Judson Smith

Date of Award

2024

Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chair

Lenora Smith

Committee Member

Lucy Tucker

Subject(s)

Sick--Mental health, Delirium--Prevention, Intensive care units, Confusion Assessment Method Short Form

Abstract

Delirium, a debilitating mental illness, poses significant challenges to patients, families, and healthcare systems, particularly among individuals aged 65 and older. This Quality Improvement (QI) project aims to introduce a best practice multicomponent delirium prevention bundle in a step-down Intensive Care Unit (ICU) floor to enhance knowledge, identification, and delirium prevention. Employing Orlando's Theory of the Deliberative Nursing Process, along with multiple Plan-Do-Study-Act (PDSA) cycles over 12 weeks, this project conducted staff education sessions to establish a baseline understanding of delirium identification, risk factors, screening tools, and implementation steps for the prevention bundle. The intervention occurred in a 16-bed step-down ICU trauma floor staffed by registered nurses and care partners. Throughout implementation, staff completed a checklist during each shift, encompassing CAMs score screening and documentation upon admission and every shift, ensuring proper room environment setup, maintaining updated whiteboards, implementing and documenting ambulation as per physical therapy recommendations, and safeguarding the sleep-wake cycle. Post-education sessions, a significant improvement in knowledge was observed (t(21) = 11.92, p < .001). Among 14 patients, high compliance with the delirium prevention bundle was noted (97%). There was no development of delirium cases, and the average CAM score of zero upon admission remained unchanged throughout the stay. These findings underscore the efficacy of delirium education sessions and multicomponent prevention bundles in averting delirium incidents in step-down ICU trauma settings. Ongoing reinforcement of staff knowledge and support are essential for successfully implementing these processes.

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Available for download on Friday, February 06, 2026

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