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Introduction of Light, Noise, and Sleep Bundle Protocol to Help Regulate Circadian Rhythms with Reduced Risk of Delirium
Dissertation   Open access

Introduction of Light, Noise, and Sleep Bundle Protocol to Help Regulate Circadian Rhythms with Reduced Risk of Delirium

Whitney Schirm
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: Delirium is a common complication of critical illness associated with increased mortality, prolonged hospitalization, and long-term cognitive impairment. Environmental disruption in the intensive care unit (ICU), including altered light exposure, excessive noise, and sleep interruption, contributes to circadian rhythm disturbance and increased delirium risk. Despite routine screening, many ICUs lack structured nonpharmacologic protocols to address these factors. Purpose: The purpose of this project was to implement and evaluate a Therapeutic Environmental Modulation (TEM) bundle to improve circadian rhythm regulation, reduce ICU-associated delirium, and enhance patient outcomes. Methods: This evidence-based practice project, guided by the Iowa Model, was conducted in a mixed medical-surgical and cardiovascular ICU. The TEM bundle included light management, noise reduction, and sleep hygiene interventions. Data collected included bundle adherence, Intensive Care Delirium Screening Checklist (ICDSC) scores, ICU length of stay (LOS), and nursing self-efficacy surveys. Statistical analyses included a one-sample proportion z-test, independent samples t-tests, and a Mann–Whitney U test. Findings: TEM bundle adherence was 85.8%, significantly exceeding the 70% benchmark (p < .001). Mean ICDSC scores decreased by 9.1% but were not statistically significant (p = .635). ICU LOS increased significantly (p < .001) with a small effect size. Nursing self-efficacy improved modestly (3.95%) but was not statistically significant (p = .335). Discussion: Implementation of a structured environmental modulation bundle is feasible and sustainable in the ICU setting. Although primary outcome targets were not fully achieved, trends toward reduced delirium severity and improved nursing confidence suggest potential clinical benefit. Findings support continued refinement and longer-term evaluation of circadian-focused, nonpharmacologic interventions to improve patient-centered critical care outcomes.
 Patient Safety icu-associated delirium circadian rhythm regulation therapeutic environmental modulation environmental modulation evidence-based practice nurse self-efficacy

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