Partnering an implementation strategy with a multi-modal education to improve delirium practices

Kaye Rolls; Mandana Mayahi-Neysi; Arjay Clamonte; Angela Williams; Nadine Oborn; Elle Waters; Susan Hair; Victoria Traynor; Josephine Sau Fan Chow

doi:10.1186/s12912-026-04644-6

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Partnering an implementation strategy with a multi-modal education to improve delirium practices

Journal article

Open access

Peer reviewed

Partnering an implementation strategy with a multi-modal education to improve delirium practices

Kaye Rolls, Mandana Mayahi-Neysi, Arjay Clamonte, Angela Williams, Nadine Oborn, Elle Waters, Susan Hair, Victoria Traynor and Josephine Sau Fan Chow

BMC Nursing, Vol.Advanced access

23-May-2026

DOI: https://doi.org/10.1186/s12912-026-04644-6

PMID: 42177491

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Abstract

Delirium

Nursing education

Quality improvement

Implementation science

Self-efficacy

Aims To improve assessment of and communication for delirium to 85% of eligible patients and to improve nurses’ knowledge of and self-efficacy for delirium. Background Detection and prevention of delirium have become a high priority safety and quality issue globally. However, inadequate screening and objective assessment by nurses remains ongoing problems, often attributed to an inadequate knowledge base. Methods A repeated cross-sectional audit study, incorporating the 4Es implementation model and a multimodal education program for nurses, was undertaken across four wards of a rural hospital between March 2023 and March 2024. Bimonthly clinical practice audits using a point prevalence approach were undertaken with a pre-determined benchmark of 85%. The 3-module education program (1. Face to face; 2. Self-directed online; 3. Objective Structured Clinical Examination OSCE) was delivered in a new ward every 2 months. Nursing knowledge of (22 items) and self-efficacy (12 items) for delirium practices were collected before the education program (T0), after program (T1) and 6 weeks following program (T2). Results 378 patient notes were audited across 7 audits. Practice outcomes for 6 key practices reached and remained at the benchmark over the study period and for three months after. 187 knowledge surveys were submitted by 90 participants across all three time points, with 30 participants submitting all three. 86% were RNs with a mean age of 41.03 and 15.86-years’ experience. Knowledge outcomes were satisfactory and remain unchanged over time [T0 16.62 [SD 2.96]; T1 17.07 [SD 2.01]; T2 17.67 [SD 1.62]). Participant self-efficacy for detection and management of delirium improved significantly between T0 and T2. Participant feedback indicated that the education program, especially module 3-OSCE, contributed significantly to this self-efficacy Conclusion This study demonstrated that pairing an evidence-based education program with an implementation strategy created synergies that led to sustainable improvements in key delirium assessment and communication practices. Nursing leaders, including nursing managers, nurse educators, and specialised expert nurses, play an integral role in ensuring successful translation of research into practice and quality improvement projects. For such projects to be successful, nurse managers need to be highly visible to legitimise the project and implementation team and to facilitate processes. Clinical trial number Not applicable

Details

Title: Partnering an implementation strategy with a multi-modal education to improve delirium practices
Authors: Kaye Rolls (Corresponding Author) - University of Wollongong
Mandana Mayahi-Neysi - Bowral & District Hospital
Arjay Clamonte - Bowral & District Hospital
Angela Williams - Bowral & District Hospital
Nadine Oborn - Bowral & District Hospital
Elle Waters - Bowral & District Hospital
Susan Hair - Bowral & District Hospital
Victoria Traynor - University of the Sunshine Coast
Josephine Sau Fan Chow - South Western Sydney Local Health District
Publication details: BMC Nursing, Vol.Advanced access
Publisher: BioMed Central Ltd.
DOI: 10.1186/s12912-026-04644-6
ISSN: 1472-6955
PMID: 42177491
Copyright note: This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Data Availability: Data subject to third party restrictions – Bowral Hospital
Organisation Unit: Healthy Ageing Research Cluster; School of Health - Nursing
Language: English
Record Identifier: 991233296702621
Output Type: Journal article

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