping mechanisms employed by patients and the support they require. Design Phenomenological study using half-standardized interviews. Methods Interpretive phenomenological research methods were used to interview postradical lung cancer patients with ED in a tertiary-level hospital in Sichuan Province through purposive sampling, and the Colaizzi 7-step analysis method was utilized to conduct a thorough analysis of the interview data. Results Nine of the 15 interview subjects were male and six were female. After analyzing the interview content, five main themes and 15 subthemes were distilled: profound experience of perceptual disorders in the face of ED, positive and negative emotions in the face of ED, various strategies for managing ED, outcomes of experiencing ED, and the need for healthcare management in the face of ED. Conclusion It is necessary to pay attention to the symptoms and needs of ED that occur in patients after radical lung cancer surgery, and healthcare staff should actively monitor and take measures to actively respond to them, help patients improve their self-coping skills, reduce the incidence of ED, mitigate cognitive impairment, strengthen medical support, and promote the early recovery of patients. Trail registration This study was approved by the ethics committee of the affiliated hospital of southwest medical university, with the approval number: KY2024439. lung cancer emergence delirium real experience qualitative study INTRODUCTION According to the latest monitoring data from the National Cancer Center, lung cancer is the malignant tumor with the highest mortality rate and morbidity rates in China [ 1 ] . Currently, comprehensive treatment based on surgery is the preferred strategy for lung cancer treatment [ 2 ] . In recent years, undergoing radical surgery for lung cancer via thoracoscopy has gained great popularity in the clinic, and it has been proved to be one of the reliable procedures for removing lung tumors [ 3 ] . It is characterized by minimally invasiveness and relatively small trauma, but it is prone to postoperative complications related to the mental system, and one of the common complications is delirium [ 4 , 5 ] , with an incidence of 5%-16% [ 6 ] . And delirium is a common postoperative complication in elderly patients, often accompanied by adverse clinical outcomes, which seriously affect the prognosis of patients [ 7 ] . Delirium can be divided into emergence delirium (ED) and postoperative delirium (POD) according to the time of onset [ 8 ] . ED is an acute cognitive dysfunction that occurs from the immediate end of anesthesia to the early post-anesthesia period, and it often occurs in the Post-anesthesia care unit (PACU).It is a new neuropsychiatric syndrome after surgery, mainly characterized by impairment of attention and cognitive function, divided into three types: low-activity, high-activity, and mixed, often occurring among the elderly and children [ 9 ] . The main clinical manifestations are acute onset, characterized by altered mental states of hyperactivity and agitation, and acute confusion. Studies have shown that the presence of ED during PACU is a causative factor for increased risk of POD, long-term cognitive decline and prolonged hospitalization [ 9 ] . Currently, domestic studies on delirium mainly focus on POD, with less attention paid to ED, and most of them are quantitative studies. Therefore, this study actively focuses on the real experience and experience of ED in patients after radical lung cancer surgery, in order to provide reference for healthcare professionals to correctly identify and manage ED and reduce the occurrence of POD. MATERIALS AND METHODS Aim To explore the real experiences of ED in patients after radical lung cancer surgery and to ascertain the most effective coping strategies. Furthermore, to provide targeted and personalized care for clinically relevant patients with ED after radical lung cancer surgery, in order to improve the patients' experience of medical treatment. Design The interpretive phenomenological research method of qualitative research was used to collect information through face-to-face and one-to-one semi-structured interviews. According to the purpose of the study combined with literature analysis and discussion in the group, the interview outline was initially formulated. After selecting two cases of ED after radical lung cancer surgery for preventive interviews, the understandability and acceptability of the interview content was modified according to the results of the pre-interviews, and the formal interview outline was formed after consulting with six experts. Using the question \"Can you talk about your experience after surgery?\" as an entry point to begin building the interview relationship. 1) Did you see or hear anything after surgery that others did not? Can you describe it? 2) Do you know where you were located and what you were doing? Can you describe it?3) What kind of emotions were you feeling?4) What kind of help would you have liked to have received?5) How did this experience affect you physically and psychologically?6) How did you cope with this experience?7) Is there any kind of support or help you would like to receive at this time? Data collection and ethical considerations Purposeful sampling was utilized to select patients with ED after radical lung cancer surgery from a certain tertiary hospital in Sichuan Province as research participants from January to September 2024.ED was determined by the anesthesiology department medical staff using the Nursing Delirium Screening Scale (Nu-DESC) to assess the patients in the PACU, and each item was scored 0–2 points according to the presence or absence of clinical symptoms and severity, respectively, with 0 points indicating nonexistence, 1 point indicating mild, and 2 points indicate moderate to severe. The maximum score was 10, and a total score of ≥ 1 indicated the presence of ED [ 10 ] . Interviews were conducted on the patients' 3rd postoperative day. The inclusion criteria were as follows: (1)age ≥ 18 years old; (2)surgical procedure was radical surgery performed via thoracoscopy;(3) judged to be those who experienced ED during the awakening period after radical surgery for lung cancer; (4)good communication skills and clear consciousness;(5) informed consent and voluntary cooperation with this study. The exclusion criteria were as follows:(1)those with a history of psychiatric illness or cognitive impairment; (2)those with hearing and speech communication disorders;(3)those who withdrew midway. The sample size was based on the principle of information saturation, i.e., the criterion that no new information would appear when the data were analyzed [ 11 ] .This study was approved by the ethics committee of the affiliated hospital of southwest medical university, with the approval number: KY2024439. Table 1 Basic patient information serial number distinguishing between the sexes (a person's) age marital status educational attainment Surgical Procedures Types of waking delirium P1 female 67 married secondary schools Thoracoscopic radical lung cancer surgery low activity type P2 male 74 bereaved of one's spouse (literary) illiteracy Thoracoscopic radical lung cancer surgery hybrid P3 male 66 married junior high school Thoracoscopic radical lung cancer surgery Highly active P4 male 72 married secondary schools Thoracoscopic radical lung cancer surgery low activity type P5 male 63 married secondary schools Thoracoscopic pulmonary wedge resection Highly active P6 male 51 married High School Thoracoscopic radical lung cancer surgery low activity type P7 female 69 married secondary schools Thoracoscopic radical lung cancer surgery Highly active P8 male 60 married vocational secondary school Thoracoscopic radical lung cancer surgery Highly active P9 male 72 bereaved of one's spouse (literary) secondary schools Thoracoscopic radical lung cancer surgery low activity type P10 male 71 married secondary schools Thoracoscopic radical lung cancer surgery hybrid P11 male 81 bereaved of one's spouse (literary) illiteracy Thoracoscopic radical lung cancer surgery low activity type P12 female 61 married High School Thoracoscopic radical lung cancer surgery low activity type P13 female 55 married High School Thoracoscopic radical lung cancer surgery hybrid P14 female 62 married junior high school Thoracoscopic radical lung cancer surgery Highly active P15 female 43 married specialized training school Thoracoscopic radical lung cancer surgery Highly active Data collection methods The researcher who acted as interviewer had thought about her role before the interview. By entering the research situation, she aimed to avoid preconceived ideas during the interviews and to avoid influencing the interviewees' answers. Two researchers attended each interview, one to ask questions and one to record and supplement. The interviews were conducted in the Thoracic Surgery consultation room, a quiet and comfortable environment that ensured the interviews were not disturbed. Before conducting the interview, a trusting relationship was established with the participants, and the purpose, method, importance, rights and privacy measures of the study were explained to them. The purpose of the recording during the interview was also explained, and the interview was initiated according to the pre-established interview outline, with the first question on the premise of obtaining the participant's informed consent. During the interview, notes were taken to record relevant information, to observe and record changes in the interviewee's expression and tone of voice, and to clarify questions in a timely manner. Towards the end of the interview, the researcher should ask subjects if they have anything to add, reassure those whose mood fluctuates greatly as a result of the content of the interview, and avoid pressuring subjects to discuss matters they prefer not to discuss. The interviewees were numbered according to the order in which they were interviewed. The average length of each interview in this study was approximately 40 minutes. Data analysis Within 24 hours after the end of the interview, the interviewer himself repeatedly listened to and converted the recorded data, checked the interview notes, verified with the research subjects to verify the authenticity of the content, and another researcher from the group verified the transcribed information. Colaizzi's 7-step analysis method was used [ 12 ] Analyzing the data: (1)Thoroughly read the material to fully understand the content; (2) Identify meaningful statements or descriptive sentences;(3) Organize meaningful statements into units of meaning; (4) Categorize and induct units of meaning to identify common themes; (5) Provide detailed descriptions of each theme, summarizing its characteristics and essence; (6) Derive a fundamental structure from the detailed descriptions, clarifying core content; and (7) Validate the accuracy and completeness of the fundamental structure through feedback. Two researchers in the research team read, analyzed, and coded the same data independently according to a certain order and theme, so as to make certain intrinsic relevance. In case of disagreement, the group discussed the data to reach a consensus, and the common themes of the real experience of waking delirium in patients after radical lung cancer surgery were finally summarized. RESULTS In total, 15 patients agreed to participate in this study, comprising 6 females and 9 males, with an average age of 64.467years ± 9.712 years. Table 1 depicts the primary sociodemographic data of the inter-viewees who had their real names replaced by P1-P15. Following data collection and analysis, five main themes and fifteen subthemes were identified, Uncovering the real experience of ED and coping with it during the awakening period in patients after radical lung cancer surgery.Table 2 depicts the five main themes and fifteen subthemes of this article. Table 2 Themes and subthemes of the study Themes Subthemes profound experience of perceptual disorders in the face of ED positive and negative audio-visual hallucinations temporal and spatial disorientation behavioral anomalies and expressive disorders situational disorientation positive and negative emotions in the face of ED fear and anxiety anger and a sense of not being understood shame and guilt neutrality and agitation various strategies for managing ED negative coping positive coping outcomes of experiencing ED different abilities to recall the experience of ED damaged self-esteem and long-term shame fear of reoccurrence and fear of the impact on the prognosis of the disease the need for healthcare management in the face of ED the desire for companionship and psychological support from family members weakness of the support system,the desire to receive clear explanations and continued attention Theme 1: profound experience of perceptual disorders in the face of ED Subtheme 1 positive and negative audio-visual hallucinations Respondents recalled their post-surgical experiences, most of which were perceived as unreal experiences or psychotic dreams or experiences of living in another world. A portion described unreal images they were seeing and voices they were hearing, unable to distinguish between reality and hallucinations. The types of visual hallucinations ranged from concrete creature types to abstract forms and geometric shapes. Auditory hallucinations ranged from concrete sounds, such as rain, music, and conversations, to indistinct voices. \"I recall now that I was dreaming like I was lying on a very small bed and saw a lot of faces floating in the air with no bodies, and I heard a lot of babies crying and it was scary.