Simulation-Based Education to Support Nurses' Critical Thinking in Delirium Recognition: A Scoping Review.

AIM: To map how simulation-based education supports the development of critical thinking skills required for nurses to recognize delirium in clinical practice.

DESIGN

A scoping review guided by the Joanna Briggs Institute methodology and the framework developed by Arksey and O'Malley, refined by Levac and colleagues.

METHODS

Two reviewers independently screened and extracted data to identify studies evaluating simulation-based education designed to strengthen nurses' delirium recognition and associated critical thinking processes. A narrative approach was used to chart and synthesize findings across varied simulation modalities and clinical contexts.

DATA SOURCES: The search was conducted on 4 September 2025, using MEDLINE, CINAHL and PsycINFO. No timeframe was applied to the search.

RESULTS

Fourteen studies met inclusion criteria. Simulation-based education consistently enhanced skills aligned with critical thinking, including observational accuracy, recognition of fluctuating cognitive cues, clinical reasoning, reflective awareness, empathy and communication within interprofessional teams. Structured debriefing played a central role in helping nurses analyse decision-making processes and integrate experiential learning into clinical judgement. Several studies reported changes in practice, including more consistent use of delirium identification tools and improved clarity of clinical documentation.

CONCLUSION

Simulation-based education strengthens interconnected domains of critical thinking that underpin nurses' capacity to recognize delirium early and respond effectively to its fluctuating presentation. These findings highlight the educational value of immersive, theory-informed simulation for developing the clinical judgement required in cognitively complex patient situations.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Integrating structured simulation into nursing education and professional development may enhance timely delirium recognition, foster more effective interprofessional communication and support safer, higher-quality care for hospitalized adults.

IMPACT: Simulation-based education offers a practical and scalable strategy for improving delirium recognition across care settings. By supporting nurses in noticing subtle cognitive changes, interpreting clinical patterns and communicating concerns with clarity and confidence, simulation contributes to stronger workforce preparedness and patient safety.

REPORTING METHOD: This review adhered to PRISMA-ScR reporting guidance.

PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.