A theory-informed toolkit for implementing a patient-assessment framework into emergency nursing practice

Dr Belinda Munroe1,2, Professor Kate Curtis1,2, Associate Professor Thomas Buckley2, Kate  Ruperto1, Orinda Jones1, Tracey Couttie1, Dr Lou Atkins3

1Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia, 2Sydney Nursing School, University of Sydney, Camperdown, Australia, 3Centre for Behaviour Change, University College, London, UK

Background: The emergency nursing assessment framework ‘HIRAID’ (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves patient assessment and communication skills of emergency nurses.¹ A range of facilitators and barriers were identified to potentially impact on the uptake and use of HIRAID.²

Aim: Design interventions to address facilitators and barriers, and optimise implementation of HIRAID in emergency nursing practice.

Methods: Implementation interventions were selected to target facilitators and barriers using the Behaviour Change Wheel.³ Resources were devised to enable delivery of interventions.

Results: A multimodal toolkit was devised to deliver behaviour change techniques selected, including feedback, demonstration, instruction, credible sources and prompts. The toolkit consists of educational and training resources for nurses and educators, an e-learning module, a preceptor program and simulation training exercises. A video was created to persuade nurses to use HIRAID in their practice, modelling executive support and demonstrating how to use the framework in practice. Electronic documentation templates, posters and reference cards were also designed to prompt use of HIRAID in the clinical environment.

Conclusion: This theory-informed toolkit has the potential to optimise implementation of HIRAID in emergency nursing practice. Further evaluation is needed to evaluate the impact of the HIRAID assessment framework and implementation strategy on clinical practice.

  1. Munroe B, Curtis K, Murphy M, Strachan L, Considine J, Hardy J, et al. A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: A pre-post study using full immersion simulation. J Clin Nurs. 2016;25(15-16):2262-74.
  2. Munroe B, Curtis K, Buckley T, Lewis M, Atkins L. Optimising implementation of a patient-assessment framework for emergency nurses: A mixed-method study. Journal of Clinical Nursing. Under review.
  3. Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science. 2011;6:42.


Belinda works a Clinical Nurse Consultant for the Emergency Departments across the Illawarra Shoalhaven. She completed her PhD in 2016, which included validating the first emergency nursing assessment tool internationally. Belinda also holds a peer nominated board position with the College of Emergency Nursing Australasia NSW, and is a Clinical Senior Lecturer at Sydney Nursing School.