\" (No.1) \"I remember it a little bit blurry, I just remember I kept trying to urinate and I was very uncomfortable...it was pouring rain outside and I tried to run to a place where there was no one to go to the toilet, but I always saw a bunch of people running after me, they were laughing and talking to each other about something, I couldn't hear them clearly, and I saw a lot of twisted and turned squares in front of me blocking me.\"(No.5) \"I saw butterflies next to me giving me fluids in a variety of fruits.\" (No.13) Some interviewees mentioned feeling that their lives were threatened at the time. \"I was tied up and the ceiling was all spinning, and I heard deafening music, and the doctor was going to kill me, and I thought I was going to die there.\" (No.11) \"I just heard a voice that kept telling me to die. I just threw up my fists and tried to beat the voice away.\"(No.14) A small minority of participants also experienced positive audio-visual hallucinations that led to involuntary behaviors. \"I thought I was playing mahjong... I had a good hand and was about to win three houses (laughs), and I kept touching the cards.\"(No.4) Subtheme 2 temporal and spatial disorientation Participants experienced a state of temporal and spatial confusion throughout the ED. They were unable to determine their location, often perceiving themselves to be in multiple places simultaneously, and were either unaware of the current time or found it confusing, resulting frequently in agitation. \"I was simply forgetting that I was having the operation, and I didn't know where I was...I thought I was back in my 50's...\"(No.2). \"I was so disorganized, I knew I was in the hospital but I felt like I was at home, it was like I was splitting into two people...I just kept trying so hard to figure out the world and it probably came across as extreme.\" (No.7). Some interviewees also mentioned that they did not feel the passage of time during the ED and thought that time was at a standstill. \"I thought that time had stood still, and I saw that the clock on the wall hadn't moved either...\"(No.6). Subtheme 3 behavioral anomalies and expressive disorders Interviewees mentioned that they were unable to control their demeanor or unconsciously performed some abnormal actions, which were different from the patient's daily life, and they were unable to act according to instructions. Patients also often felt unable to communicate and express their needs, and their language was not logical. \"I hear someone asking me questions, asking my name, telling me to stick my tongue out, talking to me all the time, but I have no way of answering him or controlling my body, and I just keep trying to get up.\" (No.3) \"I always felt like there was something in the right side of my chest that kept pushing against me very hard, and then they told me that I kept trying to pull on the closed chest drain at that point. The truth is that in the moment I was not in control of myself at all, I could only follow my instincts, I didn't want to be uncomfortable...and I didn't mean to be.\"(No.8) Subtheme 4 situational disorientation patients mentioned being conscious, believing themselves to be in another situation or jumping back and forth between multiple situations, and not being able to think clearly. \"I don't actually remember too much, I thought that I was planting rice seedlings in the field, and I saw my old partner, who had already been there, also with me. \"(No.10) \"One moment I felt I was floating in a white field, then I heard my grandchildren's voices and thought I was with them.\"(No.9) Theme 2: positive and negative emotions in the face of ED Subtheme 1 fear and anxiety Some patients feel fear and anxiety when in the face of ED, the reason may be related to the fact that the patients are in negative audiovisual hallucinations of different intensity ranges, believing that they are going to die soon. \"It's very scary, it's like a dream it's like a dream, I want to wake up but I can't wake up I feel so tired.\" (No.1). \"I always feel like someone is going to kill me and eat my flesh, I'm terrified even now thinking about it.\" (No.11). Loss of control and autonomy of the patient's behavior and excessive differences from everyday behavior are also common causes of fear and anxiety. \"I heard someone keep calling my name...my son gave me the story that he was calling me and I couldn't respond to him and I didn't have any control over my hands to catch the butterflies, I was feeling very anxious and upset. \" (No.13). \"I thought I was crazy. I was very grumpy at the time, nothing like my usual good nature. I was panicking inside.\"(No.15). Subtheme 2 anger and a sense of not being understood Some patients exhibited extreme agitation and anger when faced with ED, experienced imaginary scenarios, and were incapable of differentiating between hallucinations and reality. They perceived that medical staff and family members failed to comprehend their experiences and refused to acknowledge their legitimate needs, including defecation and standing up. \"I was so annoyed that I wanted to stand up and breathe heavily, but the next to me nurse wouldn't allow me to do that, so I got angry and struggled vigorously, and then my hands were tied up and I had a feeling of abandonment and not being understood.\" (No.3). \"I didn't even know what world I was in, I was confused also fighting with myself, I wanted to get rid of the person who was pressing on my legs and grabbing my things...I was angry.\" (No.7). Negative work attitudes of medical staff can also make patients in ED feel angry and suspicious and distrustful of medical staff. \"I see the nurses being impatient with me, not taking me seriously and even laughing at me, which makes me even more angry and makes me feel that they are not going to treat me properly.\"(No.6). Subtheme 3 shame and guilt Some participants mentioned experiencing feelings of shame, embarrassment, and guilt toward medical staff and family members during ED, which persisted for some time after the end of ED, and in some cases, permanently. \"I was trying to go and pull the tubes off me, I didn't want to feel bad, I knew they were all doing it for my own good, I couldn't help it I felt guilty. \" (No.8). \"I don't remember much...I was listening to my daughter later telling me about some of my behavior at the time and I was embarrassed and to this day I feel ashamed.\"(No.14). Subtheme 4 neutrality and agitation Patients experiencing positive audio-visual hallucinations during episodes of ED exhibited either a neutral mood or no discomfort, and, in some cases, exhibited agitation and euphoria. \"I didn't feel anything at the time, I was very much at home playing cards with my friends.\" (No.4). \"I heard my grandchildren calling out to me, I thought I was at home with my grandchildren and had no (mood) swings.\"(No.9). Patients may feel agitated if they think they have a strong power or that the experience is unreal . \"I was thinking that I had gained a superpower and was able to fly in the sky, and I saw my partner whom I hadn't seen for a long time and I knew in my heart that it was unreal, so I didn't have a burden on my mind...and felt excited, I missed her. \"(No.10). Theme 3: various strategies for managing ED Subtheme 1 negative coping The patient will try to forget the event by avoiding talking about it with others or recalling it by adopting silence, avoidance, or changing the topic of conversation about some specific experience of ED. \"I don't want to think back on what happened then, it's all in the past. That dream was too tiring.\" (No.1). \"I can't remember... (Silence) My brain turns on like a defense mechanism, he always avoids me to recall this thing, I want to forget this bad experience and I don't want others to know about it.\" (No.6). Patients take steps to avoid the reoccurrence of ED, such as avoiding returning to the hospital where the experience of ED occurred and refraining from the use of psychotropic medications. \"I'm embarrassed that this happened, I'm afraid to face these medical staff, I won't come back to this hospital in order to not have this happen again. \"(No.14). Subtheme 2 positive coping Some patients will try to get specifics of the experience by talking to others to rationalize their behavior and be more open about the experience. \"I got them [family members] to give me the whole story, that I was repeating a movement with my hands all the time, and that I should have been planting a seed, I can think of it now. I also saw my old partner. I probably miss that time so much that I did that.\" (No.10). \"My son told me that I had a urinary catheter and the doctor explained to me that having a urinary catheter meant that I wanted to relieve myself all the time, that's why I was in such a hurry to run to the toilet.\" (No.5). Some patients also sought to identify the causes of postoperative delirium through various means, such as age, anesthetic medications, and disease factors. \"I heard that this (ED) usually occurs in senior patients, and I'm still relatively young, ah, so I'm looking for the reasons why it happened to me, could it be the anesthesia medication, and I'm so afraid that I'm going to fall into that again. situation where I can't control myself.\" (No.15). Theme 4: outcomes of experiencing ED Subtheme 1 different abilities to recall the experience of ED The patients' recollections of the beginning and end of emergence delirium (ED) differed from the actual situation, and there was a partial lack of their own verbal expressions and behaviors. Furthermore, some participants reported that their memories of events occurring during the period of ED were absent. \"I can't remember where I've been after my surgery (scratching my hair) ...I have a bit of a vague recollection of being in a hospital bed with my relatives watching over me and being groggy...I went back to sleep. By the time I was fully aware that I was in the hospital it was the next day.\" (No.2). \"I can't remember at all what happened then, I just listened to them later on telling me some of the things I was doing, and I tried to think back, and I can't remember anything.\" (No.12). No concept of how long the ED lasted. \"I don't know how long I was like this (ED), I forget.\" (No.6). Some interviewees were concerned about their memory becoming worse and affecting their postoperative cognitive functioning. \"My memory has become very bad, I always lose things, will I be like this afterward oh (sigh).\" (No.7). Subtheme 2 damaged self-esteem and long-term shame Some interviewees mentioned that the experience of ED had damaged their self-esteem and undermined the social and family image they had built up. \"I've lived to this age, I'm a language teacher, and for so many years both in front of my pupils and my family I've been very reasonable, but I was at the time when I was completely unable to control my own I always wanted to pull out the tubes on my body, and I couldn't listen to anyone's advice, and I even begged them... I feel so ashamed just thinking about it.\" (No.8). \"I can't remember exactly what I did, but my daughter described me up to me like a completely unreasonable shrew, yelling at the top of my lungs, and my fellow patients didn't get a good night's rest, which made me feel so embarrassed.\" (No.14). A very small number of interviewees mentioned that the experience had left them in a permanent state of shame and caused a psychological burden. \"I cared a lot about what people thought of me, my family, friends, and especially my colleagues were there at the time, but this time my image was completely turned upside down, and the thought that I would have to face them in the future, with my face lost, I was always under a lot of pressure, and the psychological pressure was So much (tears).\" (No.15). Subtheme 3 fear of reoccurrence and fear of the impact on the prognosis of the disease Some patients mentioned that they still felt a lot of anxiety and fear after the end of ED and were afraid that it would happen again. \"I don't dare to go to the hospital, I always feel that someone in the hospital is trying to kill me, that feeling of dying is too real, I'm afraid that that experience will happen again.\" (No.11). Patients felt that ED delayed their hospitalization and adversely affected their disease prognosis. \"I got better after a long sleep, all my patients who had surgery in the same time frame as me were discharged and I'm still here, I'm getting better a little slower and I'm more worried that this experience is going to make my disease worse.