A data-driven evaluation of a train-the-trainer program for delirium management in ICUs: a mixed-methods study...

Delirium remains a prevalent and serious complication in intensive care units (ICUs), yet the translation of evidence-based monitoring and management into routine nursing practice faces persistent implementation gaps. Sustainable and scalable educational strategies are urgently needed to address this challenge.

This study employed a mixed-methods approach to comprehensively evaluate the impact of a train-the-trainer (TTT) delirium education program using a multidimensional outcome framework. Quantitatively, we assessed changes in ICU nurses' competencies across the learning, behavior, and results levels of the Kirkpatrick model. Qualitatively, we explored the underlying experiential mechanisms and contextual drivers to explain the quantitative outcomes and inform program optimization.

A mixed-methods quasi-experimental study with an embedded qualitative component was conducted in a tertiary ICU in China. Forty-seven nurses participated in the TTT program. Quantitative data acquisition included validated instruments for delirium knowledge assessment, standardized clinical simulation evaluations using the CAM-ICU tool, and the General Self-Efficacy Scale, collected at baseline and three months post-intervention. For qualitative data acquisition, semi-structured interviews were conducted with 12 purposively sampled nurses to explore experiential learning trajectories, behavioral drivers, and implementation barriers. Thematic analysis was guided by Social Cognitive Theory and performed using systematic coding procedures.

Quantitative analysis revealed statistically significant improvements across all outcome metrics: delirium knowledge scores (p < 0.05), clinical assessment accuracy (p < 0.05), and self-efficacy (p < 0.001). Qualitative analysis identified four core thematic patterns: (1) Experiential learning trilogy-simulation, practice, and teaching; (2) From experience to evidence-the construction of clinical confidence; (3) Environmental forces-barriers and facilitators in practice implementation; and (4) Systemic spillover effects-enhanced interprofessional communication and recognition of hypoactive delirium. Nurses also provided actionable recommendations for training optimization, notably the need for standardized video resources to ensure content consistency.

The TTT program significantly enhanced ICU nurses' delirium care competencies, driven by simulation-based practice, repeated application, and peer teaching. Contextual challenges and the need for standardized video resources inform future implementation and fidelity considerations. This study provides a feasible, scalable framework for evidence-based delirium care.