The effect of a nurse-led multicomponent intervention on sleep quality and delirium in orthopedic surgery patients: A randomized clinical trial

Abstract

Background

Sleep disturbances and postoperative delirium (POD) impair recovery and adversely affect cognitive and physical outcomes among orthopedic trauma patients.

Objective

This study aimed to evaluate the effects of a nurse-led multicomponent intervention on POD, sleep quality, and quality measures among orthopedic surgical patients.

Method

This double-blind randomized clinical trial was conducted on 96 orthopedic surgical patients who were assigned into intervention (n=48) and control (n=48) groups using stratified block randomization. The intervention group received a multicomponent care program including multimodal pharmacological pain management, music therapy, inspiratory muscle training (IMT), and a structured sleep enhancement protocol, initiated 24 hours before surgery and continued for 48 hours postoperatively. The control group received standard care. Sleep quality and POD were assessed using the richards-campbell sleep questionnaire (RCSQ) and the confusion assessment method (CAM), respectively. The data on length of hospital stay and 30-day mortality were collected through electronic health records and self-reports.

Results

The mean total sleep quality score and its subscales were significantly higher in the intervention group compared to the control group (P < 0.001). The average length of hospital stay was significantly shorter in the intervention group (P = 0.047). There were no statistically significant differences between the two groups regarding the incidence of POD or 30-day mortality (P > 0.05).

Conclusion

Results show, a perioperative multicomponent nurse-led intervention can effectively enhance sleep quality and reduce the length of hospital stay among orthopedic surgical patients. Nevertheless, it did not show a significant effect on delirium incidence or short-term mortality.