Efficacy of simulation-based education on intensive care nurses’ knowledge, self-efficacy, and critical thinking in delirium care: A randomised controlled trial

Background: Intensive care nurses play a key role in early detection of delirium. However, many lack knowledge of delirium care. Few randomised controlled trials have examined the effectiveness of simulation-based education in improving this knowledge. Aim: The aim of this study was to explore the longitudinal effects of a multiscenario simulation-based delirium education intervention for intensive care nurses. Methods: This randomised controlled trial recruited nurses from adult intensive care units from one medical centre. Intensive care nurses who agreed to participate (N = 60) were randomly assigned to a control group (CG, n = 33) or an intervention group (IG, n = 27). Both groups received 4 h of classroom instruction in delirium care. The IG also received simulation-based education in delirium care with objective structured clinical examination–based evaluations. Measures for delirium knowledge, delirium self-efficacy, and critical thinking were collected using self-report instruments at baseline (T0), following classroom instruction for the CG (T1) or the simulation for the IG (T1), and 3 months and 6 months post instruction (T2 and T3, respectively). The generalised estimating equation analysis examined effects of the intervention with an intention-to-treat approach. Results: Baseline measures did not differ between groups. Mean scores for knowledge and self-efficacy (T1 to T3) and critical thinking (T1) were significantly higher for the IG than for the CG (Cohen's d > 0.80). Improvements in scores from the baseline were greater for the IG than for the CG for knowledge and self-efficacy at T1 (β = 1.41; 95% confidence interval [CI]: 0.99, 1.84 and β = 3.77; 95% CI: 0.79,6.75, respectively), T2 (β = 1.40; 95% CI: 0.78, 2.03 and β = 4.99; 95% CI: 1.38, 8.60, respectively), and T3 (β = 1.46; 95% CI: 0.86, 2.01 and β = 6.45; 95% CI: 2.73, 10.17, respectively) and for critical thinking at T1 (β = 8.58; 95% CI: 1.28, 15.88). Conclusions: The multiscenario simulation-based education program effectively enhanced intensive care nurses’ knowledge, self-efficacy, and critical thinking in delirium care, with benefits lasting up to 6 months post intervention.