Implementation Competence for Evidence-based Practice Among Vascular Access Specialist Team Nurses: A Mixed-method Study

Implementation Competence for Evidence-based Practice Among Vascular Access Specialist Team Nurses: A Mixed-method Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Implementation Competence for Evidence-based Practice Among Vascular Access Specialist Team Nurses: A Mixed-method Study Ismael Fernández-Fernández, Ana Casaux-Huertas, Enrique Castro-Sánchez, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8650806/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction : Evidence-based practice (EBP) is central to high-quality nursing care and patient safety, yet its effective adoption and sustainability depend on nurses’ capability to translate evidence into routine practice. Vascular access specialist teams (VASTs) play a key role in implementing evidence-based interventions to reduce complications associated with intravenous therapy, but little is known about their capability to enact and sustain EBP in complex organisational contexts. Objectives To assess the implementation competencies for EBP among VAST nurses in Spain, exploring their experiences, attitudes, and knowledge related to implementing and sustaining EBP, as well as their role as facilitators of practice change. Methods A two-stage, mixed-methods study was conducted in 2023. The quantitative stage involved a national cross-sectional survey of VAST nurses using an adapted, validated questionnaire informed by behavioural frameworks relevant to EBP adoption. The qualitative stage consisted of in-depth semi-structured interviews with a purposive sample of participants. Quantitative data were analysed using descriptive and multivariate methods, and qualitative data through thematic analysis and integrated using triangulation. Results Fifty-one VAST nurses completed the questionnaire, reporting high self-perceived competence in domains such as social/professional role and identity (mean 4.7/5), knowledge (4.3), and collective context (4.2) for EBP. Lower scores were observed in contextual and organisational domains (mean 3.9), reflecting structural barriers to sustained EBP. Knowledge correlated positively with beliefs about capabilities (ρ = 0.574), and behavioural regulation (ρ = 0.591). Qualitative findings revealed five themes: expanded professional roles, experiential learning of implementation skills, context-sensitive strategies, organisational barriers, and enabling conditions. Participants described intuitive engagement with EBP despite lacking formal training, highlighting a gap between individual motivation and organisational support. Conclusions VAST nurses in Spain show strong intrinsic motivation and emerging capability to lead and support EBP, but limited formal training and weak organisational infrastructure restrict their ability to enact and sustain implementation activities. Strengthening nurses’ EBP capability through structured implementation training, alongside organisational strategies that formalise and support the VAST role, may improve the adoption and sustainability of evidence-based vascular access care. Evidence-based practice implementation competence vascular access nurse competence professional capability Figures Figure 1 Contributions to literature This study provides the first empirical characterisation of implementation competence for evidence-based practice (EBP) among vascular access specialist teams (VASTs), a workforce essential to evidence-based vascular access care but previously unexplored in relation to EBP capability. By integrating quantitative and qualitative evidence, the study identifies key behavioural and contextual mechanisms, such as self-efficacy, behavioural regulation, and organisational support, that influence nurses’ capability to implement and sustain EBP, offering insights into how EBP capability develops within specialised nursing teams. Findings reveal a gap between strong individual motivation for EBP and limited organisational capacity to support it, underscoring the need for structured education in implementation and EBP, as well as system-level arrangements that formally embed VAST roles within quality and safety strategies. By foregrounding the experiences and challenges of vascular access specialist nurses, this study provides actionable insights for nursing leadership, workforce development, and policy initiatives, highlighting the need to align individual motivation for EBP with organisational capacity to support its sustained implementation. BACKGROUND Catheters are intravascular devices commonly used in healthcare to administer intravenous therapy and represent one of the most frequently used medical devices in hospitals [1]. Nearly three quarters of hospitalised patients require at least one vascular access device (VAD) during their stay [1], making vascular access care a critical component of nursing practice with direct implications for patient safety [2]. The use of VADs can lead to complications such as infections, mechanical obstructions, thrombosis, phlebitis, infiltration, and extravasation [3–5]. Catheter-related bloodstream infections (CRBSI) remain one of the most serious healthcare-associated complications worldwide, with reported prevalence ranging from 0.4 to 1.2% depending on device type and clinical context and are associated with high morbidity, mortality and healthcare costs [6–8]. The selection, insertion, management, and maintenance of VADs constitute a complex, multifaceted process that requires ongoing clinical judgement and coordination by nurses and other healthcare professionals [9]. Some of the factors influencing VAD outcomes include patient diagnosis, vascular condition, characteristics and duration of the therapy administered, VAD availability, healthcare professional competence, patient preferences, organisational culture, and established standards [10,11]. This complexity contributes to variability in practice and poses a significant challenge for the consistent application of evidence-based practice (EBP) in vascular access care [2,12–14]. To address variability and improve patient outcomes, healthcare organisations have increasingly promoted the development and institutionalisation of vascular access specialist teams (VASTs) [15–17]. These teams typically involve experienced nurses with advanced knowledge and skills, who comprehensively assess patients to optimise VAD selection, insertion, maintenance, and removal, while adapting care to patients’ evolving clinical needs [11]. Beyond technical proficiency, VAST nurses frequently act as advisors and consultants to other professionals [18], supporting decision-making and recommending evidence-based interventions to address gaps between best evidence and routine practice [19,20]. As such, VASTs play a central role in facilitating the uptake of evidence-based vascular access care within multidisciplinary teams [19]. However, despite their recognised clinical value, the implementation and formal integration of VASTs within hospital organisations remain inconsistent, with reported challenges related to role definition, institutional support, and sustainability across different healthcare settings [21,22]. VASTs provide substantial benefits to patients by ensuring safe and effective vascular access management. Beyond direct patient care, these teams offer expert support to multidisciplinary healthcare teams that rely on their specialised knowledge [21]. In addition, VASTs contribute to improving healthcare delivery processes by identifying and optimising clinical pathways related to vascular access and intravenous therapy. To achieve these improvements, VAST nurses must mobilise the best available evidence and translate it into clinical practice. This requires not only clinical expertise, but also competence in implementing and sustaining EBP and practice change, enabling them to effectively bridge the gap between evidence and routine care [23]. Implementation competence for EBP can be understood as the ability to purposefully apply evidence-informed strategies and behavioural skills to promote practice change within specific organisational contexts. According to the implementation framework, this competence aligns with the facilitator role – integrating evidence, contextual knowledge, stakeholder skills and motivations, and facilitation strategies to enable change and sustainability [24]. Despite these expectations, there is limited empirical knowledge about how VAST nurses develop, enact, and perceive these implementation-related capacities. Theoretical models such as the COM-B or the theoretical domains framework offer a behavioural lens to understand the determinants of implementation competence, characterising it beyond technical or clinical skill [23]. As a specialised core component of intravenous care, VASTs, along with the rest of the healthcare team, face challenges regarding the dissemination, adoption, and sustainability of evidence, resource adequacy, and care management decisions [25–27]. Although implementation science has emerged as a valuable field to support healthcare professionals in addressing these challenges and to perform their roles effectively [28–30], most research in vascular access has focused on clinical outcomes rather than on the professional and organisational capacities required to translate evidence into routine nursing practice [19,21–23]. Addressing this gap is essential to strengthen evidence-based vascular access care and improve patient safety. By examining implementation competence for EBP among VAST nurses, this study aims to inform educational, organisational, and policy strategies that support nurses in leading and sustaining EBP. Accordingly, this study assesses implementation competence for EBP among VAST nurses in Spain, exploring their experiences, attitudes, and perceptions of organisational support, with a particular focus on their facilitative role in promoting practice change within healthcare organisations. METHODS We conducted this study in two simultaneous stages. The first stage, quantitative, adapted the online questionnaire validated by Huijg et al. [31] to the Spanish context. At the same time, the second stage, employed semi-structured in-depth interviews to explore the role of VAST nurses facilitating change and implementation of quality improvement interventions. The rationale for this multiple methodology is the complexity of implementation science itself, its intrinsic characteristics within this organisational context, skills acquisition by healthcare professionals, and the way these skills are developed in clinical practice through a facilitative role within VASTs. Each stage of the research is described in detail below: 1. Quantitative stage : Study design: We conducted a multicentre, descriptive, cross-sectional study, using an online questionnaire based on Huijg et al et al. [31] and disseminated through the RedCap platform. We adapted the original questionnaire to evaluate the implementation skills of quality improvement interventions among VAST nurses in the Spanish context. As a similar study has never been done before in our context, we conducted this exploratory study, and the domains selected are those that we considered to fit our practice environment on a clinical, social, and cultural level. Participants: Eligibility for participation in the study required, employment as part of VAST nursing team for at least three months at the time of the research, in any health care organisation (private or state-funded) in Spain. Participation in the study was voluntary and did not involve any financial compensation. Participant recruitment: We employed a recruitment matrix with participants stratified first by autonomous community (i.e., largest administrative units in Spain), then by province capital, and finally by major city to be representative of the whole of Spain. We initially identified and contacted VASTs in the leading hospital of each geographical unit mentioned by emailing or phoning hospital managers or the person in charge of the relevant unit, using publicly available information on the website of organisation. When we received no response from managers, a given hospital lacked a VASTs, or the VAST team members declined to participate in the study, then we proceeded to contact the next leading hospital in our matrix, until we obtained the necessary number of participating facilities is reached. In addition, we recruited participants were recruited by disseminating the project through social networks (Twitter/X). Once the initial contact was made, the VAST nurses were informed of the purpose and details of the research via email. If they agreed to participate, they were provided with the link to the online questionnaire for completion, which also allowed them to express their interest to participate in the qualitative stage of the study. Procedure / Data collection: We collected data, using an online questionnaire distributed to participating VAST nurses during March – June 2023 through the RedCap platform. Prior to this, all the participating institutions and VASTs were contacted to inform them about the study and obtain their informed consent. Measuring instrument and variables: Our online questionnaire developed based on Huijg et al et al. [31]. The original questionnaire was adapted to focus on implementation skills in improvement interventions, and included five sociodemographic and organisational items (age, gender, years of experience as a nurse, years of experience as VAST nurse, and hospital/facility of work), and 29 items concerning implementation science distributed across seven domains (D1. Knowledge; D2. Skills; D3. Social/professional role and identity; D4. Beliefs about capabilities; D5. Context; D6. Collective context; D7. Behavioural regulation). We scored these seven domains on a 5-point Likert scale, from 1 (little relevance) to 5 (highly relevant). (See domain and definitions in Appendix 1 ). Sample size calculation: The final sample was obtained using a purposive sampling with nurses working in VASTs on a national level, seeking to represent as many hospitals as possible in the 17 autonomous communities and the 2 autonomous cities of Spain, but at least the reference hospital from the capital from each of these regions. The participation of the principal hospitals in each autonomous community or city will be prioritised in order to obtain a representative sample of the entire Spanish territory. Statistical analysis: The analysis included descriptive statistics (with categorical and continuous data were expressed as means, medians, standard deviations (SDs), and interquartile ranges (IQRs)), and a bivariate analysis with parametric and non-parametric tests depending on the distribution of the data (correlation tests, ANOVA, and/or chi-squared tests). Missing data were not included in the analysis. The statistical significance threshold was set at p < 0.05. All statistical analyses were conducted using SPSS software (version 25 SPSS/IBM, Chicago, Illinois, USA). 