Date of Conferral

8-11-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Sandra Wise

Abstract

This Doctor of Nursing Practice (DNP) quality improvement project aimed to identify the need for a consistent sleep-promotion protocol in an adult neurosurgical intensive care unit (NSICU). Disrupted sleep is a frequent problem for patients who are seriously ill and can lead to delirium, longer hospital stays, higher health care expenses, diminished cognitive function, and death. While there was evidence supporting nonpharmacological sleep-promotion and delirium-risk-reduction interventions, they were not consistently implemented at the project site, creating a gap between evidence and clinical practice. The purpose of this project was to implement and evaluate an evidence-based night-shift sleep-promotion bundle. The practice-focused question asked whether implementation of the bundle, compared with usual care, would improve delirium prevention as measured by the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) documentation in adult NSICU patients. A pre- and post-implementation quality improvement design was used. Outcomes were evaluated using CAM-ICU documentation and Richmond Agitation-Sedation Scale (RASS) scores In pre (N = 11) and postimplementation (N = 10) periods, there were no documented positive CAM-ICU assessments, therefore, no quantifiable improvement in delirium documentation was observed. After the implementation, CAM-ICU documentation was more consistent, with opportunities to increase its completeness. Maintaining this practice change will require staff education, leadership support, compliance monitoring, and unit champions to encourage the ongoing use of evidence-based sleep-promoting practices and consistency in documentation.

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