Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2020


Doctor of Nursing Practice (DNP)

Primary Advisor

Beverly K. Lunsford, PhD, RN, FAAN; Karen Whitt, PhD, RN, FNP-C, AGN-BC, FAANP


Background: Often occurring after surgery, or hospitalization, the development of delirium in older adults, initiates a cascade of events culminating in loss of independence, increased morbidity and mortality, and high health care costs (Oh, et al., 2017).

Objective: The purpose of this quality improvement (QI) project was to adapt and implement best practices using HELP for managing older patients with postoperative delirium through the existing 1:1 observation structure and implementing cognitive care strategies. The 1:1 sitter roles and responsibilities were redesigned to include non-pharmacological, multicomponent interventions.

Methods: The QI project used a pre-test post-test intervention design comparing groups before and after the intervention measuring: 1) hours of 1:1 care; 2) number of interventions used; 3) patient length of stay; and 4) use of psychotropic drugs. Data was collected using a standard patient checklist and customized reports.

Results: There was a statistically significant difference in the number of observation hours between the pre-(n=32) and post-intervention (n=33) groups (p< .05), with a mean score of 124.1 versus 62.3 hours respectively; a significant difference in length of stay (p<0.05) with a mean score of 142.6 versus 218.9 hours respectively; a significant difference in the number of medications given (p < .001) with a mean score of 0.9 versus 0 respectively; and a significant difference in the number of interventions utilized (p < .001) with a mean score of 4.7 versus 8 respectively.

Conclusions: This project indicated that the adapted non-pharmacologic HELP model interventions resulted in decreased 1:1 sitter hours, overall length of stay and medication use in postoperative delirious patients.

Open Access


Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.