Nurses' perceptions and experiences of paediatric emergence delirium in the post-anaesthesia care unit: an interpretative qualitative study

Aim: To explore post-anaesthesia care unit nurses' perceptions and experiences in managing paediatric emergence delirium, and to understand their experiences in implementing the Cornell Assessment of Paediatric Delirium—Traditional Chinese version tool in clinical practice following delirium-focused education. Methods: This interpretive qualitative study involved 20 nurses in the post-anaesthesia care unit from a medical centre hospital in Taiwan who participated in small group interviews after completing delirium-focused education. Data were collected through semi-structured interviews between October and December 2024 and analysed using a thematic analysis approach. Findings: Five main themes were identified: (1) First impressions and reflexive actions during emergence delirium, (2) Clinical interpretation through observation and elimination, (3) The dual role of parents in emergence delirium management, (4) Negotiating trust and learning with the delirium screening tool and (5) System-level needs and recommendations. Nurses described the chaotic and emotionally charged nature of emergence delirium episodes, the intuitive yet uncertain interpretive work they performed, the complex influence of parental presence, evolving trust in structured assessment tools and systemic barriers that hindered timely emergence delirium recognition. Conclusion: Nurses face complex clinical, emotional and relational challenges in managing paediatric emergence delirium. Embedding delirium awareness into practice requires sustained training, screening integration and proactive parental engagement. Implications for Profession and Patient Care: Findings highlight the need for integrating delirium screening into post-anaesthesia care routines, the need for ongoing education and preparing parents for emergence delirium scenarios to enhance care delivery and safety.