Objective:

To evaluate the impact of a train-the-trainer (TTT) delirium education program on ICU nurses' competencies using a multidimensional outcome framework, specifically the learning, behavior, and results levels of the Kirkpatrick model.

Key Findings:

• Statistically significant improvements were observed in delirium knowledge scores (p < 0.05), clinical assessment accuracy (p < 0.05), and self-efficacy (p < 0.001).
• Four core thematic patterns emerged from qualitative analysis: experiential learning, confidence construction, environmental barriers and facilitators, and systemic spillover effects.
• Nurses recommended standardized video resources for training optimization.

Interpretation:

The TTT program significantly enhanced ICU nurses’ delirium care competencies through simulation-based practice and peer teaching, while contextual challenges were identified.

Limitations:

• Environmental factors such as patient non-cooperation and challenges in assessing neurologically compromised patients were noted as barriers, which may limit the applicability of the findings to other settings.
• The study was conducted in a single tertiary ICU, which may limit generalizability to other ICU environments.

Conclusion:

The TTT program provides a feasible framework for improving delirium care in ICUs, highlighting the importance of simulation and peer teaching in nursing education, and addressing existing gaps in delirium management.