Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Suzanne Burke Lehman


Doctor of Nursing Practice


Background: There is a notable increase in delirium incidence in patients on an orthopedic unit of a large Twin Cities healthcare organization. The Confusion Assessment Method tool is completed upon admission, and staff nurses have a knowledge deficit pertaining to positive baseline results, and the understanding this correlates with patients exhibiting delirium symptomology. The nurses on the orthopedic unit frequently contact the evening cross-cover hospitalist with post-surgical patients experiencing agitation, change in cognition, and adverse events such as falls. Staff nurses and hospitalist providers must appropriately identify early signs or risk factors of delirium to provide proactive measures to prevent it and mitigate adverse events associated with the untoward symptoms (Inouye et al.,2001).

Problem: After conducting an informal discussion on an orthopedic floor of large urban hospital, nursing staff indicated a lack of confidence in appropriately identifying early signs or risk factors of delirium.

Methods: Nonparametric testing was used to compare pre- and post-questionnaire data. Additionally, the Wilcoxon signed rank test was utilized to determine the difference in means between the pre- and posttest questionnaires. The signed rank test utilizing Statistical Analysis Software (SAS) determined the change in nurse comfort level with delirium based on Likert scale questions that was submitted prior to the project implementation and results obtained three weeks post project implementation.

Interventions: A 60-minute nurse educational session on this quality improvement project as well as pertinent information on delirium and accurate assessment of cognitive baseline, including a high-level overview on the use and interpretation of CAM assessment tool results. The intended goal is to provide a structured educational approach to improve nurses' understanding of delirium, the importance of cognitive baseline assessment on admission, and the accurate use and interpretation of the CAM assessment tool to assist with early detection.

Results: Each of the nine Likert scale survey questions were combined for a total confidence score (max score = 18). Per SAS, a Wilcoxon signed rank test indicated that the total post-test confidence scores were significantly higher than the pre-test scores with p=0.0149.

Conclusions: Providing education on delirium and the assessment of a cognitive baseline is associated with increasing orthopedic staff nurse knowledge on these topics. Including importance of the CAM assessment tool and interpretation use as an adjunct with the assessment of delirium. The intent is to reduce the impact of delirium and its adverse events for inpatients of the orthopedic unit.