2. Qualitative stage : Study design: We conducted a qualitative study, using a semi-structured interview to explore perceptions, experiences, and knowledge of implementation science among VAST nurses, identifying the facilitator role of these professionals. Participant selection and recruitment: As detailed above, VAST nurses who voluntarily provided their contact details (email address or telephone number) and consented to participate in the qualitative stage were eligible. These participants were considered as key informants to help identify and recruit other suitable participants, using snowball approach. We highlighted characteristics of sought after participants, for example, background and experience to enhance the potential richness of the interviews. Participation in the study was voluntary and did not involve any financial compensation for any of the participants. Participant selection, recruitment, and interviews were finalised once thematic saturation was reached. Data collection: All semi-structured interviews were conducted by two researchers (IB-M and EC-S, two members of the research team) using an interview guide ( Appendix 2 ). The semi-structured interviews were conducted online using MS Teams during the second half of 2023 and first of 2024, at times convenient to the participants and lasted approximately 45 minutes. The interviews were recorded and automatically transcribed verbatim by the online tool. The researchers reviewed the transcriptions against the recordings and return them to participants for fidelity and clarification. The transcriptions were then anonymised prior to analysis. The researchers also took contemporary notes during and after the interview. Analysis: We conducted a thematic analysis, following a continuous iterative familiarisation process [32]. In the inductive phase, we examined the transcripts for units of meaning that alluded to how the VAST facilitation process unfolded on the hospital wards and then code them. These codes were grouped into broader categories and subcategories. Three researchers independently coded each transcript of the semi-structured interviews. During the deductive phase, the data was analysed according to the aspects proposed in the theoretical framework and the literature review. A first coding framework was applied to the interviews, which was once again returned to respondents for codes and prominent theme validation. We employed several triangulation strategies combined to compare the results obtained and build a code tree, triangulated by three researchers (AC-H, IB-M, and EC-S), to further enhance the methodological rigour of our analysis [33]. Regarding the methods, we compared the information from the interviews, the codes applied by the researchers, and the participants’ reviews to identify coherence and discrepancies in the narrative (member checking). Regarding the data, two members of the research team with ample experience in implementation science (IB-M and EC-S) shared and discussed their findings. Another strategy to enhance rigour was to ensure meticulous adherence to procedure and that the researchers’ reflections on methodological decisions made throughout the study are properly recorded, taking their dual status as clinicians and co-researchers into consideration [34]. Research and reflexivity team: The knowledge of the implementation process held by the research team will be essential for the interpretation and contextualisation of the analysis. Two of the researchers, with previous experience in evidence implementation, social research, and vascular access, will coordinate and conduct the semi-structured interviews at the participating hospitals, which will allow them to establish a relationship and encourage open and frank discussion. IF-F is a doctoral student in the Investigación Traslacional en Salud Pública y Enfermedades de Alta Prevalencia (Translational Research in Public Health and High Prevalence Diseases) doctoral programme at the University of the Balearic Islands. RESULTS Quantitative stage 61 VASTs were contacted, of which 37 (60.65%) agreed to participate (see Fig. 1). Finally, 51 VAST nurses in Spain completed the questionnaire. The sample was predominantly female (72.5%), with a mean age of 44.5 years (SD ± 9.5). Participants had 21 years of professional experience (SD ± 9.7), and 3.8 years (SD ± 3.6) of involvement in their respective VASTs. Figure 1. Participating hospitals across Spain. The overall mean score across the seven dimensions of the questionnaire was 4,2 out of Likert scale 5-point. The highest-rated domain was Social/Professional Role and Identity (Domain 3), with a mean of 4.7 (SD ± 0.5). This was followed by Knowledge (D1) and Collective context (D6), both with mean scores above 4.2. Conversely, the Context (D5) dimension received the lowest score (mean 3.9, SD ± 0.5). All data are included in Table 1. Table 1 Sociodemographic characteristics and questionnaire scores. Characteristics N (%) Mean (SD) Minimum Maximum Range Gender Male Female Nonbinary 51 (100) 13 (25,5) 37 (72,5) 1 (2,0) Age 51 (100) 44,47 (9,52) 24 61 37 Years of experience 51 (100) 21 (9,667) 1 40 39 Years of VAST experience 51 (100) 3,75 (3,628) 0 15 15 Dimensions of the questionnaire D1 Knowledge 51 (100) 4,298 (0,441) 3,20 5,00 1,80 D2 Skills 51 (100) 4,196 (0,458) 3,00 5,00 2,00 D3 Social/professional role and identity 51 (100) 4,657 (0,485) 3,50 5,00 1,50 D4 Beliefs about capabilities 51 (100) 4,049 (0,468) 3,20 5,00 1,80 D5 Context 51 (100) 3,922 (0,504) 3,00 5,00 2,00 D6 Collective context 51 (100) 4,186 (0,547) 3,00 5,00 2,00 D7 Behavioural regulation 51 (100) 4,137 (0,722) 3,00 5,00 2,00 Table 1. Sociodemographic characteristics and questionnaire scores. The results from Table 2 indicate that participants demonstrated a strong sense of professional responsibility and role clarity regarding the implementation of intravenous therapy improvement interventions. Over 90% of participants reported high levels of knowledge, clarity about their responsibilities, and confidence in their skills to implement these interventions. Notably, 100% recognised it as part of their professional role. However, lower agreement was observed in items related to perceived behavioural control, with only 58.8% stating that implementation was “very easy” and around 70% feeling in full control of the process. Table 2 Scores for each questionnaire item regarding agreement among participants (Likert scale values 4–5). Domain Constructs (Number items) Value 4–5 (%) D1 Knowledge Knowledge (1) D1.1 I know how to implement intravenous therapy improvement interventions. 96,1 Role clarity (4) D1.2 The objectives of my role and the interventions I need to implement are clearly defined for me. 94,1 D1.3 I know what my responsibilities are regarding the implementation of intravenous therapy improvement interventions. 92,2 D1.4 Regarding the implementation of IVT improvement interventions, I know exactly what is expected of me (my supervisor and/or manager). 80,4 D1.5 The interventions to be carried out are clearly defined for me. 94,1 D2 Skills Skills (3) D2.1 I have received training in implementing intravenous therapy improvement interventions. 88,2 D2.2 I have the necessary skills to implement intravenous therapy improvement interventions. 90,2 D2.3 I can implement intravenous therapy improvement interventions. 90,2 D3 Social/professional role and identity Professional role (2) D3.1 Implementing intravenous therapy improvement interventions is part of my job as a nurse of vascular access specialist team. 96,1 D3.2 It is my responsibility as a nurse in the VAST to implement intravenous therapy improvement interventions. 100 D4 Beliefs about capabilities Self-efficacy (4) D4.1 I am confident in being able to implement intravenous therapy improvement interventions. 94,1 D4.2 I am confident in being able to implement intravenous therapy improvement interventions even when other professionals do not. 92,2 D4.3 I am confident in being able to implement intravenous therapy improvement interventions even when there is time available to do so. 90,2 D4.4 I am confident in being able to implement intravenous therapy improvement interventions even when the targeted professionals are not motivated. 80,4 Perceived behavioural control (6) D4.5 I am in control of how the implementation of intravenous therapy improvement interventions will be carried out. 72,5 D4.6 Implementing intravenous therapy improvement interventions is very easy for me. 58,8 D4.7 Delivering training related to an intravenous therapy improvement intervention is very easy for me. 80,4 D4.8 Evaluating participants who receive training related to an intravenous therapy improvement intervention is very easy for me. 80,4 D4.9 Monitoring the maintenance of optimal intravenous therapy maintenance behaviours outside of an intravenous therapy improvement intervention is very easy for me. 76,5 D4.10 Providing feedback on the intravenous therapy improvement intervention to the professional targeted by the intervention is easy for me. 70,6 D5 Context Social-political context (1) D5.1 The team receives sufficient support from the government and local authorities for the implementation of interventions to improve intravenous therapy. 72,5 Organisational resources and support (4) D5.2 In the organisation where I work, I have all the necessary resources to implement intravenous therapy improvement interventions. 66,7 D5.3 I have the support of the management of the organisation in which I work for the implementation of intravenous therapy improvement interventions. 68,6 D5.4 The management of the organisation is open to listen to the difficulties in implementing intravenous therapy improvement interventions. 60,8 D5.5 The management of the organisation in which I work offers support (financial, resources, training, etc.) for the implementation of intravenous therapy improvement interventions. 72,5 Innovation strategy (1) D5.6 The organisation in which I work provides training for professionals in the implementation of intravenous therapy improvement interventions. 74,5 D6 Collective context Social influences (2) D6.1 The professionals with whom I implement intravenous therapy improvement interventions think that I should be the one to implement and/or lead them. 72,5 D6.2 The existence of vascular access specialist team professionals from other centres carrying out implementation has an influence on me. 92,2 D7 Behavioural regulation Action planning (1) D7.1 I have a clear plan for how I would deliver an intravenous therapy improvement intervention. 80,4 Table 2. Scores for each questionnaire item regarding agreement among participants (Likert scale values 4–5). Correlation analyses revealed significant positive relationships between key domains: D1 (Knowledge) and D4 (Beliefs about Capabilities): ρ = 0.574, p < 0.01; D1 and D7 (Behavioural Regulation): ρ = 0.591, p < 0.01; D2 (Skills) and D4: ρ = 0.548, p < 0.01; and D4 and D6 (Organisational Context): ρ = 0.509, p < 0.01. All data are included in Table 3 Table 3 Correlations between domains related to implementation questionnaire Variables D1 D2 D3 D4 D5 D6 D7 D1 , ρ (p-value) 1 0,454 (0,001) 0,192 (0,178) 0,574 (< 0,001) 0,296 (0,035) 0,300 (0,032) 0,591 (< 0,001) D2 , ρ (p-value) 1 0,156 (0,275) 0,548 (< 0,001) 0,329 (0,018) 0,288 (0,040) 0,364 (0,009) D3 , ρ (p-value) 1 0,309 (0,309) 0,114 (0,424) 0,372 (0,007) 0,160 (0,262) D4 , ρ (p-value) 1 0,258 (0,068) 0,509 (< 0,001) 0,332 (0,017) D5 , ρ (p-value) 1 0,279 (0,047) 0,143 (0,246) D6 , ρ (p-value) 1 0,246 (0,082) D7 , ρ (p-value) 1 D1. Knowledge; D2. Skills; D3. Social/professional role and identity; D4. Beliefs about capabilities; D5. Context; D6. Collective context; and D7. Behavioural regulation). Table 3. Correlations between domains related to implementation questionnaire No statistically significant differences were found between groups based on age, years of professional experience, or time working in a VAST, across the domains of the implementation questionnaire. However, a statistically significant difference was observed between years of experience and the collective context domain. Detailed results are presented in Table 4. Table 4 Relationship of sociodemographic characteristics and the domains of the implementation questionnaire Variables D1 D2 D3 D4 D5 D6 D7 Age , ρ (p-value) 0,246 (0,082) 0,20 (0,891) 0,213 (0,133) 0,037 (0,797) 0,068 (0,637) 0,108 (0,452) 0,232 (0,101) Gender , ρ (p-value) 0,493 (0,486) 0,245 (0,623) 0,798 (0,376) 2,399 (0,128) 1,572 (0,216) 0,532 (0,469) 0,001 (0,971) Years of experience , ρ (p-value) 0,198 (0,163) -0,048 (0,737) 0,235 (0,097) 0,087 (0,543) -0,037 (0,797) 0,117 (0,413) 0,215 (0,130) Years of VAST experience , ρ (p-value) 0,173 (0,225) 0,078 (0,588) 0,264 (0,061) 0,102 (0,476) 0,039 (0,784) 0,293 (0,037) 0,208 (0,143) Table 4. Relationship of sociodemographic characteristics and the domains of the implementation questionnaire Qualitative stage The qualitative stage included interviews with ten nurses from VASTs in diverse hospital contexts. Thematic analysis revealed five overarching themes that collectively portray how VAST nurses enact and develop implementation competencies in the absence of formal training specific to implementation, despite receiving routine technical and device-related instruction. Appendix 3 provides a matrix of themes, subthemes, and illustrative quotes. Expanded professional role. Participants highlighted a transformation in their role, from a primarily technical focus on vascular access device insertion to a broader scope that includes education, consultancy, auditing, epidemiological monitoring, and leadership in quality improvement. While these activities extend beyond clinical expertise, they also reflect the early stages of an implementation-oriented role, as VAST nurses increasingly influence how others deliver care, guide decision-making, and embed best practices into routine workflows. Participants widely agreed that VASTs should evolve beyond a technical insertion team to become a reference service for driving practice change, supporting not only device selection but also the adoption and reinforcement of evidence-based behaviours across clinical units. This expanded role was closely mediated by organisational context. In smaller hospitals, greater autonomy and flatter hierarchies enabled VAST nurses to influence ward routines more directly and to embed informal mechanisms that supported consistent and evidence-based vascular access care. These contextual features provided greater flexibility to extend their scope and to mobilise improvements more rapidly. practice change. “ The VAST team is not just about inserting lines; there’s a lot of work behind the scenes.” (P1) “ Every day is different. I do insertion, follow-up, answer consultations, prepare teaching materials... we do everything. ” (P10) The daily responsibilities of VAST nurses extend beyond device insertion to include ongoing clinical assessments, staff education, and consultative support. Participants described providing bedside guidance, modelling best practices and tailoring training to ward needs, a set of activities that actively shape the behaviour of other clinicians. This multidimensional role positions them not only as clinical referents but also facilitators of practice change, helping teams adopt and sustain safer vascular access procedures. “We give training on the ward, advise on which device to use, and solve problems when there are complications.” (P2) Implementation competencies None of the participants had received formal education in implementation science. Learning occurs primarily through experiential processes, including trial-and-error, mentorship, and peer observation. Despite this lack of structured training, participants described a range of behaviours and skills that align with core implementation competencies, such as planning change initiatives, adapting interventions to local context, troubleshooting barriers, engaging stakeholders and monitoring outcomes over time. “ We do it intuitively… I guess it’s a science of some sort. ” (P1) “ What I used to hate—planning, metrics, follow-up—I now realise are essential. ” (P9) Across interviews, participants demonstrated elements of implementation