{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T06:03:02Z","timestamp":1780293782998,"version":"3.54.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Quantitative analysis revealed statistically significant improvements across all outcome metrics: delirium knowledge scores (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), clinical assessment accuracy (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), and self-efficacy (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Qualitative analysis identified four core thematic patterns: (\n                      <jats:xref>1<\/jats:xref>\n                      ) Experiential learning trilogy\u2014simulation, practice, and teaching; (2) From experience to evidence\u2014the construction of clinical confidence; (3) Environmental forces\u2014barriers and facilitators in practice implementation; and (4) Systemic spillover effects\u2014enhanced 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The TTT program significantly enhanced ICU nurses\u2019 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1824373","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T05:31:52Z","timestamp":1780291912000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A data-driven evaluation of a train-the-trainer program for delirium management in ICUs: a mixed-methods study integrating multidimensional outcome metrics and qualitative insights"],"prefix":"10.3389","volume":"17","author":[{"given":"Yadi","family":"Feng","sequence":"first","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Yuan","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Yi","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yana","family":"Xing","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixin","family":"Cai","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2703","DOI":"10.1001\/jama.286.21.2703","article-title":"Delirium in mechanically ventilated patients","volume":"286","author":"Ely","year":"2001","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1097\/01.CCM.0000119429.16055.92","article-title":"Costs associated with delirium in mechanically ventilated patients","volume":"32","author":"Milbrandt","year":"2004","journal-title":"Crit Care Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e214","DOI":"10.1097\/jnr.0000000000000487","article-title":"Recognizing intensive care unit delirium: are critical care nurses ready?","volume":"30","author":"Ho","year":"2022","journal-title":"J Nurs 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families","volume":"45","author":"Ely","year":"2017","journal-title":"Crit Care Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/j.ccc.2016.12.005","article-title":"The ABCDEF bundle in critical care","volume":"33","author":"Marra","year":"2017","journal-title":"Crit Care Clin"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s12871-017-0415-2","article-title":"Multicenter assessment of sedation and delirium practices in the intensive care units in Poland - is this common practice in Eastern Europe?","volume":"17","author":"Kotfis","year":"2017","journal-title":"BMC Anesthesiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1111\/jocn.12693","article-title":"Factors that contribute to underrecognition of delirium by registered nurses in acute care settings: a scoping review of the literature to explain this phenomenon","volume":"24","author":"El Hussein","year":"2015","journal-title":"J Clin 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meta-analysis","volume":"41","author":"Poitras","year":"2021","journal-title":"J Contin Educ Heal Prof"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1001\/jama.291.14.1753","article-title":"Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit","volume":"291","author":"Ely","year":"2004","journal-title":"JAMA"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"R125","DOI":"10.1186\/cc13929","article-title":"Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study","volume":"18","author":"Wolters","year":"2014","journal-title":"Crit Care"},{"key":"ref16","first-page":"174","article-title":"Measuring optimistic self-beliefs: a Chinese adaptation of the general self-efficacy scale","volume":"38","author":"Zhang","year":"1995","journal-title":"Psychologia"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.7587\/kjrehn.2019.114","article-title":"Effects of delirium management program on nursing practice and nurses' stress in comprehensive nursing care service units","author":"Hye","year":"2019","journal-title":"Korean J Rehabil Nurs"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1111\/eje.12758","article-title":"Applying the Kirkpatrick model to evaluate dental students\u2019 experience of learning about antibiotics use and resistance","volume":"26","author":"Badran","year":"2022","journal-title":"Eur J Dent Educ"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/CEH.0000000000000025","article-title":"A flipped classroom approach to improving the quality of delirium care using an interprofessional train-the-trainer program","volume":"36","author":"Sockalingam","year":"2016","journal-title":"J 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operationalization","volume":"52","author":"Saunders","year":"2018","journal-title":"Qual Quant"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1824373\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T05:31:53Z","timestamp":1780291913000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1824373\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":23,"alternative-id":["10.3389\/fneur.2026.1824373"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1824373","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]},"article-number":"1824373"}}