\" (No.13). Theme 5: the need for healthcare management in the face of ED Subtheme 1 the desire for companionship and psychological support from family members Patients desire family interaction and companionship while in the PACU in order to seek a sense of familiarity and security. \"After the operation it was as if I had been sent to a place that was not a ward, with my hands tied up, I kept looking for my partner, and the nurses wouldn't listen to me, and I wished that a family member would stay with me, and talk to me. \" (No.3). \"After that experience I had a higher need for family companionship, I didn't want to face that fear alone.\" (No.1). The patient mentioned wanting to seek treatment with a psychologist for positive psychological support. \"I seem to have a disease in my mind, I am under a lot of psychological stress, I would like to see a psychologist for psychological counseling and support.\" (No.15). Subtheme 2 weakness of the support system, the desire to receive clear explanations and continued attention The patient wanted a clear explanation from medical staff about ED. \"What happened during that time was a blank for me. Was my brain damaged? I am not sure. I hope the doctor can give me a clear explanation.\" (No.12). The patient was unsure if the experience of ED would have an impact on later life and would like to have ongoing attention from medical staff. \"I see that my fellow patients have been discharged from the hospital and I am a little bit worried if it is a result of this experience, and if this (ED) will have an impact on all of my life in the future, and I would like to have a doctor who keeps an eye on my condition. \" (No.13). DISCUSSION Currently, there are fewer studies on ED in adults at home and abroad, with inconsistent nomenclature, different onset times for definitions, and inconsistent diagnostic criteria [ 13 ] , and how to more accurately identify and manage ED is a key and difficult issue. This study shows that ED is characterized by positive and negative audiovisual hallucinations, temporal and spatial disorientation, behavioral abnormalities and expressive disorders, and situational disorientation. Meanwhile, ED can appear in three different forms: high-activity, low-activity, and mixed forms. In this study, low-activity ED appeared to be more common in elderly patients, which may be related to the residual anesthetic drugs, the occurrence of awakening agitation in patients after radical surgery for lung cancer, or moderate to severe pain with additional analgesic and sedative drugs. Some studies have shown that low-activity ED is often overlooked, thus delaying timely treatment [ 14 ] . As the PACU is a high prevalence site for ED, anesthesiologists and nurse anesthetists should actively enhance dynamic assessment of patients at the time of admission to the PACU, and in terms of screening tools, the ESA guidelines [ 14 ] recommend the use of the Nu-DESC or the Confusion Assessment Method (CAM) for assessment in the PACU. CAM) for assessment. In addition, the 4-item Rapid Diagnostic Protocol for Delirium (the 4 'A's Test, 4AT) and Nu-DESC are highly recommended for identifying low-activity EDs.Also, delirium screening should be performed in all high-risk patients prior to discharge from the PACU [ 10 ] . However, there is still a gap between clinical attitudes and practices of anesthesiologists and nurses regarding the management of ED. A survey of 243 anesthesiologists and 213 anesthesiology nurses in China on their knowledge, beliefs and behaviors regarding ED in adults showed that the healthcare team has a high awareness of the importance of ED in adults, however, the specific practices in routine delirium assessment, depth of anesthesia monitoring, and standardized treatments still need to be improved [ 15 ] , In addition, the study mentioned that anesthesiologists and nurses preferred to use clinical observation to diagnose ED in the context of delirium assessment. to diagnose ED using clinical observation, which may lead to high failure rate and invalid diagnosis [ 16 ] . In the PACU, nurses, as bedside caregivers, are able to identify the predisposing factors for the development of ED and changes in mental status and behavior of patients at an early stage. It is recommended that anesthesia nurses in the PACU should pay attention to the characteristic manifestations of ED in patients, use scientific screening tools for precise identification and management of ED, and implement interventions early to reduce or avoid the series of complications caused by ED. Evidence-based guidelines recommend the establishment of a multidisciplinary management team to standardize the delirium management process [ 17 ] . Therefore, clinical practice can be based on evidence-based guidelines, adopt a multidepartmental and multidisciplinary collaborative approach to establish a standardized management process for the prevention, assessment, and treatment of ED, and multidimensional ED interventions, with the aim of improving patient prognosis. In this study, patients' ability to recall their ED experiences varied, and most of them had partial deficits in their verbal expressions and behaviors, were burdened with varying degrees of negative emotions and uncertainty about the disease, and feared that delirium would recur, and even a small number of patients were more reticent throughout the interviews, fell into a chronic sense of shame, and were depressed, which seriously reduced the quality of life of the patients, which is in line with the findings of Schmitt [ 18 ] , Claesson [ 19 ] and other research results are basically consistent. Healthcare professionals can use specific scales to screen patients for emotional conditions and psychological problems, utilize positive psychology interventions such as cognitive-behavioral therapy [ 20 ] , positive mindfulness stress reduction therapy [ 21 ] , and early psychological interventions [ 22 ] for patients with psychological disorders after experiencing an ED, and combine them with the developmental trajectory of ED, pay attention to the patient's inner feelings, and provide patients with personalized interventions and emotional support, establish positive psychological resources to enhance patients' quality of life, encourage positive self-perception, and improve patients' negative emotions. In addition, respondents in this study mentioned wanting family interaction and companionship in the PACU to seek a sense of security and familiarity. It has been reported in the literature that the incidence of ED is higher than the incidence of postoperative POD [ 9 , 23 ] , which may be related to the more closed environment of the PACU, especially the absence of family members, the high noise level of the cardiac monitor, and the stimulation of lights. Studies have also found that family involvement is strongly associated with the quality of care for patients with delirium [ 24 ] . It is recommended that PACU healthcare professionals improve the comfort of the environment, actively encourage family participation in the ED care process, or integrate smart care technology, integrate cloud-based family accompaniment, and provide personalized humanistic care to help patients adapt to the environment, shorten the duration of ED, and improve patients' family and social support. In this study, the respondents' ways of coping with ED included negative coping (e.g., ways of avoiding memories, talking about it, and going to the same hospital) and positive coping (rationalizing their own behaviors, actively searching for the causes of ED occurrence, etc.), and the desire to receive clear explanations and continuous attention from healthcare professionals for the occurrence of ED was related to their fear of ED recurrence and its impact on disease prognosis. Studies have shown that the occurrence of ED is influenced by a variety of factors; advanced age, cognitive dysfunction, malnutrition, and other self-basic states are intrinsic to delirium, and pain, infection, and the duration of surgery are predisposing factors to delirium [ 25 ] . In the case of patients undergoing radical lung cancer surgery, prolonged intraoperative one-lung ventilation is also a cause of ED. Literature reports that the duration of intraoperative single-lung ventilation is positively correlated with its effect on blood circulation, and at the same time, there are more chances of pulling the patient's lungs and pleura during the operation process, which results in vagus nerve stimulation response and affects the oxygen supply to the patient's brain, and then leads to the occurrence of ED [ 26 , 27 ] . This suggests that during the perioperative process, the surgical team (surgeons, nurses, anesthesiologists) need to refine their professional knowledge and skills and make adequate preoperative preparations with a view to shortening the duration of the operation, reducing the duration of intraoperative single-lung ventilation, and decreasing the likelihood of infection. At the same time, pain management for patients undergoing radical lung cancer surgery should be improved, and multimodal personalized analgesia should be adopted, including thoracic paravertebral nerve block and postoperative self-control analgesic pumps, to reduce the possibility of ED and improve the overall prognosis of patients. In addition, studies have shown that elderly patients who develop postoperative delirium have a greater decline in activities of daily living and a higher 36-month mortality rate [ 28 ] . Therefore, positive psychological guidance should be provided to patients with ED so that they can correctly cope with the occurrence of ED. At the same time, by further promoting \"Internet + Nursing Service\", using small programs, APP, WeChat or telephone, etc., to provide professional continuity support for patients discharged from the hospital home after surgery, to guide patients in their daily lives, and to meet the needs of patients with more than one degree of continuity of disease management. In this study, we explored the real experience of ED occurrence in postradical lung cancer patients through board-structured in-depth interviews, and refined five themes: perceived barriers when ED occurs, emotions in the face of ED, the impact of ED on oneself, and the help one would like to receive. It is suggested that the characteristic manifestations of ED need to be emphasized, dynamically assessed, and accurately identified and managed when caring for postradical lung cancer patients who experience ED. At the same time, we should pay attention to patients' inner feelings and provide personalized intervention and emotional support. It is also necessary to pay attention to the way patients cope with ED and provide effective information support to improve their prognosis. The limitation of this study is that it only focuses on patients after radical lung cancer surgery, and the study population can be subsequently expanded to strengthen the focus on other post-surgical patients, their primary caregivers, and healthcare teams, so as to provide more effective and comprehensive support and guidance for the standardized management of ED. Declarations Ethics approval and consent to participate This study was supported by the Ethics Committee of the Affiliated Hospital of Southwest Medical University and received ethical approval (Approval No. KY2024439).All participants provided written informed consent to participate and were able to withdraw their participation without any disadvantage. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not available. Competing interests The authors declare no competing interests. Funding This study was supported by the Luzhou Science and Technology Bureau Key Research and Development Project (Project No. 2022-SYF-91). The Luzhou Science and Technology Bureau Key Research and Development Project has no role in the design of this study, data collection, analysis of data, interpretation of data and dissemination of findings. Author Contribution TY.Y was responsible for conceptualization, data collection, data management, data analysis, first draft of manuscript, and manuscript writing, review and editing. She was major contributor in writing the manuscript. QL was responsible for data collection, data management, data analysis, and manuscript writing. TY.Y was responsible for data analysis, and manuscript writing. QL was responsible for conceptualization, data collection, and manuscript writing. YF and JW were responsible for conceptualization, and manuscript writing. All authors read an approved the final manuscript. Acknowledgements We express our heartfelt gratitude to all the participants for sharing their genuine experiences and feelings. We also thank the Department of Thoracic Surgery at the Affiliated Hospital of Southwest Medical University for providing the interview venue. Data Availability Data is provided within the manuscript information files References HAN B, ZHENG R, ZENG H, et al. Cancer incidence and mortality in China, 2022[J]. Journal of the National Cancer Center, 2024, 4(1): 47-53. DOI:10.1016/j.jncc.2024.01.006. BAO T, XIAO F, LIU D, et al. Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus [ J]. Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer, 2018, 21(1): 24-31. 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Efficacy of Ramelteon for delirium after lung cancer surgery[J]. Interactive Cardiovascular and Thoracic Surgery, 2017, 24(1): 8-12. DOI:10.1093/icvts/ivw297. HESSE S, KREUZER M, HIGHT D, et al. Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications[J]. British Journal of Anaesthesia, 2019, 122(5): 622-634. DOI:10.1016/j.bja.2018.09.016. LIU X, WANG Y, WU J, et al. Emergence delirium and postoperative delirium associated with high plasma NfL and GFAP: an observational study[J]. Frontiers in Medicine, 2023, 10: 1107369. DOI:10.3389/fmed.2023.1107369. ZHANG Y, HE S T, NIE B, et al. Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study[J]. Journal of Anesthesia, 2020, 34(5): 675-687. DOI:10.1007/s00540-020-02805-8. Chinese Society of Geriatrics, Anesthesiology Branch. Expert consensus on the prevention and treatment of postoperative delirium in elderly patients in China[J]. International Journal of Anesthesiology and Resuscitation,2023,44(1):1-27. DOI:10.3760/cma.j.cn321761-20220915-10005. SAUNDERS B, SIM J, KINGSTONE T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization[J]. Quality & Quantity, 2018, 52(4): 1893-1907. doi:10.1007/s11135-017-0574-8. LIU M .Application of Colaizzi's seven steps in phenomenological research data analysis[J]. Journal of Nursing Science,2019,34(11):90-92. LIU M. Using an example to illustrate Colaizzi's phenomenological data analysis method[J]. Nursing Science,2019,34(11):90-92. YANG Y, FENG L, JI C, et al. Inhalational Versus Propofol-based Intravenous Maintenance of Anesthesia for Emergence Delirium in Adults: a Meta-analysis and Trial Sequential Analysis[J]. Journal of Neurosurgical Anesthesiology, 2023, 35(2): 177-186. DOI:10.1097/ANA.0000000000000830. ALDECOA C, BETTELLI G, BILOTTA F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium [ J]. European Journal of Anaesthesiology, 2017, 34(4): 192-214. doi:10.1097/eja.0000000000000594. YUAN Y, LEI B, LI Z, et al. A Cross-Sectional Survey on the Clinical Management of Emergence Delirium in Adults: Knowledge, Attitudes, and Practice in Mainland China[J]. Brain Sciences, 2022, 12(8): 989. DOI:10.3390/brainsci12080989. DEVLIN J W, MARQUIS F, RIKER R R, et al. Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside[J]. Critical Care (London, England), 2008, 12(1): R19. DOI:10.1186/cc6793. SOSNOWSKI K, LIN F, CHABOYER W, et al. The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: a systematic review and meta-analysis[J]. International Journal of Nursing Studies, 2023, 138: 104410. doi:10.1016/j.ijnurstu.2022.104410. ZAMOSCIK K, GODBOLD R, FREEMAN P. Intensive care nurses' experiences and perceptions of delirium and delirium care[J]. Intensive and Critical Care Nursing, 2017, 40: 94-100. doi:10.1016/j.iccn.2017.01.003. CLAESSON LINGEHALL H, SMULTER N, OLOFSSON B, et al. Experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium : one year follow-up[J]. BMC nursing, 2015, 14: 17. DOI:10.1186/s12912-015-0069-7. Shi Yuxia,Song Jingchao. Effects of nursing intervention based on cognitive behavioral therapy on delirium and negative emotions after radical thoracoscopic lung cancer surgery in the elderly[J]. Henan Medical Research,2023,32(18):3443-3449. DOI:10.3969/j.issn.1004-437X.2023.18.050. DING Meng,ZHU Xia,WANG Xiaoyan,et al. Effects of positive thought behavior training on negative emotions and coping styles of advanced lung cancer patients[J]. Medical Clinical Research,2018,35(11):2284-2286. DOI:10.3969/j.issn.1671-7171.2018.11.080. WANG Minghong,LU Dan,CHEN Ming,et al. Effects of early psychological intervention on delirium and mental health after orthopedic surgery in elderly patients[J]. International Journal of Psychiatry,2019,46(3):533-536. GU W J, ZHOU J X, JI R Q, et al. Incidence, risk factors, and consequences of emergence delirium after elective brain tumor resection[J]. The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 2022, 20(5): e214-e220. DOI:10.1016/j.surge.2021.09.005. OXENBØLL-COLLET M, EGEROD I, CHRISTENSEN V, et al. Nurses' and physicians' perceptions of Confusion Assessment Method for the intensive care unit for delirium detection: focus group study[J]. Nursing in Critical Care, 2018, 23(1): 16-22. doi:10.1111/nicc.12254. WU J, GAO S, ZHANG S, et al. Perioperative risk factors for recovery room delirium after elective non-cardiovascular surgery under general anaesthesia [ J]. Perioperative Medicine (London, England), 2021, 10(1): 3. DOI:10.1186/s13741-020-00174-0. LU Y, LIU X. Postoperative delirium and its influencing factors in elderly patients with lung cancer in the intensive care unit[J]. Journal of Thoracic Disease, 2023, 15(2): 701-710. DOI:10.21037/jtd-23-259. LIU Wei,GUAN Dandan,ZHANG Hongyan. Establishment and evaluation of a column-line diagram model of delirium occurrence after thoracoscopic radical resection in elderly lung cancer patients[J]. Modern Oncology Medicine,2024,32(6):1054-1059. DOI:10.3969/j.issn.1672-4992.2024.06.012. LU Jian, ZHOU Hongmei. Postoperative delirium is related to the long-term decline of activities of daily living[J]. Natl Med J China, 2020, 100(36): 2845. LU J, ZHOU H M. Postoperative delirium is related to the long-term decline of activities of daily living[J]. Natl Med J China, 2020, 100(36): 2845. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6854883\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":475405819,\"identity\":\"73a54a3c-d7f8-4926-980e-3109158e18f2\",\"order_by\":0,\"name\":\"Tongyang You\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIie3RsQrCMBCA4QuFuJy4pgj1CYSUgCCIvkqK0KkP4Gal4KauFQo+hOB8UOhUcXUVQRcH3ZxER50aN8H8+8fdcQA22w/WaCzOdz0SXqt1JDPipiWIa9lTfhxqMyIpAnc5DYOYImm4GW1JIc/ZJC5v+wv0vXZcIVgy10PE3Kmx2bqbwVB1qII4QDJHkXOW1DdNBAo2VYSD9hN8KSjwZEYQIsVSHQookZsRIYoQrtSTfspVN5MGtwx2SQHBQ4xXwjnsL6O+V0k+R6Lpa97It8Jms9n+oifH00Mhpb2y6QAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"the Affiliated Hospital of Southwest Medical University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Tongyang\",\"middleName\":\"\",\"lastName\":\"You\",\"suffix\":\"\"},{\"id\":475405820,\"identity\":\"1e22a4ed-7e26-40b0-b210-67b3a1b759b3\",\"order_by\":1,\"name\":\"Qin Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the Affiliated Hospital of Southwest Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Qin\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":475405824,\"identity\":\"62d032b4-adf5-4221-bdea-e17aa084139d\",\"order_by\":2,\"name\":\"Yao Fu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the Affiliated Hospital of Southwest Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yao\",\"middleName\":\"\",\"lastName\":\"Fu\",\"suffix\":\"\"},{\"id\":475405825,\"identity\":\"d2c9b9d3-b658-433b-94dc-48e8f15c6a3d\",\"order_by\":3,\"name\":\"Juan Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the Affiliated Hospital of Southwest Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Juan\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-06-09 13:23:29\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6854883/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6854883/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":98945454,\"identity\":\"191c9291-72f2-49b5-b74c-5371c7cb6c07\",\"added_by\":\"auto\",\"created_at\":\"2025-12-24 12:10:13\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1168806,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6854883/v1/66435604-d59e-4f8c-a640-2b52aa1fa41b.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003ethe real experience and coping styles of emergence delirium in patients after radical lung cancer surgery: A qualitative study\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eAccording to the latest monitoring data from the National Cancer Center, lung cancer is the malignant tumor with the highest mortality rate and morbidity rates in China \\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. Currently, comprehensive treatment based on surgery is the preferred strategy for lung cancer treatment \\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e. In recent years, undergoing radical surgery for lung cancer via thoracoscopy has gained great popularity in the clinic, and it has been proved to be one of the reliable procedures for removing lung tumors \\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e. It is characterized by minimally invasiveness and relatively small trauma, but it is prone to postoperative complications related to the mental system, and one of the common complications is delirium \\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e, with an incidence of 5%-16% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e. And delirium is a common postoperative complication in elderly patients, often accompanied by adverse clinical outcomes, which seriously affect the prognosis of patients \\u003csup\\u003e[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e. Delirium can be divided into emergence delirium (ED) and postoperative delirium (POD) according to the time of onset \\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e. ED is an acute cognitive dysfunction that occurs from the immediate end of anesthesia to the early post-anesthesia period, and it often occurs in the Post-anesthesia care unit (PACU).It is a new neuropsychiatric syndrome after surgery, mainly characterized by impairment of attention and cognitive function, divided into three types: low-activity, high-activity, and mixed, often occurring among the elderly and children \\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e. The main clinical manifestations are acute onset, characterized by altered mental states of hyperactivity and agitation, and acute confusion. Studies have shown that the presence of ED during PACU is a causative factor for increased risk of POD, long-term cognitive decline and prolonged hospitalization \\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e. Currently, domestic studies on delirium mainly focus on POD, with less attention paid to ED, and most of them are quantitative studies. Therefore, this study actively focuses on the real experience and experience of ED in patients after radical lung cancer surgery, in order to provide reference for healthcare professionals to correctly identify and manage ED and reduce the occurrence of POD.\\u003c/p\\u003e\"},{\"header\":\"MATERIALS AND METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eAim\\u003c/h2\\u003e \\u003cp\\u003eTo explore the real experiences of ED in patients after radical lung cancer surgery and to ascertain the most effective coping strategies. Furthermore, to provide targeted and personalized care for clinically relevant patients with ED after radical lung cancer surgery, in order to improve the patients' experience of medical treatment.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eDesign\\u003c/h3\\u003e\\n\\u003cp\\u003eThe interpretive phenomenological research method of qualitative research was used to collect information through face-to-face and one-to-one semi-structured interviews. According to the purpose of the study combined with literature analysis and discussion in the group, the interview outline was initially formulated. After selecting two cases of ED after radical lung cancer surgery for preventive interviews, the understandability and acceptability of the interview content was modified according to the results of the pre-interviews, and the formal interview outline was formed after consulting with six experts. Using the question \\\"Can you talk about your experience after surgery?\\\" as an entry point to begin building the interview relationship. 1) Did you see or hear anything after surgery that others did not? Can you describe it? 2) Do you know where you were located and what you were doing? Can you describe it?3) What kind of emotions were you feeling?4) What kind of help would you have liked to have received?5) How did this experience affect you physically and psychologically?6) How did you cope with this experience?7) Is there any kind of support or help you would like to receive at this time?\\u003c/p\\u003e\\n\\u003ch3\\u003eData collection and ethical considerations\\u003c/h3\\u003e\\n\\u003cp\\u003ePurposeful sampling was utilized to select patients with ED after radical lung cancer surgery from a certain tertiary hospital in Sichuan Province as research participants from January to September 2024.ED was determined by the anesthesiology department medical staff using the Nursing Delirium Screening Scale (Nu-DESC) to assess the patients in the PACU, and each item was scored 0\\u0026ndash;2 points according to the presence or absence of clinical symptoms and severity, respectively, with 0 points indicating nonexistence, 1 point indicating mild, and 2 points indicate moderate to severe. The maximum score was 10, and a total score of \\u0026ge;\\u0026thinsp;1 indicated the presence of ED \\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. Interviews were conducted on the patients' 3rd postoperative day.\\u003c/p\\u003e \\u003cp\\u003eThe inclusion criteria were as follows: (1)age\\u0026thinsp;\\u0026ge;\\u0026thinsp;18 years old; (2)surgical procedure was radical surgery performed via thoracoscopy;(3) judged to be those who experienced ED during the awakening period after radical surgery for lung cancer; (4)good communication skills and clear consciousness;(5) informed consent and voluntary cooperation with this study.