capability, even if not framed as such. Many described systematically identifying problems, developing pragmatic solutions, testing and refining strategies, and using local data to inform decisions – processes that mirror iterative cycles of improvement and facilitation found in implementation frameworks such as i-PARIHS and COM-B. These behaviours suggest an emerging but largely untapped competence that could be strengthened through formal development. Participants also expressed a strong desire for structured training to consolidate their intuitive practices and to build confidence in applying evidence-informed methods. They perceived that formal education would enable them not only to improve their own performance but also to lead change more effectively, engage colleagues, and sustain change within their organisations. “ If there was a course on this, I’d do it without hesitation. It would help us a lot. ” (P4) “ I'm interested in knowing how to make changes stick over time.” (P7) Implementation strategies VAST nurses employed a wide range of context-responsive implementation strategies to promote behaviour change and improve adherence to best practices. Training was typically delivered on-site, at the bedside or during shift transitions, ensuring immediate relevance and minimising disruption to routine workflows. Materials included short videos, infographics, posters, and digital messages, which were used to reinforce key practices in accessible formats. These approaches reflect well-established strategies, such as conducting educational meetings, using educational materials and adapting interventions to local context. “ When we detect a problem on a ward, we go there and deliver a brief session on the spot. ” (P3) “ We track all insertions and complications ourselves. That data helps justify changes. ” (P10) “ We’ve made short videos and digital infographics, anything that helps people remember. ” (P8) Participants also described extensive use of local data systems, often created and maintained independently of formal quality structures. They collected and analysed data on complication rates, device outcomes and ward-level trends to guide decision-making and support targeted interventions. This data-driven approach enabled iterative cycles of assessment, adaptation, and re-evaluation, mirroring the logic of quality improvement and implementation frameworks. “ We analyse phlebitis rates by ward. If a unit shows high rates, we act. ” (P1) “ Every month we review data and discuss it with supervisors. ” (P2) By combining real-time observation, customised education and continuous monitoring, VAST nurses applied practical facilitation strategies that enhanced their credibility, supported behaviour change and increased the likelihood that improvements would be sustained over time, even in the absence of formal organisational support structures. Organisational barriers All participants identified structural limitations as a key challenge. Most professionals reported insufficient staffing and the absence of dedicated time for implementation activities such as staff training, data analysis, or process evaluation. Their implementation efforts often occur on top of routine care, leading to overload and reactivity rather than proactive planning. “ We do everything when we are already overwhelmed. There’s no protected time. ” (P5) “ We lack time. ” (P6) Despite the importance and visibility of their work, many participants noted that their role is not formally recognised in hospital organisational charts or strategic plans. This lack of formalisation undermines the sustainability and legitimacy of the team’s efforts and makes it harder to advocate for additional resources or integration in decision-making bodies. “ We’re seen as important, but not yet structured into the organisation. ” (P2) “ Management trusts us, but it’s not formalised. There’s no structural role. ” (P5) Frequent changes in hospital staff, especially in wards, were cited as a major barrier. Implementation efforts—such as training or behavioural reinforcement—often have to be restarted from scratch, leading to fatigue and a sense of stagnation among VAST nurses. “ Staff changes so often that by the time you finish training some, you have to start again with others .” (P7) “ Lots of temporary staff, and that’s noticeable .” (P10) At the same time, many of the organisational barriers —including limited time, workforce instability and the absence of formalised structures —mirrored challenges commonly reported across clinical settings. However, these conditions had particular consequences for VAST teams, whose implementation work depends on continuity, organisational support and consistent engagement with ward staff. Consequently, such systemic constraints may disproportionately hinder their ability to initiate, scale or maintain practice change, creating an environment with limited capacity to support VAST-led implementation efforts despite the motivation and expertise of these professionals. Enabling local conditions When implementation efforts were successful, participants cited strong support from nursing leadership, informal recognition by colleagues, and collaboration across departments. They also described an organizational climate that supported professional autonomy and communication within teams. Involvement in multidisciplinary committees and the use of internal data were additionally viewed as legitimising factors that strengthened their authority to influence practice. “ The nursing management supports us, and that makes all the difference. ” (P3) “ We spotted a problem and channelled it through our Best Practice Spotlight Organisation programme lead. That connection is key. ” (P10) In addition to these existing facilitators, participants articulated several desired conditions that they believed would further enhance their capacity to implement and sustain change. These included the formal recognition of the VAST role, as well as partial or full-time role protection to ensure structured and continuous training, dedicated improvement activities and greater strategic involvement. They also emphasised the need to develop inter-institutional networks, enabling VAST teams across centres to share experiences, harmonise approaches and collectively strengthen vascular access practices at a national level. "We need at least two more nurses and a second VAST at the other hospital." (P7) "We should have meetings between VASTs from different centres, we would learn a lot." (P1) Together, these existing and envisioned conditions illustrate how organisational support, professional autonomy and networked collaboration can create a more favourable implementation environment, enabling VAST teams to scale up and sustain evidence-based vascular access practices. Mixed-methods integration To synthesise the quantitative and qualitative findings, a mixed-methods joint display was constructed (Table 5). This matrix illustrates how survey domains aligned with qualitative themes and subthemes, enabling the generation of integrated meta-inferences regarding VAST implementation competence. Table 5 Joint display of integrated mixed-methods findings. QUANTITATIVE ANALYSIS QUALITATIVE ANALYSIS Integrated interpretation Domain Findings Themes Subthemes / Codes D1. Knowledge 96,1% report knowing how to implement interventions Implementation competencies Empirical and informal acquisition High convergence : professionals feel knowledgeable, and interviews confirm deep experiential knowledge—even without formal training. Knowledge is acquired informally and pragmatically. 90% report knowing objectives, responsibilities and expectations D2. Skill High perceived skills (88–90%). Most feel capable of implementing interventions Desire for formal training Partial convergence : perceived skills are high, but interviews reveal skills learned informally and a lack of formal education. Gap between perceived vs. formal competency. 88.2% say they have received “training”. Key divergence : wording of the item likely misinterpreted → important finding demonstrating the need for formal implementation training. D3. Professional role and identity Highest scoring domain (M = 4.7). 96–100% agree implementation is part of their role. Strong role clarity. Expanded professional role From technical insertion to integral leadership Strong convergence . Both datasets show consolidated identity as implementers. Clinical, formative and consultative functions Nurses clearly perceive implementation as part of their job and describe actions aligns with this identity. D4. Beliefs about capabilities High self-efficacy but lower perceived behavioural control (only 58.8% find implementation “easy”). Organisational barriers Lack of human resources and protected time Strong triangulation : self-confidence is high, but organisational barriers reduce perceived ease, aligning low D4.6 values with narratives of overload and structural gaps. D5. Context (social–political organisational) Lowest scoring domain. Only 60–70% feel organisational support; <61% feel leadership listens. Lack of structural recognition Full convergence : interviews strongly emphasise insufficient structural support, matching low D5 values. Organisational factors = primary barrier. High staff turnover Lack of resources and time D6. Social influences / collective context High influence from peers and other ETI teams (92.2% report positive impact). Enabling conditions Collaborative culture and networking Total convergence : collaboration, peer influence, and leadership support emerge as key facilitators in both datasets. Support from leadership and professional recognition D7. Behavioural regulation Good planning (80.4%). Strong correlations D1–D7 (ρ = 0.59) and D2–D4 (ρ = 0.54). Implementation strategies On-site, tailored, context-sensitive training Strong convergence : qualitative strategies align precisely with behavioural regulation (planning, adapting, monitoring). Data-driven decisions match strong D1–D7 correlation. Visual and informal communication Use of data and iterative improvement The integration revealed areas of convergence, such as the alignment between high self-perceived knowledge, strong professional identity and the qualitative descriptions of adaptive, context-sensitive strategies used in daily practice. It also demonstrated complementarity, with the qualitative data expanding survey findings by detailing how intuitive, experiential learning compensates for the absence of formal implementation training. This integration highlighted divergences, particularly between the relatively positive quantitative ratings of organisational support and the qualitative accounts of structural limitations, insufficient recognition and lack of protected time. These integrated insights provide a more comprehensive understanding of the mechanisms, contextual influences and gaps between capability and context that shape VAST nurses’ implementation competence. Table 5. Joint display of integrated mixed-methods findings. DISCUSSION This study explored implementation competence for EBP among vascular access specialist nurses in Spain using a mixed-method approach. Combining quantitative and qualitative data provided a comprehensive understanding of how these nurses perceive, develop and enact their role in translating evidence into routine clinical practice. The findings revealed both convergence and divergence between the responses of professionals to structured scales and their descriptions of daily practice, offering nuanced insights into the strengths and weaknesses of implementation in real-world settings. Together, these findings help explain how individual-level competencies intersect with contextual and organisational determinants to enable or constrain implementation. The results showed a high level of agreement on the clarity of roles, professional identity and confidence in knowledge and skills. These findings were corroborated in the qualitative interviews, where participants demonstrated a clear understanding of their responsibilities and outlined various strategies employed in daily practice to improve intravenous therapy. A strong sense of ownership of the implementation role emerged, reflecting a shared professional commitment to influencing practice. This alignment between perceived competence and observed practice suggests that self-efficacy is a central driver of nurses’ engagement with EBP, consistent with evidence identifying self-efficacy as a key determinant of EBP adoption and implementation behaviour among healthcare professionals [35]. Despite lacking formal instruction in implementation science, participants described strategies that aligned with key implementation principles, such as tailored communication, local data use and in-situ training, but the qualitative data highlighted important structural and contextual limitations. The perceived behavioural control domain (D4) showed significantly lower agreement on items assessing ease of implementation and control. This was consistent with narratives about barriers to engaging in EBP and practice improvement activities, which emphasised a lack of time, staffing shortages, and lack of structural recognition [36,37]. Such conditions are well-documented barriers that limit the feasibility of EBP in routine care. Tensions emerged regarding training, with participants reporting that most educational opportunities focused on technical or device-related aspects rather than on skills required to implement and sustain EBP. This finding aligns with previous studies showing that proficiency in clinical procedures does not necessarily translate into competence in leading or supporting EBP-related change [38]. Notably, although a majority of participants reported some degree of organisational support, qualitative findings revealed limited institutional visibility of the VAST role with broader EBP and quality strategies. Participants described reliance on individual goodwill rather than structured organisational facilitation, suggesting that EBP in nursing is frequently maintained through personal commitment in the absence of consistent system-level support. These findings are consistent with international evidence that EBP adoption often stalls when nursing roles are not embedded within supportive organisational and policy frameworks [19,28,39]. Such organisational challenges also reflect broader system-level constraints (CFIR outer setting), including limited institutional recognition of implementation roles within national healthcare frameworks and the absence of standardised pathways for integrating evidence into policy and practice. Integrating both datasets suggests that highly motivated nurses with strong EBP capability are operating within constrained organisational environments. This interaction between self-efficacy, behavioural regulation, and contextual support aligns with established behavioural and implementation frameworks, which emphasise that sustained EBP requires both individual capability and organisational readiness [35]. Although vascular access specialist nurses appear to possess strong foundational skills and intrinsic motivation to lead EBP, their capacity to do so is constrained by inadequate structural and organisational support. This finding reflects a well-documented challenge in the EBP and implementation literature, namely the misalignment between individual readiness for change and organisational readiness to support and sustain practice change [40]. Several hypotheses may explain the observed lack of formal training in implementation methodologies among VAST professionals. One possible reason is the relative novelty