Applying Behaviour Change Theory to Develop an Implementation Strategy for Nurse‐Initiated Protocols in the Emergency Department.
Background: Emergency Departments face increasing pressure due to rising patient demand, complex presentations, and resource constraints, resulting in long waits and extended stays. Nurse‐initiated protocols enable nurses to commence investigations and treatments based on clinical guidelines, improv...
| Publicado en: | Journal of Advanced Nursing (John Wiley & Sons, Inc.) Vol. 82; no. 5; pp. 5194 - 5206 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
John Wiley & Sons, Inc.
May2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=192938804&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 192938804 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03092402 LVDY jtl: Journal of Advanced Nursing (John Wiley & Sons, Inc.) issn: 03092402 maglogo: N pubinfo: dt: May2026 vid: 82 iid: 5 pid: 52269 pub: John Wiley & Sons, Inc. artinfo: ui: 192938804 187690597 192938804 192938804 10.1111/jan.70169 192938804 ppf: 5194 ppct: 12 formats: tig: atl: Applying Behaviour Change Theory to Develop an Implementation Strategy for Nurse‐Initiated Protocols in the Emergency Department. aug: au: Gawthorne, Julie McCloughen, Andrea Branch, Justine McPhillips, Orla Scott, Darren Curtis, Kate affil: Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Camperdown New South Wales,, Australia sug: subj: Nursing Protocols Implementation Science Emergency Service Change Theory Behavioral Changes Emergency Nurses Psychosocial Factors Quality Improvement Funding Source New South Wales Human Empirical Research Qualitative Studies Convenience Sample Tertiary Health Care Nursing Staff, Hospital Focus Groups Secondary Analysis Conceptual Framework Motivation Nursing Knowledge Confidence Clinical Competence Workload Stress, Psychological Documentation Interprofessional Relations Audit Feedback Leadership Work Environment Autonomy Job Satisfaction ab: Background: Emergency Departments face increasing pressure due to rising patient demand, complex presentations, and resource constraints, resulting in long waits and extended stays. Nurse‐initiated protocols enable nurses to commence investigations and treatments based on clinical guidelines, improving care and efficiency. Despite evidence supporting their effectiveness, few nurse‐initiated protocol implementation strategies are grounded in behaviour change theory. This gap may contribute to limited uptake, as many initiatives fail to address the complex factors influencing clinician behaviour. Aim: To develop a behaviour change theory‐informed implementation strategy to enhance the uptake of nurse‐initiated protocols in the emergency department. Design: A framework‐based intervention design was used. Methods: The Behaviour Change Wheel and Theoretical Domains Framework guided the development of the implementation strategy. Barriers and enablers identified through prior research in 2023 using surveys and focus groups were mapped to relevant intervention functions. Behaviour change techniques were selected based on their potential to address barriers or strengthen enablers. The APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects, and Equity) were applied to optimise feasibility. Results: Nine barriers and ten enablers to nurse‐initiated protocols use were identified and categorised using the COM‐B (Capability, Opportunity and Motivation) framework and mapped to the Theoretical Domains Framework. Eight intervention functions were selected and mapped to 24 behaviour change techniques and 23 delivery modes. The key implementation strategies are education, clinical champions, documentation changes, audit and feedback, and leadership engagement. Stakeholders confirmed the feasibility of the selected strategies. Conclusion: Theory‐informed, context‐specific strategies are essential for implementing nurse‐initiated protocols in emergency departments. This approach enables the design of targeted, feasible interventions that directly respond to identified barriers and enablers. Future research should test context‐specific implementation strategies, assess their long‐term impact on healthcare outcomes, and evaluate their scalability across diverse healthcare settings. Impact: By targeting the behavioural determinants of clinician practice, this study fills a critical gap in implementation science within emergency nursing.This study identified 24 behaviour change techniques across eight intervention functions to support nurse‐initiated protocol uptake. Strategies such as education, clinical champions, and audit provide a practical, replicable framework to overcome barriers, enhance autonomy, and reduce care delays. Findings support sustainable implementation in emergency settings, with future research needed on long‐term impact and scalability. Reporting Method: There is no EQUATOR guideline available for this study. Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct, or reporting. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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