Table 1 Comparison between the original and the Iranian HELP programs

Screening

Elder life nurse specialist within 48 h

Geriatric nurse specialist within 48 h

Exclusion criteria

Intubation or respiratory isolation, aphasia, terminally ill, severe dementia, respiratory isolation, and expected discharge within 48 h after admission.

Another exclusion criterion was added (admitting in the participants’ group wards for the second time).

Protocols

Orientation/daily visiting: Orienting the board with the names of care team members, daily schedule, and orienting communication.

All interventions were done, without changes.

Therapeutic activities: Cognitive stimulation activities three times daily (e.g., discussion of current events, structured reminiscence, and word games).

Both of them were done as well as telling the story.

Sleep enhancements: Individualized considering of normal routines (can you think of something that might help you to sleep, or you did at home when you had trouble in sleep), offering to the patient and caregiver (drinking warm milk, back-rub, relaxation with a portable music player), additional sleep-promoting actions (avoiding caffeine after 2 p.m., increase exercise and mobility during the day as much as possible, avoid daytime napping, preserve regular time for going to bed each night), ward-wide noise reduction strategies (e.g., silent pill crushers, vibrating beepers, and quiet hallways), and schedule adjustments to allow uninterrupted sleep (e.g., re-scheduling of medications and procedures).

Some interventions were not provided, e.g., drinking herbal tea, relaxing with music, back massage, using silent pill crushers, and vibrating beepers. Although, most intervention strategies’ informed the patients and caregivers.

Also, noise reduction strategies were trained by patients and caregivers. The nurses were trained about ward-wide noise reduction strategies in the re-scheduling of medications and procedures.

Early mobilization: Ambulating or active range-of-motion exercises three times daily and minimizing the use of immobilizing equipment (e.g., bladder catheters, restraints).

All interventions were done, without changes.

Vision protocol: Visual aids (e.g., glasses or magnifying lenses) and adaptive equipment (e.g., large illuminated telephone keypads, large print books, and fluorescent tape on call bell), with daily reinforcement of their use.

Reminding in use of own glasses, caregivers’ training in how to communicate with the patient with the vision impairment. These activities failed, because of lacking facilities included magnifying lenses and adaptive equipment (e.g., large illuminated telephone keypads, large print books, and fluorescent tape on call bell)

Feeding Assistance: Feeding assistance and encouragement during meals

All interventions were done, without changes.

Fluid repletion: Early recognition of dehydration and oral volume depletion, i.e., encouragement of oral intake of fluid

All interventions were done, without changes.

volunteers

Volunteer shifts: Ranging from one to three times daily based protocols.

Role of the volunteers: Providing program interventions, directly at the bedside.

Daily, once in the morning or the evening.

Volunteer duty: Teaching family members and supervising them during the provision of the HELP interventions.

Nursing staff

The ELS and ELNS are in contact with the staff nurses.

The program director, geriatric nurse, and volunteers were in contact with the staff nurses.