Background <p>Delirium is a complex neurocognitive condition that is often difficult to recognise and manage in clinical practice. Although nursing students receive theoretical education about delirium during undergraduate training, they may feel inadequately prepared when encountering patients with delirium in real clinical settings, reflecting a persistent theory–practice gap in nursing education. This study aimed to explore nursing students’ experiences of their first clinical encounters with patients experiencing delirium.</p> Methods <p>This qualitative descriptive study was conducted with 13 first-semester, fourth-year nursing students at a university in Türkiye who had recently completed delirium-related theoretical education and intensive care clinical placements. Participants were recruited using purposive sampling. Data were collected through face-to-face, semi-structured interviews and analysed using inductive reflexive thematic analysis.</p> Results <p>Five main themes were identified: (1) making sense of delirium through diagnostic uncertainty; (2) emotional burden, including fear, inadequacy, and empathy; (3) clinical and ethical challenges related to behavioural disturbances and restraint practices; (4) professional learning through role modelling, communication, and increasing self-efficacy; and (5) critical reflections on education, highlighting the limitations of theory-based preparation. Students described their first encounters with delirium as emotionally intense and clinically demanding experiences. Although students initially struggled with uncertainty, fear, and communication difficulties, repeated clinical exposure and supportive nurse role models contributed to the development of professional confidence, communication strategies, and more empathic approaches to delirium care. Students also reported that nurses’ attitudes and approaches toward patients influenced their own professional perspectives on nursing care.</p> Conclusions <p>Nursing students’ first encounters with delirium were experienced as both emotionally challenging and professionally transformative. The findings suggest that theoretical education alone may be insufficient to prepare students for the complexity of delirium care. Integrating experiential and practice-oriented educational approaches, such as simulation, case-based learning, and communication-focused training, may help bridge the theory–practice gap and improve students’ preparedness, confidence, and competence in delirium care.</p>