Gawthorne Julie, Curtis Kate, McCloughen Andrea
Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Camperdown, New South Wales, Australia.
St Vincents Health Network, Sydney, New South Wales, Australia.
J Clin Nurs. 2025 Jun;34(6):2375-2385. doi: 10.1111/jocn.17744. Epub 2025 Mar 18.
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.
确定在急诊科实施护士主导方案的障碍和促进因素。
护士主导方案使急诊护士能够根据预先确定的临床指南自主启动干预措施、检查和治疗。这些方案可减少等待时间，提高工作人员和患者的满意度。然而，它们的采用情况仍然不一致，而且这种差异的原因尚不清楚。
使用基于理论领域框架的访谈指南与急诊护士进行焦点小组讨论，以探讨方案实施中感知到的障碍和促进因素。对录音进行转录，并采用归纳式内容分析法进行分析。
六个焦点小组的34名参与者确定了影响方案实施的七个类别。障碍包括：（i）护士的工作量和心理压力，（ii）缺乏能力、信心和经验，以及（iii）文件负担和资源获取受限。促进因素包括：（i）教育和临床支持，（ii）临床实践的改善，以及（iii）积极的医疗结果。护士与医生的关系被确定为既是障碍也是促进因素。
有效实施护士主导方案需要进行系统性变革，在支持良好、资源充足的环境中赋予护士权力。应对结构和专业发展方面的挑战对于确保这些方案持续融入急诊科至关重要。
