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In this paper, the development of an evidence-informed, data-driven strategy for implementation of the HIRAID emergency nursing framework in Thailand is reported. HIRAID stands for H istory including I nfection risk, R ed flags, A ssessment, I nterventions, D iagnostics, reassessment and communication.
This exploratory descriptive study was underpinned by the Knowledge-to-Action framework.
The study was conducted in Chiangrai Prachanukroh Hospital (CRH) in Northern Thailand. The identified problem was no standardised approach to patient assessment and management. Adaptation of knowledge to local context occurred by feasibility assessments and experience-based co-design. Surveys designed and analysed using the Behaviour Change Wheel and Theoretical Domains Framework were used to understand the barriers to knowledge use. Selecting, tailoring and implementing the intervention was guided by the Behaviour Change Wheel.
Practice environment and behavioural diagnostics surveys were completed by 49 nurses (response rate 100%) who identified 19 enablers and 33 barriers to HIRAID implementation at CRH. Enablers and barriers were mapped to seven intervention functions (education, modelling, persuasion, enablement, training, environment restructuring, incentivisation) and 19 behaviour change techniques most likely to be effective. The study methods and results culminated in an evidence-informed, data-driven HIRAID Thailand Implementation Strategy.
In-depth understanding of context-specific enablers and barriers, active engagement of end-users was critical to maximising likelihood of successful implementation. Development of an evidence-informed implementation strategy for a limited resource setting was achievable with robust application of theory, key stakeholder and end-user engagement and multi-agency collaboration.
Implementation of clinical interventions in emergency care settings is challenging, even in well-resourced settings. For end-users, knowledge that an intervention would improve patient care was a powerful enabler coupled with meaningful organisational support is critical to sustained implementation in complex nursing environments.
This study addresses the lack of standardised approach to patient assessment and management in the emergency department in a resource-limited setting. Application of robust theory is possible in middle-resource settings, and this study identified 19 behaviour change techniques that were distilled to develop a sustainable, context specific implementation strategy. Development of an evidence-informed implementation strategy for a limited resource setting with robust application of theory is possible with key stakeholder and end-user engagement and multi-agency collaboration.
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 determine characteristics, variability and enablers/barriers to evidence-based care and generate recommendations with implementation strategies to improve the management of early pregnancy bleeding in the emergency department (ED).
Multi-method study.
This paper reports the integration phase of a multi-method study conducted in a regional health service with five sites. Quantitative results (characteristics, variabilities in care and barriers/enablers to evidence-based care) and qualitative findings (ED clinicians' perspectives and experiences) were integrated to generate new findings and recommendations, mapped to the Theoretical Domains Framework (TDF) and corresponding intervention strategies using the Behaviour Change Wheel.
This study integrated findings from two cohort studies of 9859 women over 10 years and a mixed-method study of 104 ED clinicians from five sites. The four key findings were (i) ED remains a critical source of assessment, (ii) Improved access to resources is needed to provide evidence-based care, (iii) Gaps in ED clinician knowledge, skill and confidence have potential patient and health service consequences and (iv) A practice guideline is available; however, it needs refinement. These were mapped to five TDF domains: beliefs about capabilities and consequences, environmental context and resources, knowledge and skills and seven intervention functions. Recommended implementation strategies included multimodal education, clinical champions and an updated practice guideline.
Recommendations to improve delivery of care to women with early pregnancy bleeding in the ED focus on clinical skills and resources. An implementation strategy, considering resource availability, clinician knowledge, skills and confidence, was developed using behaviour change theory.
Integration of characteristics, variability of, and influences on evidence-based care generated recommendations that could contribute to more consistent and effective care, improving patient and health service outcomes.
No patient or public involvement.
To understand the current evidence base regarding holistic nursing assessments performed by registered nurses in residential aged care homes in Australia, and identify the gaps in knowledge and potential areas for future research.
A scoping review informed by JBI guidelines and the PRISMA extension for Scoping Reviews.
The electronic databases Medline, EMBASE, CINAHL, Scopus and ProQuest Central were searched, alongside citation chaining and manual journal searches. Limits of English language and publication after the year 2000 were applied. Studies were screened against pre-defined eligibility criteria. Data were extracted and analysed using descriptive statistics and a narrative synthesis.
A total of 3987 studies were identified, of which 28 were categorised as comprehensive or multimodal assessment programmes, standalone assessment tools or assessment infrastructure papers. Key outcomes described included staff factors and resident emergency department transfers or hospitalisations. The key feature of existing nursing assessments across studies was education, which was generally associated with improved staff knowledge, confidence and efficiency. Apart from this, there was large heterogeneity among assessment interventions with inconsistent effects. Few studies focused on residents with dementia or palliative care needs.
There is currently no standardised, systematic approach to the holistic assessment of residents by registered nurses in Australia. This gap in assessment is especially evident for residents with dementia or palliative care needs.
This research highlights the need to develop standardised holistic nursing assessments to bridge this gap in practice.
No Patient or Public Contribution.
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.
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