of the VAST role or model within our healthcare context. Being a recently established professional group, formalized training programs and educational pathways focused on implementation competencies might still be under development or limited in availability. This lack of formalised training and inconsistent organisational recognition suggests an absence of shared professional consensus regarding the implementation-related responsibilities that VAST members are expected to assume. Establishing such consensus is therefore a necessary preliminary step before competencies can be formally developed, taught, and integrated into professional practice. This reflects broader challenges described in implementation scholarship, where professional groups often acquire implementation roles before structured training pathways are established [41]. Finally, organizational factors such as limited resources, competing priorities, or insufficient institutional support may also contribute to this gap. Understanding and addressing these underlying causes is essential for designing effective strategies to build implementation capacity in VASTs. To enhance the implementation capacity of VASTs, a dual strategy is required. Firstly, there should be sustained investment in formal education, and secondly, mentoring in implementation frameworks must be provided by organisational programmes, alongside the creation of supportive institutional conditions. This encompasses formally recognising the VAST role as implementers, allocating time for conducting interventions, and incorporating VASTs into strategic quality committees. Implementing these measures could enhance the effectiveness of improvement interventions and ultimately contribute to the broader objective of embedding evidence-based practices in routine clinical work [42]. This study should be interpreted with consideration of several limitations. The absence of an official national registry of VASTs in Spain meant that participants from different geographical regions could not be identified and recruited systematically. This may have resulted in unbalanced geographical representation and sampling bias, potentially limiting the external validity of the findings. Moreover, because recruitment relied predominantly on large, tertiary, and university-affiliated hospitals, which often have more mature VAST structures and stronger organisational infrastructures, the findings may overestimate the level of implementation competence or organisational support available in smaller or less resourced institutions. This limits the transferability of the results to contexts where VAST teams are newer, less formalised, or operate with fewer institutional enablers. Furthermore, using a Likert-scale questionnaire to explore constructs with which many participants may be unfamiliar –particularly those lacking formal training in implementation science– introduces the possibility of response bias. This bias may manifest as socially desirable answers or a disproportionate response rate from nurses who are already engaged with, motivated by, or sensitised to implementation-related issues. This is consistent with the lower levels of agreement observed in the perceived behavioural control domain, where unfamiliarity with implementation concepts may have influenced how participants approached the items. Additionally, self-reported data may be unreliable due to differences in how individuals interpret items and variations in respondents' understanding of the theoretical constructs being measured. Nevertheless, the inclusion of qualitative data provided substantial contextual depth, allowing cross-validation of quantitative patterns and enhancing interpretive rigour. Taken together, this mixed-method triangulation helped mitigate some of these limitations and strengthened the credibility and interpretive validity of the findings. These methodological constraints suggest that future efforts to strengthen VAST implementation competence should move beyond reliance on individual motivation and towards approaches that embed implementation capability as an organisational function. CONCLUSION This study provides the first in-depth characterisation of implementation competence for EBP among VAST nurses in Spain. Using a mixed-method approach, we identified a highly motivated and experienced workforce that views EBP as integral to its professional role, supported by strong role clarity, knowledge, and adaptive practice strategies. Despite these strengths, a substantial gap emerged between individual readiness for EBP and organisational capacity to support, which restricted nurses’ perceived control over practice change. These findings highlight the need to strengthen both individual capability and contextual enablers to ensure that VASTs can function as effective leaders of EBP. A dual strategy is therefore required, combining targeted education aligned with EBP and implementation frameworks with organisational conditions that formally recognise and integrate VAST roles within quality and patient safety strategies. At a system level, national mechanisms that enhance coordination, role visibility, and standardisation may further support the sustainability and scale-up of evidence-based vascular access practices across healthcare settings. Declarations Ethical approval and consent to participate: The study was approved by the Clinical Research Ethics Committee at the Health Research Institute of the Jiménez Díaz Foundation in Madrid (reference PIC241-22_FJD). Informed consent was sought in writing from the participants. The researchers will not release any information that could identify participants, although the units where the study will be conducted will be mentioned. In any case, the research team commits to strict compliance with the applicable Spanish data protection legislation, ensuring that participants in the study may exercise their rights by request to the principal investigator. Consent for publication: The views expressed in this article are those of the author and are not necessarily those of United Kingdom Health Security Agency or the Department of Health and Social Care. This manuscript does not contain data from any individual person. Competing interests: No conflict of interest has been declared by the authors. Funding: The authors declare that this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution IF-F and AC-H are the principal investigators and EC-S and IB-M are the co-seniors of the study. All authors contributed to the original idea and design of the study. All authors are responsible for the conduct of the study. IF-F and IB-M prepared the first draft of the manuscript. IB-M and EC-S provided qualitative expertise and conducted the analyses and IF-F and AZ-S provided expertise for statistical analyses. All authors provided critical commentary on drafts and approved the final protocol manuscript. Acknowledgement We wish to express our sincere gratitude to all the nurses who participated in and supported the project. Their commitment, professionalism, and willingness to contribute their time and expertise were essential to the successful development of this study. We are particularly grateful for their engagement throughout the different phases of the project and for their valuable insights, which greatly enriched the research process. Data Availability The datasets generated during and/or analysed during the current study are/will be available upon request from the corresponding author on reasonable request and will be included in the published article (and its supplementary information files). The data will be available beginning 3 months and ending 5 years following article publication for to investigators, whose proposed use of data will have been approved by an independent review committee identified for to realise the qualitative meta-analysis. Proposals may be submitted up to 36 months following article publication. 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12:19:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1405470,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8650806/v1/7400eebb-4eb5-436d-9c95-a7b9520a2e0d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImplementation Competence for Evidence-based Practice Among Vascular Access Specialist Team Nurses: A Mixed-method Study\u003c/p\u003e","fulltext":[{"header":"Contributions to literature","content":"\u003cul\u003e\n \u003cli\u003eThis study provides the first empirical characterisation of implementation competence for evidence-based practice (EBP) among vascular access specialist teams (VASTs), a workforce essential to evidence-based vascular access care but previously unexplored in relation to EBP capability.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBy integrating quantitative and qualitative evidence, the study identifies key behavioural and contextual mechanisms, such as self-efficacy, behavioural regulation, and organisational support, that influence nurses’ capability to implement and sustain EBP, offering insights into how EBP capability develops within specialised nursing teams.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFindings reveal a gap between strong individual motivation for EBP and limited organisational capacity to support it, underscoring the need for structured education in implementation and EBP, as well as system-level arrangements that formally embed VAST roles within quality and safety strategies.\u003c/li\u003e\n \u003cli\u003eBy foregrounding the experiences and challenges of vascular access specialist nurses, this study provides actionable insights for nursing leadership, workforce development, and policy initiatives, highlighting the need to align individual motivation for EBP with organisational capacity to support its sustained implementation.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"BACKGROUND","content":"\u003cp\u003eCatheters are intravascular devices commonly used in healthcare to administer intravenous therapy and represent one of the most frequently used medical devices in hospitals [1]. Nearly three quarters of hospitalised patients require at least one vascular access device (VAD) during their stay [1], making vascular access care a critical component of nursing practice with direct implications for patient safety [2]. The use of VADs can lead to complications such as infections, mechanical obstructions, thrombosis, phlebitis, infiltration, and extravasation [3\u0026ndash;5]. Catheter-related bloodstream infections (CRBSI) remain one of the most serious healthcare-associated complications worldwide, with reported prevalence ranging from 0.4 to 1.2% depending on device type and clinical context and are associated with high morbidity, mortality and healthcare costs [6\u0026ndash;8].\u003c/p\u003e \u003cp\u003eThe selection, insertion, management, and maintenance of VADs constitute a complex, multifaceted process that requires ongoing clinical judgement and coordination by nurses and other healthcare professionals [9]. Some of the factors influencing VAD outcomes include patient diagnosis, vascular condition, characteristics and duration of the therapy administered, VAD availability, healthcare professional competence, patient preferences, organisational culture, and established standards [10,11]. This complexity contributes to variability in practice and poses a significant challenge for the consistent application of evidence-based practice (EBP) in vascular access care [2,12\u0026ndash;14]. To address variability and improve patient outcomes, healthcare organisations have increasingly promoted the development and institutionalisation of vascular access specialist teams (VASTs) [15\u0026ndash;17]. These teams typically involve experienced nurses with advanced knowledge and skills, who comprehensively assess patients to optimise VAD selection, insertion, maintenance, and removal, while adapting care to patients\u0026rsquo; evolving clinical needs [11]. Beyond technical proficiency, VAST nurses frequently act as advisors and consultants to other professionals [18], supporting decision-making and recommending evidence-based interventions to address gaps between best evidence and routine practice [19,20]. As such, VASTs play a central role in facilitating the uptake of evidence-based vascular access care within multidisciplinary teams [19]. However, despite their recognised clinical value, the implementation and formal integration of VASTs within hospital organisations remain inconsistent, with reported challenges related to role definition, institutional support, and sustainability across different healthcare settings [21,22].\u003c/p\u003e \u003cp\u003eVASTs provide substantial benefits to patients by ensuring safe and effective vascular access management. Beyond direct patient care, these teams offer expert support to multidisciplinary healthcare teams that rely on their specialised knowledge [21]. In addition, VASTs contribute to improving healthcare delivery processes by identifying and optimising clinical pathways related to vascular access and intravenous therapy. To achieve these improvements, VAST nurses must mobilise the best available evidence and translate it into clinical practice. This requires not only clinical expertise, but also competence in implementing and sustaining EBP and practice change, enabling them to effectively bridge the gap between evidence and routine care [23]. Implementation competence for EBP can be understood as the ability to purposefully apply evidence-informed strategies and behavioural skills to promote practice change within specific organisational contexts. According to the implementation framework, this competence aligns with the facilitator role \u0026ndash; integrating evidence, contextual knowledge, stakeholder skills and motivations, and facilitation strategies to enable change and sustainability [24].\u003c/p\u003e \u003cp\u003eDespite these expectations, there is limited empirical knowledge about how VAST nurses develop, enact, and perceive these implementation-related capacities. Theoretical models such as the COM-B or the theoretical domains framework offer a behavioural lens to understand the determinants of implementation competence, characterising it beyond technical or clinical skill [23]. As a specialised core component of intravenous care, VASTs, along with the rest of the healthcare team, face challenges regarding the dissemination, adoption, and sustainability of evidence, resource adequacy, and care management decisions [25\u0026ndash;27]. Although implementation science has emerged as a valuable field to support healthcare professionals in addressing these challenges and to perform their roles effectively [28\u0026ndash;30], most research in vascular access has focused on clinical outcomes rather than on the professional and organisational capacities required to translate evidence into routine nursing practice [19,21\u0026ndash;23]. Addressing this gap is essential to strengthen evidence-based vascular access care and improve patient safety. By examining implementation competence for EBP among VAST nurses, this study aims to inform educational, organisational, and policy strategies that support nurses in leading and sustaining EBP. Accordingly, this study assesses implementation competence for EBP among VAST nurses in Spain, exploring their experiences, attitudes, and perceptions of organisational support, with a particular focus on their facilitative role in promoting practice change within healthcare organisations.