Brief education and nudging to facilitate TENS use in postoperative care: a quasi-experimental mixed methods study

Implementing evidence-based practices into routine clinical care remains a challenge, with traditional implementation strategies yielding modest effects on clinical behavior. In postoperative pain management, evidence-based non-pharmacological modalities such as transcutaneous electrical nerve stimulation (TENS) remain underutilized. Nudging, through subtle modifications to the choice architecture, offers a cost-effective, resource-efficient approach to enhancing adoption and sustaining action at the point of care. This study evaluated whether combining a brief educational workshop with a nudging phase using visual prompts could enhance the adoption of TENS in routine postoperative care.

An explanatory sequential mixed methods design was applied, combining a quasi-experimental pre-post study with three observation points and qualitative interviews. The study was conducted in a 15-bed postoperative ward at a Swedish university hospital. The intervention comprised a 45-minute hands-on educational workshop followed by a 12-week asynchronous and passive nudging phase. Quantitative data on TENS use were collected from a logbook maintained by healthcare professionals and analyzed with descriptive statistics and comparative tests. To contextualize and explain observed practice changes, semi-structured interviews with a purposive sample of healthcare professionals (n = 13) were thematically analyzed.

TENS administrations increased significantly after the interventions compared to baseline. Qualitative findings showed that the interventions reframed TENS from a peripheral option to an integrated component of postoperative pain care. Nudging reinforced awareness, normalized TENS administration in everyday practice, and contributed to early routinization and maintained integration into clinical reasoning.

A brief educational workshop followed by a transparent asynchronous and passive nudging strategy was associated with increased and continued documented use of TENS during the study period, in a setting where no administrations were recorded at baseline despite available devices and a local protocol. This low-resource approach might complement traditional implementation strategies by increasing the visibility of evidence-based non-pharmacological options in routine postoperative care.

ClinicalTrials.gov, NCT06696430. Registered 13 November 2024, https://clinicaltrials.gov/study/NCT06696430 .