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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.
To develop a behaviour change theory-informed implementation strategy to enhance the uptake of nurse-initiated protocols in the emergency department.
A framework-based intervention design was used.
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.
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.
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.
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.
There is no EQUATOR guideline available for this study.
This study did not include patient or public involvement in its design, conduct, or reporting.
To canvas the contemporary contextual forces within the Australian residential aged care sector and argue for new research and innovation. There is a pressing need to provide systematised, high-quality and person-centred care to our ageing populations, especially for those who rely on residential care. This paper advances a warrant for establishing a new systematic framework for assessment and management that serves as a foundation for effective person-centred care delivery.
Position paper.
This paper promulgates the current dialogue among key stakeholders of quality residential aged care in Australia, including clinicians, regulatory agencies, researchers and consumers. A desktop review gathered relevant literature spanning research, standards and guidelines regarding current and future challenges in aged care in Australia.
This position paper explores the issues of improving the quality and safety of residential aged care in Australia, including the lingering impact of COVID-19 and incoming reforms. It calls for nurse-led research and innovation to deliver tools to address these challenges.
The paper proposes an appropriate holistic, evidence-based nursing framework to optimise the quality and safety of residential aged care in Australia.
This study did not include patient or public involvement in its design, conduct, or reporting.
To identify the barriers and enablers to implementing nurse-initiated protocols in an emergency department.
Nurse-initiated protocols empower emergency nurses to autonomously initiate interventions, investigations and treatments based on predefined clinical guidelines. These protocols reduce waiting times and enhance staff and patient satisfaction. However, their uptake remains inconsistent, and the reasons for this variability are not well understood.
Focus groups were conducted with emergency nurses using an interview guide informed by the theoretical domains framework to explore perceived barriers and enablers to protocol implementation. Audio recordings were transcribed and analysed using inductive content analysis.
Six focus groups with 34 participants identified seven categories influencing protocol implementation. Barriers were: (i) nurses' workload and psychological stress, (ii) lack of competence, confidence and experience, and (iii) documentation burden and limited access to resources. Enablers were: (i) education and clinical support, (ii) improved clinical practice, and (iii) positive healthcare outcomes. The nurses and doctor relationship was identified as both a barrier and an enabler.
Effective implementation of nurse-initiated protocols requires systemic changes that empower nurses within a well-supported, adequately resourced environment. Addressing structural and professional development challenges is crucial to ensuring these protocols are consistently integrated into emergency departments.
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