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eWe conducted this study in two simultaneous stages. The first stage, quantitative, adapted the online questionnaire validated by Huijg et al. [31] to the Spanish context. At the same time, the second stage, employed semi-structured in-depth interviews to explore the role of VAST nurses facilitating change and implementation of quality improvement interventions. The rationale for this multiple methodology is the complexity of implementation science itself, its intrinsic characteristics within this organisational context, skills acquisition by healthcare professionals, and the way these skills are developed in clinical practice through a facilitative role within VASTs. Each stage of the research is described in detail below:\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1. Quantitative stage\u003c/span\u003e:\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design:\u003c/h2\u003e \u003cp\u003eWe conducted a multicentre, descriptive, cross-sectional study, using an online questionnaire based on Huijg et al et al. [31] and disseminated through the RedCap platform. We adapted the original questionnaire to evaluate the implementation skills of quality improvement interventions among VAST nurses in the Spanish context. As a similar study has never been done before in our context, we conducted this exploratory study, and the domains selected are those that we considered to fit our practice environment on a clinical, social, and cultural level.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants:\u003c/h3\u003e\n\u003cp\u003eEligibility for participation in the study required, employment as part of VAST nursing team for at least three months at the time of the research, in any health care organisation (private or state-funded) in Spain. Participation in the study was voluntary and did not involve any financial compensation.\u003c/p\u003e\n\u003ch3\u003eParticipant recruitment:\u003c/h3\u003e\n\u003cp\u003eWe employed a recruitment matrix with participants stratified first by autonomous community (i.e., largest administrative units in Spain), then by province capital, and finally by major city to be representative of the whole of Spain. We initially identified and contacted VASTs in the leading hospital of each geographical unit mentioned by emailing or phoning hospital managers or the person in charge of the relevant unit, using publicly available information on the website of organisation. When we received no response from managers, a given hospital lacked a VASTs, or the VAST team members declined to participate in the study, then we proceeded to contact the next leading hospital in our matrix, until we obtained the necessary number of participating facilities is reached. In addition, we recruited participants were recruited by disseminating the project through social networks (Twitter/X). Once the initial contact was made, the VAST nurses were informed of the purpose and details of the research via email. If they agreed to participate, they were provided with the link to the online questionnaire for completion, which also allowed them to express their interest to participate in the qualitative stage of the study.\u003c/p\u003e\n\u003ch3\u003eProcedure / Data collection:\u003c/h3\u003e\n\u003cp\u003eWe collected data, using an online questionnaire distributed to participating VAST nurses during March \u0026ndash; June 2023 through the RedCap platform. Prior to this, all the participating institutions and VASTs were contacted to inform them about the study and obtain their informed consent.\u003c/p\u003e\n\u003ch3\u003eMeasuring instrument and variables:\u003c/h3\u003e\n\u003cp\u003eOur online questionnaire developed based on Huijg et al et al. [31]. The original questionnaire was adapted to focus on implementation skills in improvement interventions, and included five sociodemographic and organisational items (age, gender, years of experience as a nurse, years of experience as VAST nurse, and hospital/facility of work), and 29 items concerning implementation science distributed across seven domains (D1. Knowledge; D2. Skills; D3. Social/professional role and identity; D4. Beliefs about capabilities; D5. Context; D6. Collective context; D7. Behavioural regulation). We scored these seven domains on a 5-point Likert scale, from 1 (little relevance) to 5 (highly relevant). (See domain and definitions in \u003cb\u003eAppendix 1\u003c/b\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSample size calculation:\u003c/h2\u003e \u003cp\u003eThe final sample was obtained using a purposive sampling with nurses working in VASTs on a national level, seeking to represent as many hospitals as possible in the 17 autonomous communities and the 2 autonomous cities of Spain, but at least the reference hospital from the capital from each of these regions. The participation of the principal hospitals in each autonomous community or city will be prioritised in order to obtain a representative sample of the entire Spanish territory.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eThe analysis included descriptive statistics (with categorical and continuous data were expressed as means, medians, standard deviations (SDs), and interquartile ranges (IQRs)), and a bivariate analysis with parametric and non-parametric tests depending on the distribution of the data (correlation tests, ANOVA, and/or chi-squared tests). Missing data were not included in the analysis. The statistical significance threshold was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All statistical analyses were conducted using SPSS software (version 25 SPSS/IBM, Chicago, Illinois, USA).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2. Qualitative stage\u003c/span\u003e:\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design:\u003c/h3\u003e\n\u003cp\u003eWe conducted a qualitative study, using a semi-structured interview to explore perceptions, experiences, and knowledge of implementation science among VAST nurses, identifying the facilitator role of these professionals.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eParticipant selection and recruitment:\u003c/h2\u003e \u003cp\u003eAs detailed above, VAST nurses who voluntarily provided their contact details (email address or telephone number) and consented to participate in the qualitative stage were eligible. These participants were considered as key informants to help identify and recruit other suitable participants, using snowball approach. We highlighted characteristics of sought after participants, for example, background and experience to enhance the potential richness of the interviews. Participation in the study was voluntary and did not involve any financial compensation for any of the participants. Participant selection, recruitment, and interviews were finalised once thematic saturation was reached.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData collection:\u003c/h2\u003e \u003cp\u003eAll semi-structured interviews were conducted by two researchers (IB-M and EC-S, two members of the research team) using an interview guide (\u003cb\u003eAppendix 2\u003c/b\u003e). The semi-structured interviews were conducted online using MS Teams during the second half of 2023 and first of 2024, at times convenient to the participants and lasted approximately 45 minutes. The interviews were recorded and automatically transcribed verbatim by the online tool. The researchers reviewed the transcriptions against the recordings and return them to participants for fidelity and clarification. The transcriptions were then anonymised prior to analysis. The researchers also took contemporary notes during and after the interview.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis:\u003c/h2\u003e \u003cp\u003eWe conducted a thematic analysis, following a continuous iterative familiarisation process [32]. In the inductive phase, we examined the transcripts for units of meaning that alluded to how the VAST facilitation process unfolded on the hospital wards and then code them. These codes were grouped into broader categories and subcategories. Three researchers independently coded each transcript of the semi-structured interviews. During the deductive phase, the data was analysed according to the aspects proposed in the theoretical framework and the literature review. A first coding framework was applied to the interviews, which was once again returned to respondents for codes and prominent theme validation.\u003c/p\u003e \u003cp\u003e We employed several triangulation strategies combined to compare the results obtained and build a code tree, triangulated by three researchers (AC-H, IB-M, and EC-S), to further enhance the methodological rigour of our analysis [33]. Regarding the methods, we compared the information from the interviews, the codes applied by the researchers, and the participants\u0026rsquo; reviews to identify coherence and discrepancies in the narrative (member checking). Regarding the data, two members of the research team with ample experience in implementation science (IB-M and EC-S) shared and discussed their findings. Another strategy to enhance rigour was to ensure meticulous adherence to procedure and that the researchers\u0026rsquo; reflections on methodological decisions made throughout the study are properly recorded, taking their dual status as clinicians and co-researchers into consideration [34].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eResearch and reflexivity team:\u003c/h2\u003e \u003cp\u003eThe knowledge of the implementation process held by the research team will be essential for the interpretation and contextualisation of the analysis. Two of the researchers, with previous experience in evidence implementation, social research, and vascular access, will coordinate and conduct the semi-structured interviews at the participating hospitals, which will allow them to establish a relationship and encourage open and frank discussion. IF-F is a doctoral student in the \u003cem\u003eInvestigaci\u0026oacute;n Traslacional en Salud P\u0026uacute;blica y Enfermedades de Alta Prevalencia\u003c/em\u003e (Translational Research in Public Health and High Prevalence Diseases) doctoral programme at the University of the Balearic Islands.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003eQuantitative stage\u003c/h2\u003e\n \u003cp\u003e61 VASTs were contacted, of which 37 (60.65%) agreed to participate (see Fig.\u0026nbsp;1). Finally, 51 VAST nurses in Spain completed the questionnaire. The sample was predominantly female (72.5%), with a mean age of 44.5 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5). Participants had 21 years of professional experience (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7), and 3.8 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6) of involvement in their respective VASTs.\u003c/p\u003e\n \u003cp\u003eFigure 1. \u003cstrong\u003eParticipating hospitals across Spain.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe overall mean score across the seven dimensions of the questionnaire was 4,2 out of Likert scale 5-point. The highest-rated domain was Social/Professional Role and Identity (Domain 3), with a mean of 4.7 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5). This was followed by Knowledge (D1) and Collective context (D6), both with mean scores above 4.2. Conversely, the Context (D5) dimension received the lowest score (mean 3.9, SD\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5). All data are included in Table\u0026nbsp;1.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSociodemographic characteristics and questionnaire scores.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eNonbinary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003cp\u003e13 (25,5)\u003c/p\u003e\n \u003cp\u003e37 (72,5)\u003c/p\u003e\n \u003cp\u003e1 (2,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44,47 (9,52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYears of experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (9,667)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYears of VAST experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,75 (3,628)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eDimensions of the questionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD1 Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,298 (0,441)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD2 Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,196 (0,458)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD3 Social/professional role and identity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,657 (0,485)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4 Beliefs about capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,049 (0,468)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD5 Context\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,922 (0,504)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD6 Collective context\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,186 (0,547)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD7 Behavioural regulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,137 (0,722)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTable\u0026nbsp;1. \u003cstrong\u003eSociodemographic characteristics and questionnaire scores.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe results from Table\u0026nbsp;2 indicate that participants demonstrated a strong sense of professional responsibility and role clarity regarding the implementation of intravenous therapy improvement interventions. Over 90% of participants reported high levels of knowledge, clarity about their responsibilities, and confidence in their skills to implement these interventions. Notably, 100% recognised it as part of their professional role. However, lower agreement was observed in items related to perceived behavioural control, with only 58.8% stating that implementation was \u0026ldquo;very easy\u0026rdquo; and around 70% feeling in full control of the process.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eScores for each questionnaire item regarding agreement among participants (Likert scale values 4\u0026ndash;5).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDomain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eConstructs (Number items)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValue 4\u0026ndash;5 (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003eD1 Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKnowledge (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD1.1 I know how to implement intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eRole clarity (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD1.2 The objectives of my role and the interventions I need to implement are clearly defined for me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD1.3 I know what my responsibilities are regarding the implementation of intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD1.4 Regarding the implementation of IVT improvement interventions, I know exactly what is expected of me (my supervisor and/or manager).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD1.5 The interventions to be carried out are clearly defined for me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eD2 Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSkills (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD2.1 I have received training in implementing intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD2.2 I have the necessary skills to implement intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD2.3 I can implement intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eD3 Social/professional role and identity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eProfessional role (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD3.1 Implementing intravenous therapy improvement interventions is part of my job as a nurse of vascular access specialist team.