Date of Award

Spring 6-7-2024

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Erla Champ-Gibson

Faculty Reader


Executive Summary

Executive Summary

Title: Increasing Confidence and Knowledge of Nonpharmacological Interventions Among ICU Nurses Caring for Patients with Agitation due to Traumatic Brain Injury: A Quality Improvement Project

Background and Significance: Among the patient population in the Neuro/Trauma ICU at a level two trauma center in Washington State, patients with Traumatic Brain Injuries are typical. Management of the patient diagnosed with a TBI in the critical care (ICU) setting is complex, given the unique behavioral alterations from the injury. Agitation is often a common symptom displayed by approximately seventy percent of patients recovering from a TBI in the ICU. Agitation complicates the treatment of the TBI patient even further as there is often no clear underlying cause. Appropriate management of agitation requires specialized care, which is often limited to the Neuro/Trauma critical care setting.

Problem and Purpose Statement: Multiple studies report a need for more consistency in protocols and education specifically focused on nonpharmacological intervention to alleviate agitation symptoms in patients diagnosed with a TBI. Sufficient evidence supports the effectiveness of education aimed explicitly at nonpharmacological intervention to assist ICU nurses caring for patients with a TBI. The primary aim of this program is to determine whether knowledge and confidence increase among Neuro/Trauma trained ICU nurses after participation in a training program specifically focused on nonpharmacological interventions to alleviate agitation in a patient diagnosed with a Traumatic Brain Injury.

Methods: An educational TBI program and identical pretest and posttest questions were developed from published or validated resources and test questions. Concepts covered in the program included an overview of a TBI, the expectation of a thorough neurological exam, medications used for treatment in the ICU, symptoms of varying stages of agitation, early intervention to alleviate agitation, nonpharmacological techniques to reduce agitation, scheduled quiet time, family involvement, additional resources for family and staff, stages of recovery, lifelong comorbidities related to the TBI diagnosis, and treatment/therapy options after discharge. Test questions were created with incorporation of knowledge from the previously listed topics. Eleven ICU nurses participated in the pretest, intervention, and posttest. Test scores were calculated and compared to assess for changes in knowledge and confidence. Descriptive statistics of the paired data were calculated and analyzed quantitatively for change.

Results/Outcomes: Significant improvement in participant knowledge and confidence was found after implementing the educational program. The overall mean test score increased, answer variability decreased, and a significant p-values (<0.05) resulted, indicating statistical significance. The education program effectively demonstrated improvement in Neuro/Trauma ICU nurses’ knowledge and confidence in caring for patients with a TBI.

Sustainability: This program will have the potential to be used in the education of newly hired nurses. Since project implementation, interdisciplinary interest has been expressed. Specifically, there is interest in the potential for future implementation of scheduled quiet time in the ICU. Further aims are to educate a more comprehensive array of health professionals, including physicians, advanced practice nurses, physician assistants, care assistants, and nurse techs working in the Neuro/Trauma ICU.

Implications: Increased nonpharmacological intervention to alleviate agitation in a patient with a TBI indicates that the program content efficiently increases nurses’ knowledge and confidence. The program outcomes also demonstrate that it is likely to educate other staff successfully. Ultimately, the results indicate a safer and more quality outcome for patients admitted to the ICU after sustaining a TBI.


Bibby, H., & McDonald, S. (2005). Theory of mind after traumatic brain injury. Neuropsychologia, 43(1), 99-14.

Centers for Disease Control and Prevention. (2022, March 21). TBI data. Centers for Disease Control and Prevention. Retrieved July 19, 2022, from

Goeren, D., John, S., Meskill, K., Iacono, L., Wahl, S., & Scanlon, K. (2018). Quiet time: A noise reduction initiative in a neurosurgical intensive care unit. Critical Care Nurse, 38(4), 38–44.

Larsen, L. K., Frøkjær, V. G., Nielsen, J. S., Skrobik, Y., Winkler, Y., Møller, K., Petersen, M., & Egerod, I. (2019). Delirium assessment in neuro-critically ill patients: A validation study. Acta Anaesthesiologica Scandinavica, 63(3), 352–359.

Larsen, L. K., Møller, K., Petersen, M., & Egerod, I. (2020). Delirium prevalence and prevention in patients with acute brain injury: A prospective before-and-after intervention study. Intensive and Critical Care Nursing, 59. Management of Post Traumatic Brain Injury (TBI) Agitation. (2020).

TBI Digital Poster - Final.pptx (118 kB)
Digital Poster