\\u003c/p\\u003e \\u003cp\\u003eThe exclusion criteria were as follows:(1)those with a history of psychiatric illness or cognitive impairment; (2)those with hearing and speech communication disorders;(3)those who withdrew midway. The sample size was based on the principle of information saturation, i.e., the criterion that no new information would appear when the data were analyzed \\u003csup\\u003e[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e .This study was approved by the ethics committee of the affiliated hospital of southwest medical university, with the approval number: KY2024439.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eBasic patient information\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eserial number\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003edistinguishing between the sexes\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(a person's) age\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarital status\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eeducational attainment\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eSurgical Procedures\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTypes of waking delirium\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003efemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e67\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003esecondary schools\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003elow activity type\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e74\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ebereaved of one's spouse (literary)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eilliteracy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ehybrid\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e66\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ejunior high school\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eHighly active\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003esecondary schools\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003elow activity type\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e63\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003esecondary schools\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic pulmonary wedge resection\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eHighly active\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eHigh School\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003elow activity type\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003efemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003esecondary schools\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eHighly active\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003evocational secondary school\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eHighly active\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ebereaved of one's spouse (literary)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003esecondary schools\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003elow activity type\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e71\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003esecondary schools\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ehybrid\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e81\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ebereaved of one's spouse (literary)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eilliteracy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003elow activity type\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003efemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eHigh School\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003elow activity type\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003efemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e55\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eHigh School\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ehybrid\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003efemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e62\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ejunior high school\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eHighly active\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003efemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003emarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003especialized training school\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eThoracoscopic radical lung cancer surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eHighly active\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eData collection methods\\u003c/h3\\u003e\\n\\u003cp\\u003eThe researcher who acted as interviewer had thought about her role before the interview. By entering the research situation, she aimed to avoid preconceived ideas during the interviews and to avoid influencing the interviewees' answers. Two researchers attended each interview, one to ask questions and one to record and supplement. The interviews were conducted in the Thoracic Surgery consultation room, a quiet and comfortable environment that ensured the interviews were not disturbed. Before conducting the interview, a trusting relationship was established with the participants, and the purpose, method, importance, rights and privacy measures of the study were explained to them. The purpose of the recording during the interview was also explained, and the interview was initiated according to the pre-established interview outline, with the first question on the premise of obtaining the participant's informed consent. During the interview, notes were taken to record relevant information, to observe and record changes in the interviewee's expression and tone of voice, and to clarify questions in a timely manner. Towards the end of the interview, the researcher should ask subjects if they have anything to add, reassure those whose mood fluctuates greatly as a result of the content of the interview, and avoid pressuring subjects to discuss matters they prefer not to discuss. The interviewees were numbered according to the order in which they were interviewed. The average length of each interview in this study was approximately 40 minutes.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData analysis\\u003c/h2\\u003e \\u003cp\\u003eWithin 24 hours after the end of the interview, the interviewer himself repeatedly listened to and converted the recorded data, checked the interview notes, verified with the research subjects to verify the authenticity of the content, and another researcher from the group verified the transcribed information. Colaizzi's 7-step analysis method was used \\u003csup\\u003e[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/sup\\u003e Analyzing the data: (1)Thoroughly read the material to fully understand the content; (2) Identify meaningful statements or descriptive sentences;(3) Organize meaningful statements into units of meaning; (4) Categorize and induct units of meaning to identify common themes; (5) Provide detailed descriptions of each theme, summarizing its characteristics and essence; (6) Derive a fundamental structure from the detailed descriptions, clarifying core content; and (7) Validate the accuracy and\\u003c/p\\u003e \\u003cp\\u003ecompleteness of the fundamental structure through feedback. Two researchers in the research team read, analyzed, and coded the same data independently according to a certain order and theme, so as to make certain intrinsic relevance. In case of disagreement, the group discussed the data to reach a consensus, and the common themes of the real experience of waking delirium in patients after radical lung cancer surgery were finally summarized.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eIn total, 15 patients agreed to participate in this study, comprising 6 females and 9 males, with an average age of 64.467years\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.712 years. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e depicts the primary sociodemographic data of the inter-viewees who had their real names replaced by P1-P15. Following data collection and analysis, five main themes and fifteen subthemes were identified, Uncovering the real experience of ED and coping with it during the awakening period in patients after radical lung cancer surgery.Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e depicts the five main themes and fifteen subthemes of this article.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eThemes and subthemes of the study\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eThemes\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSubthemes\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eprofound experience of perceptual disorders in the face of ED\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003epositive and negative audio-visual hallucinations\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003etemporal and spatial disorientation\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ebehavioral anomalies and expressive disorders\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esituational disorientation\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003epositive and negative emotions in the face of ED\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003efear and anxiety\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eanger and a sense of not being understood\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eshame and guilt\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eneutrality and agitation\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003evarious strategies for managing ED\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003enegative coping\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003epositive coping\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eoutcomes of experiencing ED\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003edifferent abilities to recall the experience of ED\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003edamaged self-esteem and long-term shame\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003efear of reoccurrence and fear of the impact on the prognosis of the disease\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ethe need for healthcare management in the face of ED\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ethe desire for companionship and psychological support from family members\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eweakness of the support system,the desire to receive clear explanations and continued attention\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eTheme 1: profound experience of perceptual disorders in the face of ED\\u003c/h3\\u003e\\n\\u003cp\\u003e \\u003cstrong\\u003eSubtheme 1 positive and negative audio-visual hallucinations\\u003c/strong\\u003e \\u003cp\\u003eRespondents recalled their post-surgical experiences, most of which were perceived as unreal experiences or psychotic dreams or experiences of living in another world. A portion described unreal images they were seeing and voices they were hearing, unable to distinguish between reality and hallucinations. The types of visual hallucinations ranged from concrete creature types to abstract forms and geometric shapes. Auditory hallucinations ranged from concrete sounds, such as rain, music, and conversations, to indistinct voices.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I recall now that I was dreaming like I was lying on a very small bed and saw a lot of faces floating in the air with no bodies, and I heard a lot of babies crying and it was scary.\\\" (No.1)\\u003c/p\\u003e \\u003cp\\u003e\\\"I remember it a little bit blurry, I just remember I kept trying to urinate and I was very uncomfortable...it was pouring rain outside and I tried to run to a place where there was no one to go to the toilet, but I always saw a bunch of people running after me, they were laughing and talking to each other about something, I couldn't hear them clearly, and I saw a lot of twisted and turned squares in front of me blocking me.\\\"(No.5)\\u003c/p\\u003e \\u003cp\\u003e\\\"I saw butterflies next to me giving me fluids in a variety of fruits.\\\" (No.13)\\u003c/p\\u003e \\u003cp\\u003eSome interviewees mentioned feeling that their lives were threatened at the time.\\u003c/p\\u003e \\u003cp\\u003e\\\"I was tied up and the ceiling was all spinning, and I heard deafening music, and the doctor was going to kill me, and I thought I was going to die there.\\\" (No.11)\\u003c/p\\u003e \\u003cp\\u003e\\\"I just heard a voice that kept telling me to die. I just threw up my fists and tried to beat the voice away.\\\"(No.14)\\u003c/p\\u003e \\u003cp\\u003eA small minority of participants also experienced positive audio-visual hallucinations that led to involuntary behaviors.\\u003c/p\\u003e \\u003cp\\u003e\\\"I thought I was playing mahjong... I had a good hand and was about to win three houses (laughs), and I kept touching the cards.