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD3.2 It is my responsibility as a nurse in the VAST to implement intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"12\"\u003e\n \u003cp\u003eD4 Beliefs about capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSelf-efficacy (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.1 I am confident in being able to implement intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.2 I am confident in being able to implement intravenous therapy improvement interventions even when other professionals do not.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.3 I am confident in being able to implement intravenous therapy improvement interventions even when there is time available to do so.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.4 I am confident in being able to implement intravenous therapy improvement interventions even when the targeted professionals are not motivated.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePerceived behavioural control (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.5 I am in control of how the implementation of intravenous therapy improvement interventions will be carried out.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.6 Implementing intravenous therapy improvement interventions is very easy for me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.7 Delivering training related to an intravenous therapy improvement intervention is very easy for me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.8 Evaluating participants who receive training related to an intravenous therapy improvement intervention is very easy for me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.9 Monitoring the maintenance of optimal intravenous therapy maintenance behaviours outside of an intravenous therapy improvement intervention is very easy for me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4.10 Providing feedback on the intravenous therapy improvement intervention to the professional targeted by the intervention is easy for me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"9\"\u003e\n \u003cp\u003eD5 Context\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSocial-political context (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD5.1 The team receives sufficient support from the government and local authorities for the implementation of interventions to improve intravenous therapy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eOrganisational resources and support (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD5.2 In the organisation where I work, I have all the necessary resources to implement intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD5.3 I have the support of the management of the organisation in which I work for the implementation of intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD5.4 The management of the organisation is open to listen to the difficulties in implementing intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD5.5 The management of the organisation in which I work offers support (financial, resources, training, etc.) for the implementation of intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eInnovation strategy (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD5.6 The organisation in which I work provides training for professionals in the implementation of intravenous therapy improvement interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eD6 Collective context\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSocial influences (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD6.1 The professionals with whom I implement intravenous therapy improvement interventions think that I should be the one to implement and/or lead them.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD6.2 The existence of vascular access specialist team professionals from other centres carrying out implementation has an influence on me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eD7 Behavioural regulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAction planning (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD7.1 I have a clear plan for how I would deliver an intravenous therapy improvement intervention.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTable\u0026nbsp;2. \u003cstrong\u003eScores for each questionnaire item regarding agreement among participants (Likert scale values 4\u0026ndash;5).\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCorrelation analyses revealed significant positive relationships between key domains: D1 (Knowledge) and D4 (Beliefs about Capabilities): \u0026rho;\u0026thinsp;=\u0026thinsp;0.574, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; D1 and D7 (Behavioural Regulation): \u0026rho;\u0026thinsp;=\u0026thinsp;0.591, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; D2 (Skills) and D4: \u0026rho;\u0026thinsp;=\u0026thinsp;0.548, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; and D4 and D6 (Organisational Context): \u0026rho;\u0026thinsp;=\u0026thinsp;0.509, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01. All data are included in Table 3\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCorrelations between domains related to implementation questionnaire\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD6\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD7\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eD1\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,454 (0,001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,192 (0,178)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,574\u003c/p\u003e\n \u003cp\u003e(\u0026lt;\u0026thinsp;0,001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,296 (0,035)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,300 (0,032)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,591 (\u0026lt;\u0026thinsp;0,001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eD2\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,156 (0,275)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,548 (\u0026lt;\u0026thinsp;0,001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,329 (0,018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,288 (0,040)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,364 (0,009)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eD3\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,309 (0,309)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,114 (0,424)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,372 (0,007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,160 (0,262)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eD4\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,258 (0,068)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,509 (\u0026lt;\u0026thinsp;0,001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,332 (0,017)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eD5\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,279 (0,047)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,143 (0,246)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eD6\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,246 (0,082)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eD7\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eD1. Knowledge; D2. Skills; D3. Social/professional role and identity; D4. Beliefs about capabilities; D5. Context; D6. Collective context; and D7. Behavioural regulation).\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTable\u0026nbsp;3. \u003cstrong\u003eCorrelations between domains related to implementation questionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo statistically significant differences were found between groups based on age, years of professional experience, or time working in a VAST, across the domains of the implementation questionnaire. However, a statistically significant difference was observed between years of experience and the collective context domain. Detailed results are presented in Table\u0026nbsp;4.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eRelationship of sociodemographic characteristics and the domains of the implementation questionnaire\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD6\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD7\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,246\u003c/p\u003e\n \u003cp\u003e(0,082)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,20\u003c/p\u003e\n \u003cp\u003e(0,891)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,213\u003c/p\u003e\n \u003cp\u003e(0,133)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,037\u003c/p\u003e\n \u003cp\u003e(0,797)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,068\u003c/p\u003e\n \u003cp\u003e(0,637)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,108\u003c/p\u003e\n \u003cp\u003e(0,452)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,232\u003c/p\u003e\n \u003cp\u003e(0,101)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,493\u003c/p\u003e\n \u003cp\u003e(0,486)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,245\u003c/p\u003e\n \u003cp\u003e(0,623)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,798\u003c/p\u003e\n \u003cp\u003e(0,376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,399\u003c/p\u003e\n \u003cp\u003e(0,128)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,572\u003c/p\u003e\n \u003cp\u003e(0,216)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,532\u003c/p\u003e\n \u003cp\u003e(0,469)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003cp\u003e(0,971)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of experience\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,198\u003c/p\u003e\n \u003cp\u003e(0,163)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,048\u003c/p\u003e\n \u003cp\u003e(0,737)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,235\u003c/p\u003e\n \u003cp\u003e(0,097)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,087\u003c/p\u003e\n \u003cp\u003e(0,543)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,037\u003c/p\u003e\n \u003cp\u003e(0,797)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,117\u003c/p\u003e\n \u003cp\u003e(0,413)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,215\u003c/p\u003e\n \u003cp\u003e(0,130)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of VAST experience\u003c/strong\u003e, \u0026rho; (p-value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,173\u003c/p\u003e\n \u003cp\u003e(0,225)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,078\u003c/p\u003e\n \u003cp\u003e(0,588)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,264\u003c/p\u003e\n \u003cp\u003e(0,061)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,102\u003c/p\u003e\n \u003cp\u003e(0,476)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,039\u003c/p\u003e\n \u003cp\u003e(0,784)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,293\u003c/p\u003e\n \u003cp\u003e(0,037)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,208 (0,143)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTable\u0026nbsp;4. \u003cstrong\u003eRelationship of sociodemographic characteristics and the domains of the implementation questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003eQualitative stage\u003c/h2\u003e\n \u003cp\u003eThe qualitative stage included interviews with ten nurses from VASTs in diverse hospital contexts. Thematic analysis revealed five overarching themes that collectively portray how VAST nurses enact and develop implementation competencies in the absence of formal training specific to implementation, despite receiving routine technical and device-related instruction. \u003cstrong\u003eAppendix 3\u003c/strong\u003e provides a matrix of themes, subthemes, and illustrative quotes.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eExpanded professional role.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eParticipants highlighted a transformation in their role, from a primarily technical focus on vascular access device insertion to a broader scope that includes education, consultancy, auditing, epidemiological monitoring, and leadership in quality improvement. While these activities extend beyond clinical expertise, they also reflect the early stages of an implementation-oriented role, as VAST nurses increasingly influence how others deliver care, guide decision-making, and embed best practices into routine workflows. Participants widely agreed that VASTs should evolve beyond a technical insertion team to become a reference service for driving practice change, supporting not only device selection but also the adoption and reinforcement of evidence-based behaviours across clinical units.\u003c/p\u003e\n \u003cp\u003eThis expanded role was closely mediated by organisational context. In smaller hospitals, greater autonomy and flatter hierarchies enabled VAST nurses to influence ward routines more directly and to embed informal mechanisms that supported consistent and evidence-based vascular access care. These contextual features provided greater flexibility to extend their scope and to mobilise improvements more rapidly. practice change.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eThe VAST team is not just about inserting lines; there\u0026rsquo;s a lot of work behind the scenes.\u0026rdquo;\u003c/em\u003e (P1)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eEvery day is different. I do insertion, follow-up, answer consultations, prepare teaching materials... we do everything.\u003c/em\u003e\u0026rdquo; (P10)\u003c/p\u003e\n \u003cp\u003eThe daily responsibilities of VAST nurses extend beyond device insertion to include ongoing clinical assessments, staff education, and consultative support. Participants described providing bedside guidance, modelling best practices and tailoring training to ward needs, a set of activities that actively shape the behaviour of other clinicians. This multidimensional role positions them not only as clinical referents but also facilitators of practice change, helping teams adopt and sustain safer vascular access procedures.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;We give training on the ward, advise on which device to use, and solve problems when there are complications.\u0026rdquo; (P2)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eImplementation competencies\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNone of the participants had received formal education in implementation science. Learning occurs primarily through experiential processes, including trial-and-error, mentorship, and peer observation. Despite this lack of structured training, participants described a range of behaviours and skills that align with core implementation competencies, such as planning change initiatives, adapting interventions to local context, troubleshooting barriers, engaging stakeholders and monitoring outcomes over time.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWe do it intuitively\u0026hellip; I guess it\u0026rsquo;s a science of some sort.\u003c/em\u003e\u0026rdquo; (P1)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWhat I used to hate\u0026mdash;planning, metrics, follow-up\u0026mdash;I now realise are essential.