Current Practices and Attitudes of Cardiac Nurses Regarding Cognitive Screening in Patients With Acute Coronary Syndrome

Emma Zhao; Nicole Lowres; Jacqueline Bloomfield; Joseph Weddell; Geoffrey Tofler; Robyn Gallagher

doi:10.1016/j.hlc.2024.01.017

Current Practices and Attitudes of Cardiac Nurses Regarding Cognitive Screening in Patients With Acute Coronary Syndrome

Heart Lung Circ. 2024 Mar 9:S1443-9506(24)00047-7. doi: 10.1016/j.hlc.2024.01.017. Online ahead of print.

Authors

Emma Zhao¹, Nicole Lowres², Jacqueline Bloomfield³, Joseph Weddell⁴, Geoffrey Tofler⁵, Robyn Gallagher⁴

Affiliations

¹ Charles Perkins Centre & Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Electronic address: Emma.Zhao@sydney.edu.au.
² Charles Perkins Centre & Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Heart Research Institute, Sydney, NSW, Australia.
³ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁴ Charles Perkins Centre & Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁵ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.

PMID: 38462415
DOI: 10.1016/j.hlc.2024.01.017

Abstract

Background: Cognitive impairment (CI) is common in patients with acute coronary syndrome (ACS) but is often undetected and may affect recovery and secondary prevention uptake. Nurses play a crucial role providing care for patients with ACS and promoting secondary prevention.

Aim: This study aimed to explore current nursing practices and barriers regarding CI screening in patients with ACS.

Methods: Cardiac nurses were recruited from three metropolitan teaching hospitals and two professional associations in Australia and undertook a 38-question purpose-built survey.

Results: A total of 95 nurses participated (mean age 38±13 years; 78% [n=74] female): 69 were registered nurses, and 48% had received CI training. Only 16% of nurses in our sample reported that they regularly screen for CI, and 23% reported that they never screen; however, 59% believed screening should be part of everyday practice. Nurses mostly screened when ward policy required admission/daily cognitive screening (34%) or when they suspected cognitive problems or decline (39%). Nurses in acute settings (vs non-acute) were nine times more likely to screen when adjusting for confounders. The typically used screening instruments assessed delirium/confusion and dementia but not milder CI. Common barriers to screening included communication difficulties, patients too unstable/unwell, time constraints requiring clinical care prioritisation, and being unaware of patients' normal cognition status.

Conclusions: Screening practices for CI in the context of ACS were found to be suboptimal, with only 16% of nurses in our sample reporting regularly screening. The most used methods focus on screening for delirium. Given current practice, many CI cases will be missed, especially mild CI, which will negatively affect secondary prevention efforts. Further research is required to identify appropriate methods to implement routine screening within the nursing clinical workflow and establish a suitable screening tool.

Keywords: Acute coronary syndrome; Cardiac nurses; Cognitive impairment; Cognitive screening.