\\\"(No.4)\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 2 temporal and spatial disorientation\\u003c/strong\\u003e \\u003cp\\u003eParticipants experienced a state of temporal and spatial confusion throughout the ED. They were unable to determine their location, often perceiving themselves to be in multiple places simultaneously, and were either unaware of the current time or found it confusing, resulting frequently in agitation.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I was simply forgetting that I was having the operation, and I didn't know where I was...I thought I was back in my 50's...\\\"(No.2).\\u003c/p\\u003e \\u003cp\\u003e\\\"I was so disorganized, I knew I was in the hospital but I felt like I was at home, it was like I was splitting into two people...I just kept trying so hard to figure out the world and it probably came across as extreme.\\\" (No.7).\\u003c/p\\u003e \\u003cp\\u003eSome interviewees also mentioned that they did not feel the passage of time during the ED and thought that time was at a standstill.\\u003c/p\\u003e \\u003cp\\u003e\\\"I thought that time had stood still, and I saw that the clock on the wall hadn't moved either...\\\"(No.6).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 3 behavioral anomalies and expressive disorders\\u003c/strong\\u003e \\u003cp\\u003e Interviewees mentioned that they were unable to control their demeanor or unconsciously performed some abnormal actions, which were different from the patient's daily life, and they were unable to act according to instructions. Patients also often felt unable to communicate and express their needs, and their language was not logical.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I hear someone asking me questions, asking my name, telling me to stick my tongue out, talking to me all the time, but I have no way of answering him or controlling my body, and I just keep trying to get up.\\\" (No.3)\\u003c/p\\u003e \\u003cp\\u003e\\\"I always felt like there was something in the right side of my chest that kept pushing against me very hard, and then they told me that I kept trying to pull on the closed chest drain at that point. The truth is that in the moment I was not in control of myself at all, I could only follow my instincts, I didn't want to be uncomfortable...and I didn't mean to be.\\\"(No.8)\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 4 situational disorientation\\u003c/strong\\u003e \\u003cp\\u003epatients mentioned being conscious, believing themselves to be in another situation or jumping back and forth between multiple situations, and not being able to think clearly.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I don't actually remember too much, I thought that I was planting rice seedlings in the field, and I saw my old partner, who had already been there, also with me. \\\"(No.10)\\u003c/p\\u003e \\u003cp\\u003e\\\"One moment I felt I was floating in a white field, then I heard my grandchildren's voices and thought I was with them.\\\"(No.9)\\u003c/p\\u003e\\n\\u003ch3\\u003eTheme 2: positive and negative emotions in the face of ED\\u003c/h3\\u003e\\n\\u003cp\\u003e \\u003cstrong\\u003eSubtheme 1 fear and anxiety\\u003c/strong\\u003e \\u003cp\\u003eSome patients feel fear and anxiety when in the face of ED, the reason may be related to the fact that the patients are in negative audiovisual hallucinations of different intensity ranges, believing that they are going to die soon.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"It's very scary, it's like a dream it's like a dream, I want to wake up but I can't wake up I feel so tired.\\\" (No.1).\\u003c/p\\u003e \\u003cp\\u003e\\\"I always feel like someone is going to kill me and eat my flesh, I'm terrified even now thinking about it.\\\" (No.11).\\u003c/p\\u003e \\u003cp\\u003eLoss of control and autonomy of the patient's behavior and excessive differences from everyday behavior are also common causes of fear and anxiety.\\u003c/p\\u003e \\u003cp\\u003e\\\"I heard someone keep calling my name...my son gave me the story that he was calling me and I couldn't respond to him and I didn't have any control over my hands to catch the butterflies, I was feeling very anxious and upset. \\\" (No.13).\\u003c/p\\u003e \\u003cp\\u003e\\\"I thought I was crazy. I was very grumpy at the time, nothing like my usual good nature. I was panicking inside.\\\"(No.15).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 2 anger and a sense of not being understood\\u003c/strong\\u003e \\u003cp\\u003eSome patients exhibited extreme agitation and anger when faced with ED, experienced imaginary scenarios, and were incapable of differentiating between hallucinations and reality. They perceived that medical staff and family members failed to comprehend their experiences and refused to acknowledge their legitimate needs, including defecation and standing up.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I was so annoyed that I wanted to stand up and breathe heavily, but the next to me nurse wouldn't allow me to do that, so I got angry and struggled vigorously, and then my hands were tied up and I had a feeling of abandonment and not being understood.\\\" (No.3).\\u003c/p\\u003e \\u003cp\\u003e\\\"I didn't even know what world I was in, I was confused also fighting with myself, I wanted to get rid of the person who was pressing on my legs and grabbing my things...I was angry.\\\" (No.7).\\u003c/p\\u003e \\u003cp\\u003eNegative work attitudes of medical staff can also make patients in ED feel angry and suspicious and distrustful of medical staff.\\u003c/p\\u003e \\u003cp\\u003e\\\"I see the nurses being impatient with me, not taking me seriously and even laughing at me, which makes me even more angry and makes me feel that they are not going to treat me properly.\\\"(No.6).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 3 shame and guilt\\u003c/strong\\u003e \\u003cp\\u003eSome participants mentioned experiencing feelings of shame, embarrassment, and guilt toward medical staff and family members during ED, which persisted for some time after the end of ED, and in some cases, permanently.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I was trying to go and pull the tubes off me, I didn't want to feel bad, I knew they were all doing it for my own good, I couldn't help it I felt guilty. \\\" (No.8).\\u003c/p\\u003e \\u003cp\\u003e\\\"I don't remember much...I was listening to my daughter later telling me about some of my behavior at the time and I was embarrassed and to this day I feel ashamed.\\\"(No.14).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 4 neutrality and agitation\\u003c/strong\\u003e \\u003cp\\u003ePatients experiencing positive audio-visual hallucinations during episodes of ED exhibited either a neutral mood or no discomfort, and, in some cases, exhibited agitation and euphoria.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I didn't feel anything at the time, I was very much at home playing cards with my friends.\\\" (No.4).\\u003c/p\\u003e \\u003cp\\u003e\\\"I heard my grandchildren calling out to me, I thought I was at home with my grandchildren and had no (mood) swings.\\\"(No.9).\\u003c/p\\u003e \\u003cp\\u003ePatients may feel agitated if they think they have a strong power or that the experience is unreal .\\u003c/p\\u003e \\u003cp\\u003e\\\"I was thinking that I had gained a superpower and was able to fly in the sky, and I saw my partner whom I hadn't seen for a long time and I knew in my heart that it was unreal, so I didn't have a burden on my mind...and felt excited, I missed her. \\\"(No.10).\\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme 3: various strategies for managing ED\\u003c/h2\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 1 negative coping\\u003c/strong\\u003e \\u003cp\\u003eThe patient will try to forget the event by avoiding talking about it with others or recalling it by adopting silence, avoidance, or changing the topic of conversation about some specific experience of ED.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I don't want to think back on what happened then, it's all in the past. That dream was too tiring.\\\" (No.1).\\u003c/p\\u003e \\u003cp\\u003e\\\"I can't remember... (Silence) My brain turns on like a defense mechanism, he always avoids me to recall this thing, I want to forget this bad experience and I don't want others to know about it.\\\" (No.6).\\u003c/p\\u003e \\u003cp\\u003ePatients take steps to avoid the reoccurrence of ED, such as avoiding returning to the hospital where the experience of ED occurred and refraining from the use of psychotropic medications.\\u003c/p\\u003e \\u003cp\\u003e\\\"I'm embarrassed that this happened, I'm afraid to face these medical staff, I won't come back to this hospital in order to not have this happen again. \\\"(No.14).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 2 positive coping\\u003c/strong\\u003e \\u003cp\\u003eSome patients will try to get specifics of the experience by talking to others to rationalize their behavior and be more open about the experience.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I got them [family members] to give me the whole story, that I was repeating a movement with my hands all the time, and that I should have been planting a seed, I can think of it now. I also saw my old partner. I probably miss that time so much that I did that.\\\" (No.10).\\u003c/p\\u003e \\u003cp\\u003e\\\"My son told me that I had a urinary catheter and the doctor explained to me that having a urinary catheter meant that I wanted to relieve myself all the time, that's why I was in such a hurry to run to the toilet.\\\" (No.5).\\u003c/p\\u003e \\u003cp\\u003eSome patients also sought to identify the causes of postoperative delirium through various means, such as age, anesthetic medications, and disease factors.\\u003c/p\\u003e \\u003cp\\u003e\\\"I heard that this (ED) usually occurs in senior patients, and I'm still relatively young, ah, so I'm looking for the reasons why it happened to me, could it be the anesthesia medication, and I'm so afraid that I'm going to fall into that again. situation where I can't control myself.\\\" (No.15).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme 4: outcomes of experiencing ED\\u003c/h2\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 1 different abilities to recall the experience of ED\\u003c/strong\\u003e \\u003cp\\u003eThe patients' recollections of the beginning and end of emergence delirium (ED) differed from the actual situation, and there was a partial lack of their own verbal expressions and behaviors. Furthermore, some participants reported that their memories of events occurring during the period of ED were absent.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I can't remember where I've been after my surgery (scratching my hair) ...I have a bit of a vague recollection of being in a hospital bed with my relatives watching over me and being groggy...I went back to sleep. By the time I was fully aware that I was in the hospital it was the next day.\\\" (No.2).\\u003c/p\\u003e \\u003cp\\u003e\\\"I can't remember at all what happened then, I just listened to them later on telling me some of the things I was doing, and I tried to think back, and I can't remember anything.\\\" (No.12).\\u003c/p\\u003e \\u003cp\\u003eNo concept of how long the ED lasted.\\u003c/p\\u003e \\u003cp\\u003e\\\"I don't know how long I was like this (ED), I forget.\\\" (No.6).\\u003c/p\\u003e \\u003cp\\u003eSome interviewees were concerned about their memory becoming worse and affecting their postoperative cognitive functioning.\\u003c/p\\u003e \\u003cp\\u003e\\\"My memory has become very bad, I always lose things, will I be like this afterward oh (sigh).\\\" (No.7).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 2 damaged self-esteem and long-term shame\\u003c/strong\\u003e \\u003cp\\u003eSome interviewees mentioned that the experience of ED had damaged their self-esteem and undermined the social and family image they had built up.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"I've lived to this age, I'm a language teacher, and for so many years both in front of my pupils and my family I've been very reasonable, but I was at the time when I was completely unable to control my own I always wanted to pull out the tubes on my body, and I couldn't listen to anyone's advice, and I even begged them... I feel so ashamed just thinking about it.\\\" (No.8).\\u003c/p\\u003e \\u003cp\\u003e\\\"I can't remember exactly what I did, but my daughter described me up to me like a completely unreasonable shrew, yelling at the top of my lungs, and my fellow patients didn't get a good night's rest, which made me feel so embarrassed.\\\" (No.14).\\u003c/p\\u003e \\u003cp\\u003eA very small number of interviewees mentioned that the experience had left them in a permanent state of shame and caused a psychological burden.\\u003c/p\\u003e \\u003cp\\u003e\\\"I cared a lot about what people thought of me, my family, friends, and especially my colleagues were there at the time, but this time my image was completely turned upside down, and the thought that I would have to face them in the future, with my face lost, I was always under a lot of pressure, and the psychological pressure was So much (tears).\\\" (No.15).