Individualized Nursing Care and Frailty Outcomes in Cardiac Surgery

Primary outcomes

1. Cognitive Function - Standardized Mini-Mental State Examination (MMSE)

   Time frame: Postoperative day 1 and the day of discharge

   Cognitive status will be assessed using the Standardized Mini-Mental State Examination (MMSE). The MMSE evaluates orientation, memory, attention, recall, language, and visuospatial skills. The total score ranges from 0 to 30, with higher scores indicating better cognitive function. Scores of 23 or below are generally considered indicative of cognitive impairment.

2. Cognitive Function - Delirium Risk - Nursing Delirium Screening Scale (Nu-DESC)

   Time frame: Postoperative day 1 and the day of discharge

   Delirium risk will be evaluated using the Nursing Delirium Screening Scale (Nu-DESC). The scale assesses five domains: disorientation, inappropriate behavior, inappropriate communication, hallucinations, and psychomotor retardation.

   Each symptom is scored per shift as follows:

   0 points: Symptom absent, 1 point: Symptom present/mild, 2 points: Symptom present and pronounced/severe A total score of 2 points or higher is considered indicative of delirium.

3. Physical Status Assessment - Pain Level - Numeric Rating Scale (NRS)

   Time frame: Postoperative day 1 and the day of discharge

   Pain Level - Numeric Rating Scale (NRS): Pain intensity will be assessed using the Numeric Rating Scale (NRS). Patients rate their pain from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate greater pain intensity.

4. Physical Status Assessment - Katz Activities of Daily Living (ADL) Scale

   Time frame: Postoperative day 1 and the day of discharge

   Katz Activities of Daily Living (ADL) Scale: Functional status will be evaluated using the Katz Activities of Daily Living (ADL) Scale, which assesses independence in six activities: bathing, dressing, toileting, transferring, continence, and feeding. Higher scores indicate greater independence in daily activities.

   Evaluation of the scale is based on the total score obtained from these items:

   0-6 points: Dependent, 7-12 points: Partially dependent, 13-18 points: Independent.

5. Physical Status Assessment - Itaki Fall Risk Scale

   Time frame: Postoperative day 1 and the day of discharge

   Itaki Fall Risk Scale: The Itaki Fall Risk Scale will be used to evaluate patients' risk of falling. The scale assesses various risk factors related to falls in hospitalized patients. The scale consists of 19 risk factors that may contribute to patient falls. The risk factors are categorized as major and minor, with 1 point assigned for each minor risk factor and 5 points for each major risk factor. Based on the total score obtained from evaluating all risk factors, two risk levels are defined: 0-4 points: Low risk, 5 points and above: High risk.

6. Nutritional Status - Mini Nutritional Assessment Short Form (MNA-SF)

   Time frame: Postoperative day 1 and the day of discharge

   Mini Nutritional Assessment Short Form (MNA-SF): Nutritional status will be assessed using the Mini Nutritional Assessment-Short Form (MNA-SF). The total score ranges from 0 to 14, with higher scores indicating better nutritional status.

7. Psychological Status Assessment - Geriatric Depression Scale (GDS)

   Time frame: Postoperative day 1 and the day of discharge

   Geriatric Depression Scale-15 (Short Form): It is a scale used to screen for depression in older adults. The total score ranges from 0 to 15. Scores of 0-4 indicate no depression, 5-8 indicate mild depression, 9-11 indicate moderate depression, and 12-15 indicate severe depression.