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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov, NCT06696430. Registered 13 November 2024, https://clinicaltrials.gov/study/NCT06696430 .