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.