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 3 fear of reoccurrence and fear of the impact on the prognosis of the disease\\u003c/strong\\u003e \\u003cp\\u003eSome patients mentioned that they still felt a lot of anxiety and fear after the end of ED and\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003ewere afraid that it would happen again.\\u003c/p\\u003e \\u003cp\\u003e\\\"I don't dare to go to the hospital, I always feel that someone in the hospital is trying to kill\\u003c/p\\u003e \\u003cp\\u003eme, that feeling of dying is too real, I'm afraid that that experience will happen again.\\\" (No.11).\\u003c/p\\u003e \\u003cp\\u003ePatients felt that ED delayed their hospitalization and adversely affected their disease prognosis.\\u003c/p\\u003e \\u003cp\\u003e\\\"I got better after a long sleep, all my patients who had surgery in the same time frame as me were discharged and I'm still here, I'm getting better a little slower and I'm more worried that this experience is going to make my disease worse.\\\" (No.13).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme 5: the need for healthcare management in the face of ED\\u003c/h2\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 1 the desire for companionship and psychological support from family members\\u003c/strong\\u003e \\u003cp\\u003ePatients desire family interaction and companionship while in the PACU in order to seek a sense of familiarity and security.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"After the operation it was as if I had been sent to a place that was not a ward, with my hands tied up, I kept looking for my partner, and the nurses wouldn't listen to me, and I wished that a family member would stay with me, and talk to me. \\\" (No.3).\\u003c/p\\u003e \\u003cp\\u003e\\\"After that experience I had a higher need for family companionship, I didn't want to face that fear alone.\\\" (No.1).\\u003c/p\\u003e \\u003cp\\u003eThe patient mentioned wanting to seek treatment with a psychologist for positive psychological support.\\u003c/p\\u003e \\u003cp\\u003e\\\"I seem to have a disease in my mind, I am under a lot of psychological stress, I would like to see a psychologist for psychological counseling and support.\\\" (No.15).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSubtheme 2 weakness of the support system, the desire to receive clear explanations and continued attention\\u003c/strong\\u003e \\u003cp\\u003eThe patient wanted a clear explanation from medical staff about ED.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\\"What happened during that time was a blank for me. Was my brain damaged? I am not sure. I hope the doctor can give me a clear explanation.\\\" (No.12).\\u003c/p\\u003e \\u003cp\\u003eThe patient was unsure if the experience of ED would have an impact on later life and would like to have ongoing attention from medical staff.\\u003c/p\\u003e \\u003cp\\u003e\\\"I see that my fellow patients have been discharged from the hospital and I am a little bit worried if it is a result of this experience, and if this (ED) will have an impact on all of my life in the future, and I would like to have a doctor who keeps an eye on my condition. \\\" (No.13).\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eCurrently, there are fewer studies on ED in adults at home and abroad, with inconsistent nomenclature, different onset times for definitions, and inconsistent diagnostic criteria \\u003csup\\u003e[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e, and how to more accurately identify and manage ED is a key and difficult issue. This study shows that ED is characterized by positive and negative audiovisual hallucinations, temporal and spatial disorientation, behavioral abnormalities and expressive disorders, and situational disorientation. Meanwhile, ED can appear in three different forms: high-activity, low-activity, and mixed forms. In this study, low-activity ED appeared to be more common in elderly patients, which may be related to the residual anesthetic drugs, the occurrence of awakening agitation in patients after radical surgery for lung cancer, or moderate to severe pain with additional analgesic and sedative drugs. Some studies have shown that low-activity ED is often overlooked, thus delaying timely treatment \\u003csup\\u003e[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e. As the PACU is a high prevalence site for ED, anesthesiologists and nurse anesthetists should actively enhance dynamic assessment of patients at the time of admission to the PACU, and in terms of screening tools, the ESA guidelines \\u003csup\\u003e[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e recommend the use of the Nu-DESC or the Confusion Assessment Method (CAM) for assessment in the PACU. CAM) for assessment. In addition, the 4-item Rapid Diagnostic Protocol for Delirium (the 4 'A's Test, 4AT) and Nu-DESC are highly recommended for identifying low-activity EDs.Also, delirium screening should be performed in all high-risk patients prior to discharge from the PACU \\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. However, there is still a gap between clinical attitudes and practices of anesthesiologists and nurses regarding the management of ED. A survey of 243 anesthesiologists and 213 anesthesiology nurses in China on their knowledge, beliefs and behaviors regarding ED in adults showed that the healthcare team has a high awareness of the importance of ED in adults, however, the specific practices in routine delirium assessment, depth of anesthesia monitoring, and standardized treatments still need to be improved \\u003csup\\u003e[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e, In addition, the study mentioned that anesthesiologists and nurses preferred to use clinical observation to diagnose ED in the context of delirium assessment. to diagnose ED using clinical observation, which may lead to high failure rate and invalid diagnosis \\u003csup\\u003e[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e. In the PACU, nurses, as bedside caregivers, are able to identify the predisposing factors for the development of ED and changes in mental status and behavior of patients at an early stage. It is recommended that anesthesia nurses in the PACU should pay attention to the characteristic manifestations of ED in patients, use scientific screening tools for precise identification and management of ED, and implement interventions early to reduce or avoid the series of complications caused by ED. Evidence-based guidelines recommend the establishment of a multidisciplinary management team to standardize the delirium management process \\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, clinical practice can be based on evidence-based guidelines, adopt a multidepartmental and multidisciplinary collaborative approach to establish a standardized management process for the prevention, assessment, and treatment of ED, and multidimensional ED interventions, with the aim of improving patient prognosis.\\u003c/p\\u003e \\u003cp\\u003eIn this study, patients' ability to recall their ED experiences varied, and most of them had partial deficits in their verbal expressions and behaviors, were burdened with varying degrees of negative emotions and uncertainty about the disease, and feared that delirium would recur, and even a small number of patients were more reticent throughout the interviews, fell into a chronic sense of shame, and were depressed, which seriously reduced the quality of life of the patients, which is in line with the findings of Schmitt \\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e, Claesson \\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e and other research results are basically consistent. Healthcare professionals can use specific scales to screen patients for emotional conditions and psychological problems, utilize positive psychology interventions such as cognitive-behavioral therapy \\u003csup\\u003e[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e, positive mindfulness stress reduction therapy \\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/sup\\u003e, and early psychological interventions \\u003csup\\u003e[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e for patients with psychological disorders after experiencing an ED, and combine them with the developmental trajectory of ED, pay attention to the patient's inner feelings, and provide patients with personalized interventions and emotional support, establish positive psychological resources to enhance patients' quality of life, encourage positive self-perception, and improve patients' negative emotions. In addition, respondents in this study mentioned wanting family interaction and companionship in the PACU to seek a sense of security and familiarity. It has been reported in the literature that the incidence of ED is higher than the incidence of postoperative POD \\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e, which may be related to the more closed environment of the PACU, especially the absence of family members, the high noise level of the cardiac monitor, and the stimulation of lights. Studies have also found that family involvement is strongly associated with the quality of care for patients with delirium \\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e. It is recommended that PACU healthcare professionals improve the comfort of the environment, actively encourage family participation in the ED care process, or integrate smart care technology, integrate cloud-based family accompaniment, and provide personalized humanistic care to help patients adapt to the environment, shorten the duration of ED, and improve patients' family and social support.\\u003c/p\\u003e \\u003cp\\u003eIn this study, the respondents' ways of coping with ED included negative coping (e.g., ways of avoiding memories, talking about it, and going to the same hospital) and positive coping (rationalizing their own behaviors, actively searching for the causes of ED occurrence, etc.), and the desire to receive clear explanations and continuous attention from healthcare professionals for the occurrence of ED was related to their fear of ED recurrence and its impact on disease prognosis. Studies have shown that the occurrence of ED is influenced by a variety of factors; advanced age, cognitive dysfunction, malnutrition, and other self-basic states are intrinsic to delirium, and pain, infection, and the duration of surgery are predisposing factors to delirium \\u003csup\\u003e[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e. In the case of patients undergoing radical lung cancer surgery, prolonged intraoperative one-lung ventilation is also a cause of ED. Literature reports that the duration of intraoperative single-lung ventilation is positively correlated with its effect on blood circulation, and at the same time, there are more chances of pulling the patient's lungs and pleura during the operation process, which results in vagus nerve stimulation response and affects the oxygen supply to the patient's brain, and then leads to the occurrence of ED \\u003csup\\u003e[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e. This suggests that during the perioperative process, the surgical team (surgeons, nurses, anesthesiologists) need to refine their professional knowledge and skills and make adequate preoperative preparations with a view to shortening the duration of the operation, reducing the duration of intraoperative single-lung ventilation, and decreasing the likelihood of infection. At the same time, pain management for patients undergoing radical lung cancer surgery should be improved, and multimodal personalized analgesia should be adopted, including thoracic paravertebral nerve block and postoperative self-control analgesic pumps, to reduce the possibility of ED and improve the overall prognosis of patients. In addition, studies have shown that elderly patients who develop postoperative delirium have a greater decline in activities of daily living and a higher 36-month mortality rate \\u003csup\\u003e[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, positive psychological guidance should be provided to patients with ED so that they can correctly cope with the occurrence of ED. At the same time, by further promoting \\\"Internet\\u0026thinsp;+\\u0026thinsp;Nursing Service\\\", using small programs, APP, WeChat or telephone, etc., to provide professional continuity support for patients discharged from the hospital home after surgery, to guide patients in their daily lives, and to meet the needs of patients with more than one degree of continuity of disease management.\\u003c/p\\u003e \\u003cp\\u003eIn this study, we explored the real experience of ED occurrence in postradical lung cancer patients through board-structured in-depth interviews, and refined five themes: perceived barriers when ED occurs, emotions in the face of ED, the impact of ED on oneself, and the help one would like to receive. It is suggested that the characteristic manifestations of ED need to be emphasized, dynamically assessed, and accurately identified and managed when caring for postradical lung cancer patients who experience ED. At the same time, we should pay attention to patients' inner feelings and provide personalized intervention and emotional support. It is also necessary to pay attention to the way patients cope with ED and provide effective information support to improve their prognosis. The limitation of this study is that it only focuses on patients after radical lung cancer surgery, and the study population can be subsequently expanded to strengthen the focus on other post-surgical patients, their primary caregivers, and healthcare teams, so as to provide more effective and comprehensive support and guidance for the standardized management of ED.