Effects of a simulation-based education program on delirium care for critical care nurses: A randomised controlled trial
Thank you for allowing me to review your manuscript. Comments correspond to the bold page numbers in the header of the full document.
Title: Clearly written
Abstract: Page 2-Differences between groups not mentioned
Introduction: Ok except issues with changing tenses. (past and present)
Background: page 4 line 28. What are live slides?
Page 5 line 4- opposed instead of supposed.
Page 5 line 35-Are OSCEs an educational program or an evaluative method? The simulation-based education was the program.
The Study: Page 6 line 44-are the five videos part of the intervention? Didn’t both groups receive them?
Page 6 line 1-Was anyone excluded?
Page 6 line 47-Did the ICU nurses learn about CAM assessment tool? Was that used in the simulation?
Page 7-What is the content in the 40-page Delirium Care Flip Chart? Need more information about the simulation program so the reader is able to replicate the study if desired. Need to discuss the use of SPs.
Page 7 line 22-ICUs (CAM-ICU assessment) Not clear what the association is between the words ICUs and what is in the parentheses. Was the CAM-ICU part of the flip chart? Did nurses learn how to use it?
Page 7 link 49-No mention of validity or reliability of the instruments. This needs discussed.
Page 7 line 30-what qualifications did the assessors have?
Page 7 line 43-what was the content of the five online videos?
Page 8 line 9-What survey? Are they all self-reported measures? Is there any psychometric properties that can be listed?
Page 8 line 23-discuss ways that you validated the delirium quiz.
Page 8 Line 38- clarify confidence and competence of what.
Page 8 lines 40- Was there only one question related to confidence and one questions related to competence?
Page 8 lines 48-49-Has this audit been employed in other studies or did the authors create it? Did you measure inter-rater reliability? How did you train the assessors?
Data Collection: ok
Data Analysis: ok
Results: Page 10 line 39 whey were 27 excluded?
Page 12 lines 19 and 24-discussed using CAM-ICU but not discussed above
General comment-It is clear that both the control group and intervention group improved their scores from T0 to T2 in Knowledge, Confidence, and Competence but is there a difference is the amount improvement? Did one group have greater improvement? I find it interesting that the control group scored higher at T0 in all three outcomes. Can you explain that? Is that significant? Maybe they showed less degree of improvement because they had less room to improve compared to the intervention group.
Discussion: Page 12 line 45 and 47-sentence needs tweaked. It was designed to evaluate whether there were improved outcomes were improved and whether these changes were sustained.
Limitations: Page 15 line 6-This is not a limitation of the study- the OCSEs and clinical observation audit were time-consuming and completing all OSCEs at onetime point and within a few days was difficult
Conclusion: brief
Reference list: page 16 line 43-Department of Health and Ageing., 2011. Dlirium Clinical Pathway-not clear of this citation. How would I locate it?
Tables/figures: OSCE-what was assessed? Would be nice to show it in a table.
All other tables and figures very clearly displayed.
Overall comments: The methods section needs more explanation.

Revisions were made based on previous comments.