Ways of understanding cognitive impairment in cardiac arrest survivors: A phenomenographic study.

AIM:To describe the variation in ways that registered nurses perceive and understand cognitive impairment in cardiac arrest survivors. DESIGN:A qualitative, inductive design with individual semi-structured interviews was applied. Data was analysed using a phenomenographic approach. SETTING:The participants were nineteen Swedish registered nurses, experienced in cardiovascular care and providing follow-up care. FINDINGS:The nurses perceived the cognitive impairment of the survivors in qualitatively different ways, as illustrated in two categories: 'The perceptible and obvious' and 'The elusive and challenging'. The nurses perceived a variety of signs of cognitive impairment, emotional expressions related to these, and recovery from cognitive impairment. They perceived confidence in capturing cognitive function when they understood the signs of cognitive impairment as severe and obvious. However, it was perceived as difficult to assess cognitive function when impairments were subtle, resulting in uncertainty in terms of how to make assessments. Nurses made use of their own strategies for assessments, which were sometimes found to be inadequate when they understood that they had misinterpreted the survivors' cognitive impairment. CONCLUSION:Nurses feel uncertainty regarding detecting mild impairment in cardiac arrest survivors. By involving next of kin, nurses will gain a broader understanding of survivors' cognitive function.