\u003c/em\u003e\u0026rdquo; (P9)\u003c/p\u003e\n \u003cp\u003eAcross interviews, participants demonstrated elements of implementation capability, even if not framed as such. Many described systematically identifying problems, developing pragmatic solutions, testing and refining strategies, and using local data to inform decisions \u0026ndash; processes that mirror iterative cycles of improvement and facilitation found in implementation frameworks such as i-PARIHS and COM-B. These behaviours suggest an emerging but largely untapped competence that could be strengthened through formal development. Participants also expressed a strong desire for structured training to consolidate their intuitive practices and to build confidence in applying evidence-informed methods. They perceived that formal education would enable them not only to improve their own performance but also to lead change more effectively, engage colleagues, and sustain change within their organisations.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eIf there was a course on this, I\u0026rsquo;d do it without hesitation. It would help us a lot.\u003c/em\u003e\u0026rdquo; (P4)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eI\u0026apos;m interested in knowing how to make changes stick over time.\u0026rdquo;\u003c/em\u003e (P7)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eImplementation strategies\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eVAST nurses employed a wide range of context-responsive implementation strategies to promote behaviour change and improve adherence to best practices. Training was typically delivered on-site, at the bedside or during shift transitions, ensuring immediate relevance and minimising disruption to routine workflows. Materials included short videos, infographics, posters, and digital messages, which were used to reinforce key practices in accessible formats. These approaches reflect well-established strategies, such as conducting educational meetings, using educational materials and adapting interventions to local context.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWhen we detect a problem on a ward, we go there and deliver a brief session on the spot.\u003c/em\u003e\u0026rdquo; (P3)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWe track all insertions and complications ourselves. That data helps justify changes.\u003c/em\u003e\u0026rdquo; (P10)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWe\u0026rsquo;ve made short videos and digital infographics, anything that helps people remember.\u003c/em\u003e\u0026rdquo; (P8)\u003c/p\u003e\n \u003cp\u003eParticipants also described extensive use of local data systems, often created and maintained independently of formal quality structures. They collected and analysed data on complication rates, device outcomes and ward-level trends to guide decision-making and support targeted interventions. This data-driven approach enabled iterative cycles of assessment, adaptation, and re-evaluation, mirroring the logic of quality improvement and implementation frameworks.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWe analyse phlebitis rates by ward. If a unit shows high rates, we act.\u003c/em\u003e\u0026rdquo; (P1)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eEvery month we review data and discuss it with supervisors.\u003c/em\u003e\u0026rdquo; (P2)\u003c/p\u003e\n \u003cp\u003eBy combining real-time observation, customised education and continuous monitoring, VAST nurses applied practical facilitation strategies that enhanced their credibility, supported behaviour change and increased the likelihood that improvements would be sustained over time, even in the absence of formal organisational support structures.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOrganisational barriers\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAll participants identified structural limitations as a key challenge. Most professionals reported insufficient staffing and the absence of dedicated time for implementation activities such as staff training, data analysis, or process evaluation. Their implementation efforts often occur on top of routine care, leading to overload and reactivity rather than proactive planning.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWe do everything when we are already overwhelmed. There\u0026rsquo;s no protected time.\u003c/em\u003e\u0026rdquo; (P5)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWe lack time.\u003c/em\u003e\u0026rdquo; (P6)\u003c/p\u003e\n \u003cp\u003eDespite the importance and visibility of their work, many participants noted that their role is not formally recognised in hospital organisational charts or strategic plans. This lack of formalisation undermines the sustainability and legitimacy of the team\u0026rsquo;s efforts and makes it harder to advocate for additional resources or integration in decision-making bodies.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWe\u0026rsquo;re seen as important, but not yet structured into the organisation.\u003c/em\u003e\u0026rdquo; (P2)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eManagement trusts us, but it\u0026rsquo;s not formalised. There\u0026rsquo;s no structural role.\u003c/em\u003e\u0026rdquo; (P5)\u003c/p\u003e\n \u003cp\u003eFrequent changes in hospital staff, especially in wards, were cited as a major barrier. Implementation efforts\u0026mdash;such as training or behavioural reinforcement\u0026mdash;often have to be restarted from scratch, leading to fatigue and a sense of stagnation among VAST nurses.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eStaff changes so often that by the time you finish training some, you have to start again with others\u003c/em\u003e.\u0026rdquo; (P7)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eLots of temporary staff, and that\u0026rsquo;s noticeable\u003c/em\u003e.\u0026rdquo; (P10)\u003c/p\u003e\n \u003cp\u003eAt the same time, many of the organisational barriers \u0026mdash;including limited time, workforce instability and the absence of formalised structures \u0026mdash;mirrored challenges commonly reported across clinical settings. However, these conditions had particular consequences for VAST teams, whose implementation work depends on continuity, organisational support and consistent engagement with ward staff. Consequently, such systemic constraints may disproportionately hinder their ability to initiate, scale or maintain practice change, creating an environment with limited capacity to support VAST-led implementation efforts despite the motivation and expertise of these professionals.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEnabling local conditions\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eWhen implementation efforts were successful, participants cited strong support from nursing leadership, informal recognition by colleagues, and collaboration across departments. They also described an organizational climate that supported professional autonomy and communication within teams. Involvement in multidisciplinary committees and the use of internal data were additionally viewed as legitimising factors that strengthened their authority to influence practice.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eThe nursing management supports us, and that makes all the difference.\u003c/em\u003e\u0026rdquo; (P3)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWe spotted a problem and channelled it through our Best Practice Spotlight Organisation programme lead. That connection is key.\u003c/em\u003e\u0026rdquo; (P10)\u003c/p\u003e\n \u003cp\u003eIn addition to these existing facilitators, participants articulated several desired conditions that they believed would further enhance their capacity to implement and sustain change. These included the formal recognition of the VAST role, as well as partial or full-time role protection to ensure structured and continuous training, dedicated improvement activities and greater strategic involvement. They also emphasised the need to develop inter-institutional networks, enabling VAST teams across centres to share experiences, harmonise approaches and collectively strengthen vascular access practices at a national level.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026quot;We need at least two more nurses and a second VAST at the other hospital.\u0026quot; (P7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026quot;We should have meetings between VASTs from different centres, we would learn a lot.\u0026quot; (P1)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eTogether, these existing and envisioned conditions illustrate how organisational support, professional autonomy and networked collaboration can create a more favourable implementation environment, enabling VAST teams to scale up and sustain evidence-based vascular access practices.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\"\u003e\n \u003ch2\u003eMixed-methods integration\u003c/h2\u003e\n \u003cp\u003eTo synthesise the quantitative and qualitative findings, a mixed-methods joint display was constructed (Table\u0026nbsp;5). This matrix illustrates how survey domains aligned with qualitative themes and subthemes, enabling the generation of integrated meta-inferences regarding VAST implementation competence.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eJoint display of integrated mixed-methods findings.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eQUANTITATIVE ANALYSIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eQUALITATIVE ANALYSIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eIntegrated interpretation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDomain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFindings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThemes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubthemes / Codes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eD1. Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96,1% report knowing how to implement interventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eImplementation competencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eEmpirical and informal acquisition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh convergence\u003c/strong\u003e: professionals feel knowledgeable, and interviews confirm deep experiential knowledge\u0026mdash;even without formal training. Knowledge is acquired informally and pragmatically.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90% report knowing objectives, responsibilities and expectations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eD2. Skill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh perceived skills (88\u0026ndash;90%). Most feel capable of implementing interventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDesire for formal training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartial convergence\u003c/strong\u003e: perceived skills are high, but interviews reveal skills learned informally and a lack of formal education. Gap between perceived vs. formal competency.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.2% say they have received \u0026ldquo;training\u0026rdquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKey divergence\u003c/strong\u003e: wording of the item likely misinterpreted \u0026rarr; important finding demonstrating the need for formal implementation training.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eD3. Professional role and identity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHighest scoring domain (M\u0026thinsp;=\u0026thinsp;4.7). 96\u0026ndash;100% agree implementation is part of their role. Strong role clarity.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eExpanded professional role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrom technical insertion to integral leadership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrong convergence\u003c/strong\u003e.\u003c/p\u003e\n \u003cp\u003eBoth datasets show consolidated identity as implementers.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinical, formative and consultative functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurses clearly perceive implementation as part of their job and describe actions aligns with this identity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD4. Beliefs about capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh self-efficacy but lower perceived behavioural control (only 58.8% find implementation \u0026ldquo;easy\u0026rdquo;).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eOrganisational barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of human resources and protected time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrong triangulation\u003c/strong\u003e: self-confidence is high, but organisational barriers reduce perceived ease, aligning low D4.6 values with narratives of overload and structural gaps.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eD5. Context (social\u0026ndash;political organisational)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eLowest scoring domain. Only 60\u0026ndash;70% feel organisational support; \u0026lt;61% feel leadership listens.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of structural recognition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull convergence\u003c/strong\u003e: interviews strongly emphasise insufficient structural support, matching low D5 values. Organisational factors\u0026thinsp;=\u0026thinsp;primary barrier.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh staff turnover\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of resources and time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eD6. Social influences / collective context\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHigh influence from peers and other ETI teams (92.2% report positive impact).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eEnabling conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollaborative culture and networking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal convergence\u003c/strong\u003e: collaboration, peer influence, and leadership support emerge as key facilitators in both datasets.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupport from leadership and professional recognition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eD7. Behavioural regulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eGood planning (80.4%). Strong correlations D1\u0026ndash;D7 (\u0026rho;\u0026thinsp;=\u0026thinsp;0.59) and D2\u0026ndash;D4 (\u0026rho;\u0026thinsp;=\u0026thinsp;0.54).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eImplementation strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOn-site, tailored, context-sensitive training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrong convergence\u003c/strong\u003e: qualitative strategies align precisely with behavioural regulation (planning, adapting, monitoring). Data-driven decisions match strong D1\u0026ndash;D7 correlation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVisual and informal communication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUse of data and iterative improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe integration revealed areas of convergence, such as the alignment between high self-perceived knowledge, strong professional identity and the qualitative descriptions of adaptive, context-sensitive strategies used in daily practice. It also demonstrated complementarity, with the qualitative data expanding survey findings by detailing how intuitive, experiential learning compensates for the absence of formal implementation training. This integration highlighted divergences, particularly between the relatively positive quantitative ratings of organisational support and the qualitative accounts of structural limitations, insufficient recognition and lack of protected time. These integrated insights provide a more comprehensive understanding of the mechanisms, contextual influences and gaps between capability and context that shape VAST nurses\u0026rsquo; implementation competence.