Education and Nudging Strategy Increases Transcutaneous Electrical Nerve Stimulation Use in Postoperative Care

The persistent challenge of translating evidence-based clinical practices into routine, day-to-day healthcare delivery remains a significant hurdle within modern medicine. In the domain of postoperative pain management, non-pharmacological modalities such as transcutaneous electrical nerve stimulation (TENS) represent a valuable evidence-based intervention. This study investigated the efficacy of a low-resource, dual-component intervention—combining brief educational workshops with subtle behavioral nudging—to enhance the adoption and sustain the practical application of TENS within the challenging environment of postoperative care.

The research employed an explanatory sequential mixed methods design, integrating a quasi-experimental pre–post study with rigorous qualitative data collection. The intervention was specifically tailored for a 15-bed postoperative ward situated within a Swedish university hospital. The intervention protocol was structured in two distinct phases: initially, a focused 45-minute hands-on educational workshop was delivered to healthcare professionals. This was immediately followed by a 12-week asynchronous and passive nudging phase. Quantitative data regarding TENS utilization were meticulously collected from a logbook maintained by the clinical staff. This quantitative data was subsequently analyzed using descriptive statistics and comparative tests to determine the impact of the intervention against the established baseline usage rates.

Crucially, to provide a deep contextual understanding of the observed shifts in clinical practice, the study incorporated qualitative data gathered through semi-structured interviews. A purposive sample of 13 healthcare professionals participated in these interviews. Thematic analysis of these interviews was conducted to contextualize and explain the observed changes in TENS usage patterns.

The quantitative results demonstrated a statistically significant increase in TENS administrations following the implementation of the combined educational and nudging interventions when compared to the baseline period. This finding was particularly noteworthy given the baseline conditions, where no TENS administrations were recorded despite the availability of devices and the existence of a local institutional protocol.

Complementary qualitative findings provided profound insights into the behavioral transformation occurring among the clinical staff. Specifically, TENS transitioned in the perception of the healthcare professionals from being viewed as merely a peripheral or secondary option to being recognized as an integrated and essential component of comprehensive postoperative pain care.

The asynchronous and passive nudging strategy was instrumental in reinforcing the awareness of TENS benefits and normalizing its administration within the daily flow of patient care. This consistent, subtle reinforcement contributed directly to the early routinization of TENS use and ensured its sustained integration into the overall clinical reasoning processes of the medical staff. The authors suggest that this low-resource approach might complement traditional implementation strategies by increasing the visibility of evidence-based non-pharmacological options in routine postoperative care.

Subject of Research: Implementation of TENS in postoperative care using education and nudging.

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

Article References: Diwan, S., Andréll, P., Wolf, A., & Jildenstål, P. (2026). Brief education and nudging to facilitate TENS use in postoperative care: a quasi-experimental mixed methods study. BMC Health Services Research, 26(1), Article 1479. https://doi.org/10.1186/s12913-026-15913-0

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15913-0

Keywords: TENS, Pain Management, Implementation Science, Nudging, Healthcare, Postoperative Care, Mixed Methods, Clinical Adoption, Brief, education, facilitate, postoperative