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Applying Behaviour Change Theory to Develop an Implementation Strategy for Nurse-Initiated Protocols in the Emergency
Julie Gawthorne1,2, Andrea McCloughen1, Justine Branch2
1Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Camperdown, New South Wales, Australia.
Journal of Advanced Nursing
|September 3, 2025
Summary
This study developed a theory-informed strategy to improve nurse-initiated protocols in emergency departments. Key strategies include education and clinical champions, enhancing autonomy and reducing care delays.
Area of Science:
- Implementation Science
- Nursing Practice
- Behaviour Change Theory
Background:
- Emergency departments face significant pressure from increased patient demand and resource limitations, leading to prolonged wait times.
- Nurse-initiated protocols improve efficiency and care but often face limited adoption due to a lack of behaviour change theory integration.
- Existing implementation strategies frequently overlook the complex factors influencing clinician behaviour.
Purpose of the Study:
- To develop a behaviour change theory-informed implementation strategy for enhancing the uptake of nurse-initiated protocols within emergency departments.
- To address the gap in understanding and applying behavioural science to the implementation of nurse-initiated protocols.
Main Methods:
- A framework-based intervention design utilized the Behaviour Change Wheel and Theoretical Domains Framework.
- Barriers and enablers to protocol use were identified and mapped to intervention functions and behaviour change techniques.
- The APEASE criteria were applied to optimize the feasibility of the proposed strategies.
Main Results:
- Nine barriers and ten enablers were identified using the COM-B framework and mapped to the Theoretical Domains Framework.
- Eight intervention functions were selected, leading to 24 behaviour change techniques and 23 delivery modes.
- Key strategies include education, clinical champions, documentation changes, audit and feedback, and leadership engagement, all confirmed as feasible by stakeholders.
Conclusions:
- Theory-informed, context-specific strategies are crucial for successful implementation of nurse-initiated protocols in emergency settings.
- This approach provides a practical, replicable framework to overcome barriers and improve healthcare outcomes.
- Future research should focus on testing these strategies' long-term impact and scalability across different healthcare environments.
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