Rethinking Facilitation - Pragmatic Nudging to Facilitate Adoption of Transcutaneous Electrical Nerve Stimulation in Postoperative Care

Abstract

Acute postoperative pain remains highly prevalent, yet effective nonpharmacological methods such as transcutaneous electrical nerve stimulation (TENS) are underused in routine care. This thesis investigates how system-embedded, low-resource strategies, specifically nudging combined with a brief educational workshop, can facilitate the adoption of TENS during the acute postoperative phase. The thesis comprises four studies. Study I was a national survey exploring healthcare professional (HCP) knowledge, attitudes, and practices regarding TENS. Study II was a systematic scoping review mapping the use and effects of nudge strategies targeting HCP opioid prescribing behavior. Study III employed a quasi-experimental design to evaluate the effects of combining a brief educational workshop with a 12-week nudge strategy to facilitate TENS adoption in postoperative care. Study IV used descriptive phenomenology to describe HCP lived experiences of being nudged in practice. Study I showed limited knowledge and infrequent use of TENS despite generally positive attitudes and interest in strengthening theoretical and practical competence. Study II showed that nudging influences HCP behavior when embedded within clinical workflows in various settings. Study III showed increased and sustained TENS adoption following the combined education-and-nudge intervention. Study IV described that HCPs perceived nudges as acceptable when they were transparent, contextually adapted, and aligned with professional values. Collectively, the findings suggest that nudging functions as a feasible, acceptable, and low-cost facilitative mechanism when combined with a brief educational component. Furthermore, this thesis expands the conceptualization of facilitation by demonstrating how facilitative functions are distributed across both interpersonal and system-embedded mechanisms. This approach highlights a pragmatic pathway toward practice change in postoperative pain management and reducing reliance on person-dependent facilitation.