Date of Conferral

2017

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Dr. Diane Whitehead

Abstract

The aim of this project was to implement and evaluate the effectiveness of the Clear Minds protocol for early detection and prevention of delirium in hospitalized, elderly patients. The protocol was used to monitor for delirium and improve sleep quality by reducing sleep disturbances caused by environmental factors in hospital settings. Due to the risk of delirium for patients in late adulthood, implementation of a delirium-prevention protocol was needed. Upon admission, patients 60 years and older or patients that screened positive for the Brief Confusion Assessment Method (bCAM) were placed on the Clear Minds protocol. The protocol consisted of establishing healthy habits including structured eating, toileting, and sleeping times. Patients were oriented, exposed to light during the day, and had orders to not disturb during the night unless medically necessary. A convenience sample of 100 patients were reassessed using the bCAM every shift. Sleep patterns, morbidity, mortality, and length of hospital stay of patients were examined pre- and post- implementation of the protocol through surveys and aggregate data pulled from the electronic medical record. Results from a 2-sample t-test indicated no difference between the pre- and post- implementation groups, although there was a positive relationship between the use of the protocol by clinical staff nurses and the length and quality of sleep for patients, suggesting that nurses can have a positive impact on sleep patterns of hospitalized patients. The potential for a positive social change will result from nurses using a standardized approach with a validated tool in clinical practice to assess for delirium; intervene with patients predisposed to sleep disturbances; and thereby decrease morbidity, mortality, length of stay, and readmissions.

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