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e \\u003cp\\u003e This study was supported by the Ethics Committee of the Affiliated Hospital of Southwest Medical University and received ethical approval (Approval No. KY2024439).All participants provided written informed consent to participate and were able to withdraw their participation without any disadvantage. The study was conducted in accordance with the Declaration of Helsinki.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e \\u003cp\\u003eNot available.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e \\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003eThis study was supported by the Luzhou Science and Technology Bureau Key Research and Development Project (Project No. 2022-SYF-91). The Luzhou Science and Technology Bureau Key Research and Development Project has no role in the design of this study, data collection, analysis of data, interpretation of data and dissemination of findings.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eTY.Y was responsible for conceptualization, data collection, data management, data analysis, first draft of manuscript, and manuscript writing, review and editing. She was major contributor in writing the manuscript. QL was responsible for data collection, data management, data analysis, and manuscript writing. TY.Y was responsible for data analysis, and manuscript writing. QL was responsible for conceptualization, data collection, and manuscript writing. YF and JW were responsible for conceptualization, and manuscript writing. All authors read an approved the final manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e \\u003cp\\u003eWe express our heartfelt gratitude to all the participants for sharing their genuine experiences and feelings. We also thank the Department of Thoracic Surgery at the Affiliated Hospital of Southwest Medical University for providing the interview venue.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eData is provided within the manuscript information files\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eHAN B, ZHENG R, ZENG H, et al. Cancer incidence and mortality in China, 2022[J]. Journal of the National Cancer Center, 2024, 4(1): 47-53. DOI:10.1016/j.jncc.2024.01.006.\\u003c/li\\u003e\\n\\u003cli\\u003eBAO T, XIAO F, LIU D, et al. Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus [ J]. Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer, 2018, 21(1): 24-31. DOI:10.3779/j.issn.1009-3419.2018.01.04.\\u003c/li\\u003e\\n\\u003cli\\u003eREMON J, SORIA J C, PETERS S, et al. Early and locally advanced non-small-cell lung cancer: an update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy[J]. Annals of Oncology: Official Journal of the European Society for Medical Oncology, 2021, 32(12): 1637-1642. DOI:10.1016/j.annonc.2021.08.1994.\\u003c/li\\u003e\\n\\u003cli\\u003eWEI W, ZHENG X, GU Y, et al. Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: a randomized-controlled trial[J]. BMC anesthesiology, 2022, 22(1): 1. DOI:10.1186/s12871-021-01532-1.\\u003c/li\\u003e\\n\\u003cli\\u003eJEONG D M, KIM J A, AHN H J, et al. Decreased Incidence of Postoperative Delirium in Robot-assisted Thoracoscopic Esophagectomy Compared With Open Transthoracic Esophagectomy[J]. Surgical Laparoscopy, Endoscopy \\u0026amp; Percutaneous Techniques, 2016, 26(6): 516-522. DOI:10.1097/SLE.0000000000000356.\\u003c/li\\u003e\\n\\u003cli\\u003eMIYATA R, OMASA M, FUJIMOTO R, et al. Efficacy of Ramelteon for delirium after lung cancer surgery[J]. Interactive Cardiovascular and Thoracic Surgery, 2017, 24(1): 8-12. DOI:10.1093/icvts/ivw297.\\u003c/li\\u003e\\n\\u003cli\\u003eHESSE S, KREUZER M, HIGHT D, et al. Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications[J]. British Journal of Anaesthesia, 2019, 122(5): 622-634. DOI:10.1016/j.bja.2018.09.016.\\u003c/li\\u003e\\n\\u003cli\\u003eLIU X, WANG Y, WU J, et al. Emergence delirium and postoperative delirium associated with high plasma NfL and GFAP: an observational study[J]. Frontiers in Medicine, 2023, 10: 1107369. DOI:10.3389/fmed.2023.1107369.\\u003c/li\\u003e\\n\\u003cli\\u003eZHANG Y, HE S T, NIE B, et al. Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study[J]. Journal of Anesthesia, 2020, 34(5): 675-687. DOI:10.1007/s00540-020-02805-8.\\u003c/li\\u003e\\n\\u003cli\\u003eChinese Society of Geriatrics, Anesthesiology Branch. Expert consensus on the prevention and treatment of postoperative delirium in elderly patients in China[J]. International Journal of Anesthesiology and Resuscitation,2023,44(1):1-27. DOI:10.3760/cma.j.cn321761-20220915-10005.\\u003c/li\\u003e\\n\\u003cli\\u003eSAUNDERS B, SIM J, KINGSTONE T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization[J]. Quality \\u0026amp; Quantity, 2018, 52(4): 1893-1907. doi:10.1007/s11135-017-0574-8.\\u003c/li\\u003e\\n\\u003cli\\u003eLIU M .Application of Colaizzi\\u0026apos;s seven steps in phenomenological research data analysis[J]. Journal of Nursing Science,2019,34(11):90-92. LIU M. Using an example to illustrate Colaizzi\\u0026apos;s phenomenological data analysis method[J]. Nursing Science,2019,34(11):90-92.\\u003c/li\\u003e\\n\\u003cli\\u003eYANG Y, FENG L, JI C, et al. Inhalational Versus Propofol-based Intravenous Maintenance of Anesthesia for Emergence Delirium in Adults: a Meta-analysis and Trial Sequential Analysis[J]. Journal of Neurosurgical Anesthesiology, 2023, 35(2): 177-186. DOI:10.1097/ANA.0000000000000830.\\u003c/li\\u003e\\n\\u003cli\\u003eALDECOA C, BETTELLI G, BILOTTA F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium [ J]. European Journal of Anaesthesiology, 2017, 34(4): 192-214. doi:10.1097/eja.0000000000000594.\\u003c/li\\u003e\\n\\u003cli\\u003eYUAN Y, LEI B, LI Z, et al. A Cross-Sectional Survey on the Clinical Management of Emergence Delirium in Adults: Knowledge, Attitudes, and Practice in Mainland China[J]. Brain Sciences, 2022, 12(8): 989. DOI:10.3390/brainsci12080989.\\u003c/li\\u003e\\n\\u003cli\\u003eDEVLIN J W, MARQUIS F, RIKER R R, et al. Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside[J]. Critical Care (London, England), 2008, 12(1): R19. DOI:10.1186/cc6793.\\u003c/li\\u003e\\n\\u003cli\\u003eSOSNOWSKI K, LIN F, CHABOYER W, et al. The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: a systematic review and meta-analysis[J]. International Journal of Nursing Studies, 2023, 138: 104410. doi:10.1016/j.ijnurstu.2022.104410.\\u003c/li\\u003e\\n\\u003cli\\u003eZAMOSCIK K, GODBOLD R, FREEMAN P. Intensive care nurses\\u0026apos; experiences and perceptions of delirium and delirium care[J]. Intensive and Critical Care Nursing, 2017, 40: 94-100. doi:10.1016/j.iccn.2017.01.003.\\u003c/li\\u003e\\n\\u003cli\\u003eCLAESSON LINGEHALL H, SMULTER N, OLOFSSON B, et al. Experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium : one year follow-up[J]. BMC nursing, 2015, 14: 17. DOI:10.1186/s12912-015-0069-7.\\u003c/li\\u003e\\n\\u003cli\\u003eShi Yuxia,Song Jingchao. Effects of nursing intervention based on cognitive behavioral therapy on delirium and negative emotions after radical thoracoscopic lung cancer surgery in the elderly[J]. Henan Medical Research,2023,32(18):3443-3449. DOI:10.3969/j.issn.1004-437X.2023.18.050.\\u003c/li\\u003e\\n\\u003cli\\u003eDING Meng,ZHU Xia,WANG Xiaoyan,et al. Effects of positive thought behavior training on negative emotions and coping styles of advanced lung cancer patients[J]. Medical Clinical Research,2018,35(11):2284-2286. DOI:10.3969/j.issn.1671-7171.2018.11.080.\\u003c/li\\u003e\\n\\u003cli\\u003eWANG Minghong,LU Dan,CHEN Ming,et al. Effects of early psychological intervention on delirium and mental health after orthopedic surgery in elderly patients[J]. International Journal of Psychiatry,2019,46(3):533-536.\\u003c/li\\u003e\\n\\u003cli\\u003eGU W J, ZHOU J X, JI R Q, et al. Incidence, risk factors, and consequences of emergence delirium after elective brain tumor resection[J]. The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 2022, 20(5): e214-e220. DOI:10.1016/j.surge.2021.09.005.\\u003c/li\\u003e\\n\\u003cli\\u003eOXENB\\u0026Oslash;LL-COLLET M, EGEROD I, CHRISTENSEN V, et al. Nurses\\u0026apos; and physicians\\u0026apos; perceptions of Confusion Assessment Method for the intensive care unit for delirium detection: focus group study[J]. Nursing in Critical Care, 2018, 23(1): 16-22. doi:10.1111/nicc.12254.\\u003c/li\\u003e\\n\\u003cli\\u003eWU J, GAO S, ZHANG S, et al. Perioperative risk factors for recovery room delirium after elective non-cardiovascular surgery under general anaesthesia [ J]. Perioperative Medicine (London, England), 2021, 10(1): 3. DOI:10.1186/s13741-020-00174-0.\\u003c/li\\u003e\\n\\u003cli\\u003eLU Y, LIU X. Postoperative delirium and its influencing factors in elderly patients with lung cancer in the intensive care unit[J]. Journal of Thoracic Disease, 2023, 15(2): 701-710. DOI:10.21037/jtd-23-259.\\u003c/li\\u003e\\n\\u003cli\\u003eLIU Wei,GUAN Dandan,ZHANG Hongyan. Establishment and evaluation of a column-line diagram model of delirium occurrence after thoracoscopic radical resection in elderly lung cancer patients[J]. Modern Oncology Medicine,2024,32(6):1054-1059. DOI:10.3969/j.issn.1672-4992.2024.06.012.\\u003c/li\\u003e\\n\\u003cli\\u003eLU Jian, ZHOU Hongmei. Postoperative delirium is related to the long-term decline of activities of daily living[J]. Natl Med J China, 2020, 100(36): 2845. LU J, ZHOU H M. Postoperative delirium is related to the long-term decline of activities of daily living[J]. Natl Med J China, 2020, 100(36): 2845.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"lung cancer, emergence delirium, real experience, qualitative study\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6854883/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6854883/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e \\u003cb\\u003eBackground\\u003c/b\\u003e This study employs a interpretative phenomenological approach to explore the real experience of emergence delirium (ED) in patients following radical lung cancer surgery, a common and complex postoperative complication in the post-anesthesia care unit.Despite the prevalence and impact of ED in this specific patient population, the real experience of ED has not been extensively explored. There is a paucity of research on the coping mechanisms employed by patients and the support they require.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eDesign\\u003c/b\\u003e Phenomenological study using half-standardized interviews.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eMethods\\u003c/b\\u003e Interpretive phenomenological research methods were used to interview postradical lung cancer patients with ED in a tertiary-level hospital in Sichuan Province through purposive sampling, and the Colaizzi 7-step analysis method was utilized to conduct a thorough analysis of the interview data.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eResults\\u003c/b\\u003e Nine of the 15 interview subjects were male and six were female. After analyzing the interview content, five main themes and 15 subthemes were distilled: profound experience of perceptual disorders in the face of ED, positive and negative emotions in the face of ED, various strategies for managing ED, outcomes of experiencing ED, and the need for healthcare management in the face of ED.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eConclusion\\u003c/b\\u003e It is necessary to pay attention to the symptoms and needs of ED that occur in patients after radical lung cancer surgery, and healthcare staff should actively monitor and take measures to actively respond to them, help patients improve their self-coping skills, reduce the incidence of ED, mitigate cognitive impairment, strengthen medical support, and promote the early recovery of patients.\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003eTrail registration\\u003c/b\\u003e This study was approved by the ethics committee of the affiliated hospital of southwest medical university, with the approval number: KY2024439.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\",\"manuscriptTitle\":\"the real experience and coping styles of emergence delirium in patients after radical lung cancer surgery: A qualitative study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-06-25 10:28:23\",\"doi\":\"10.21203/rs.3.rs-6854883/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"f831b4e1-584e-4959-a3e8-42cc78cc8755\",\"owner\":[],\"postedDate\":\"June 25th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-12-24T12:09:48+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-06-25 10:28:23\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6854883\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6854883\",\"identity\":\"rs-6854883\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}