TESTING A NURSE-GUIDED SLEEP HYGIENE PROTOCOL VERSUS USUAL CARE FOR PREVENTING HOSPITAL-ACQUIRED DELIRIUM IN OLDER INPATIENTS: A COMPARATIVE TRIAL

Abstract

Background: Hospital-acquired delirium is a frequent and serious complication among older inpatients, associated with adverse clinical and functional outcomes. Sleep disruption is a well-recognized yet modifiable risk factor in the hospital environment. Pharmacological sleep aids are often limited in older adults due to safety concerns, highlighting the need for effective non-pharmacological, nurse-led preventive strategies.

Objective: To determine whether a structured, nurse-guided sleep hygiene protocol reduces the incidence of hospital-acquired delirium among older inpatients compared with usual care.

Methods: A comparative trial was conducted in acute medical wards, enrolling hospitalized adults aged 65 years and older without delirium at admission. Participants were allocated to either a nurse-guided sleep hygiene intervention or usual care. The intervention included environmental modifications, clustering of nighttime care, sleep routine reinforcement, and patient orientation. Delirium was assessed daily using the Confusion Assessment Method, while sleep quality was measured using the Richards–Campbell Sleep Questionnaire. Functional status was evaluated using the Katz Index of Independence in Activities of Daily Living. Group differences were analyzed using independent t-tests and chi-square tests, with correlation analysis examining associations between sleep quality and delirium occurrence.

Results: A total of 80 participants completed the study. Delirium occurred in 15.0% of participants in the intervention group compared with 35.0% in the usual care group (p = 0.043). Mean sleep quality scores were significantly higher in the nurse-guided group (71.4 ± 9.6) than in the usual care group (62.1 ± 11.2; p < 0.001). Better sleep quality was moderately associated with lower delirium incidence (r = −0.46, p < 0.001).

Conclusion: Nurse-guided sleep hygiene was associated with improved sleep quality and reduced hospital-acquired delirium in older inpatients. These findings support the integration of structured, non-pharmacological sleep interventions into routine nursing care to enhance geriatric inpatient outcomes.