\u003c/p\u003e\n \u003cp\u003eTable\u0026nbsp;5. \u003cstrong\u003eJoint display of integrated mixed-methods findings.\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study explored implementation competence for EBP among vascular access specialist nurses in Spain using a mixed-method approach. Combining quantitative and qualitative data provided a comprehensive understanding of how these nurses perceive, develop and enact their role in translating evidence into routine clinical practice. The findings revealed both convergence and divergence between the responses of professionals to structured scales and their descriptions of daily practice, offering nuanced insights into the strengths and weaknesses of implementation in real-world settings. Together, these findings help explain how individual-level competencies intersect with contextual and organisational determinants to enable or constrain implementation.\u003c/p\u003e \u003cp\u003eThe results showed a high level of agreement on the clarity of roles, professional identity and confidence in knowledge and skills. These findings were corroborated in the qualitative interviews, where participants demonstrated a clear understanding of their responsibilities and outlined various strategies employed in daily practice to improve intravenous therapy. A strong sense of ownership of the implementation role emerged, reflecting a shared professional commitment to influencing practice. This alignment between perceived competence and observed practice suggests that self-efficacy is a central driver of nurses\u0026rsquo; engagement with EBP, consistent with evidence identifying self-efficacy as a key determinant of EBP adoption and implementation behaviour among healthcare professionals [35].\u003c/p\u003e \u003cp\u003eDespite lacking formal instruction in implementation science, participants described strategies that aligned with key implementation principles, such as tailored communication, local data use and in-situ training, but the qualitative data highlighted important structural and contextual limitations. The perceived behavioural control domain (D4) showed significantly lower agreement on items assessing ease of implementation and control. This was consistent with narratives about barriers to engaging in EBP and practice improvement activities, which emphasised a lack of time, staffing shortages, and lack of structural recognition [36,37]. Such conditions are well-documented barriers that limit the feasibility of EBP in routine care.\u003c/p\u003e \u003cp\u003eTensions emerged regarding training, with participants reporting that most educational opportunities focused on technical or device-related aspects rather than on skills required to implement and sustain EBP. This finding aligns with previous studies showing that proficiency in clinical procedures does not necessarily translate into competence in leading or supporting EBP-related change [38]. Notably, although a majority of participants reported some degree of organisational support, qualitative findings revealed limited institutional visibility of the VAST role with broader EBP and quality strategies. Participants described reliance on individual goodwill rather than structured organisational facilitation, suggesting that EBP in nursing is frequently maintained through personal commitment in the absence of consistent system-level support. These findings are consistent with international evidence that EBP adoption often stalls when nursing roles are not embedded within supportive organisational and policy frameworks [19,28,39]. Such organisational challenges also reflect broader system-level constraints (CFIR outer setting), including limited institutional recognition of implementation roles within national healthcare frameworks and the absence of standardised pathways for integrating evidence into policy and practice.\u003c/p\u003e \u003cp\u003eIntegrating both datasets suggests that highly motivated nurses with strong EBP capability are operating within constrained organisational environments. This interaction between self-efficacy, behavioural regulation, and contextual support aligns with established behavioural and implementation frameworks, which emphasise that sustained EBP requires both individual capability and organisational readiness [35]. Although vascular access specialist nurses appear to possess strong foundational skills and intrinsic motivation to lead EBP, their capacity to do so is constrained by inadequate structural and organisational support. This finding reflects a well-documented challenge in the EBP and implementation literature, namely the misalignment between individual readiness for change and organisational readiness to support and sustain practice change [40].\u003c/p\u003e \u003cp\u003eSeveral hypotheses may explain the observed lack of formal training in implementation methodologies among VAST professionals. One possible reason is the relative novelty of the VAST role or model within our healthcare context. Being a recently established professional group, formalized training programs and educational pathways focused on implementation competencies might still be under development or limited in availability. This lack of formalised training and inconsistent organisational recognition suggests an absence of shared professional consensus regarding the implementation-related responsibilities that VAST members are expected to assume. Establishing such consensus is therefore a necessary preliminary step before competencies can be formally developed, taught, and integrated into professional practice. This reflects broader challenges described in implementation scholarship, where professional groups often acquire implementation roles before structured training pathways are established [41]. Finally, organizational factors such as limited resources, competing priorities, or insufficient institutional support may also contribute to this gap.\u003c/p\u003e \u003cp\u003eUnderstanding and addressing these underlying causes is essential for designing effective strategies to build implementation capacity in VASTs. To enhance the implementation capacity of VASTs, a dual strategy is required. Firstly, there should be sustained investment in formal education, and secondly, mentoring in implementation frameworks must be provided by organisational programmes, alongside the creation of supportive institutional conditions. This encompasses formally recognising the VAST role as implementers, allocating time for conducting interventions, and incorporating VASTs into strategic quality committees. Implementing these measures could enhance the effectiveness of improvement interventions and ultimately contribute to the broader objective of embedding evidence-based practices in routine clinical work [42].\u003c/p\u003e \u003cp\u003eThis study should be interpreted with consideration of several limitations. The absence of an official national registry of VASTs in Spain meant that participants from different geographical regions could not be identified and recruited systematically. This may have resulted in unbalanced geographical representation and sampling bias, potentially limiting the external validity of the findings. Moreover, because recruitment relied predominantly on large, tertiary, and university-affiliated hospitals, which often have more mature VAST structures and stronger organisational infrastructures, the findings may overestimate the level of implementation competence or organisational support available in smaller or less resourced institutions. This limits the transferability of the results to contexts where VAST teams are newer, less formalised, or operate with fewer institutional enablers. Furthermore, using a Likert-scale questionnaire to explore constructs with which many participants may be unfamiliar \u0026ndash;particularly those lacking formal training in implementation science\u0026ndash; introduces the possibility of response bias. This bias may manifest as socially desirable answers or a disproportionate response rate from nurses who are already engaged with, motivated by, or sensitised to implementation-related issues. This is consistent with the lower levels of agreement observed in the perceived behavioural control domain, where unfamiliarity with implementation concepts may have influenced how participants approached the items. Additionally, self-reported data may be unreliable due to differences in how individuals interpret items and variations in respondents' understanding of the theoretical constructs being measured. Nevertheless, the inclusion of qualitative data provided substantial contextual depth, allowing cross-validation of quantitative patterns and enhancing interpretive rigour. Taken together, this mixed-method triangulation helped mitigate some of these limitations and strengthened the credibility and interpretive validity of the findings. These methodological constraints suggest that future efforts to strengthen VAST implementation competence should move beyond reliance on individual motivation and towards approaches that embed implementation capability as an organisational function.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study provides the first in-depth characterisation of implementation competence for EBP among VAST nurses in Spain. Using a mixed-method approach, we identified a highly motivated and experienced workforce that views EBP as integral to its professional role, supported by strong role clarity, knowledge, and adaptive practice strategies. Despite these strengths, a substantial gap emerged between individual readiness for EBP and organisational capacity to support, which restricted nurses\u0026rsquo; perceived control over practice change. These findings highlight the need to strengthen both individual capability and contextual enablers to ensure that VASTs can function as effective leaders of EBP.\u003c/p\u003e \u003cp\u003eA dual strategy is therefore required, combining targeted education aligned with EBP and implementation frameworks with organisational conditions that formally recognise and integrate VAST roles within quality and patient safety strategies. At a system level, national mechanisms that enhance coordination, role visibility, and standardisation may further support the sustainability and scale-up of evidence-based vascular access practices across healthcare settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate:\u003c/strong\u003e \u003cp\u003e The study was approved by the Clinical Research Ethics Committee at the Health Research Institute of the Jim\u0026eacute;nez D\u0026iacute;az Foundation in Madrid (reference PIC241-22_FJD). Informed consent was sought in writing from the participants. The researchers will not release any information that could identify participants, although the units where the study will be conducted will be mentioned. In any case, the research team commits to strict compliance with the applicable Spanish data protection legislation, ensuring that participants in the study may exercise their rights by request to the principal investigator.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eThe views expressed in this article are those of the author and are not necessarily those of United Kingdom Health Security Agency or the Department of Health and Social Care. This manuscript does not contain data from any individual person.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eNo conflict of interest has been declared by the authors.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors declare that this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eIF-F and AC-H are the principal investigators and EC-S and IB-M are the co-seniors of the study. All authors contributed to the original idea and design of the study. All authors are responsible for the conduct of the study. IF-F and IB-M prepared the first draft of the manuscript. IB-M and EC-S provided qualitative expertise and conducted the analyses and IF-F and AZ-S provided expertise for statistical analyses. All authors provided critical commentary on drafts and approved the final protocol manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe wish to express our sincere gratitude to all the nurses who participated in and supported the project. Their commitment, professionalism, and willingness to contribute their time and expertise were essential to the successful development of this study. We are particularly grateful for their engagement throughout the different phases of the project and for their valuable insights, which greatly enriched the research process.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analysed during the current study are/will be available upon request from the corresponding author on reasonable request and will be included in the published article (and its supplementary information files). The data will be available beginning 3 months and ending 5 years following article publication for to investigators, whose proposed use of data will have been approved by an independent review committee identified for to realise the qualitative meta-analysis. Proposals may be submitted up to 36 months following article publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlexandrou E, Ray-Barruel G, Carr PJ, Frost SA, Inwood S, Higgins N, et al. Use of Short Peripheral Intravenous Catheters: Characteristics, Management, and Outcomes Worldwide. J Hosp Med [Internet]. 2018;13. https://doi.org/10.12788/jhm.3039\u003c/li\u003e\n\u003cli\u003ePronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU. New England Journal of Medicine [Internet]. 2006;355:2725–32. https://doi.org/10.1056/NEJMoa061115\u003c/li\u003e\n\u003cli\u003eMarsh N, Webster J, Larsen E, Cooke M, Mihala G, Rickard CM. Observational Study of Peripheral Intravenous Catheter Outcomes in Adult Hospitalized Patients: A Multivariable Analysis of Peripheral Intravenous Catheter Failure. J Hosp Med [Internet]. 2017;13:83–9. https://doi.org/10.12788/jhm.2867\u003c/li\u003e\n\u003cli\u003eBlanco-Mavillard I, Rodríguez-Calero MÁ, de Pedro-Gómez J, Parra-García G, Fernández-Fernández I, Castro-Sánchez E. Incidence of peripheral intravenous catheter failure among inpatients: variability between microbiological data and clinical signs and symptoms. Antimicrob Resist Infect Control [Internet]. 2019;8:124. https://doi.org/10.1186/s13756-019-0581-8\u003c/li\u003e\n\u003cli\u003eEuropean Centre for Disease Prevention and Control. 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Effect of a vascular access team on central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit: A systematic review. Int J Nurs Stud. 2015;52:1003–10. https://doi.org/10.1016/j.ijnurstu.2014.11.010\u003c/li\u003e\n\u003cli\u003eFernandez-Fernandez I, Parra-García G, Blanco-Mavillard I, Carr P, Santos-Costa P, Rodríguez-Calero MÁ. Vascular access specialist teams versus standard practice for catheter insertion and prevention of failure: a systematic review. BMJ Open. 2024;14:e082631. https://doi.org/10.1136/bmjopen-2023-082631\u003c/li\u003e\n\u003cli\u003eRodríguez-Calero MÁ, Carr PJ, Santos-Costa P, Blanco-Mavillard I. Vascular access specialist teams as a strategy to address future challenges in intravenous therapy. Enfermería Clínica (English Edition). 2025;35:502217. https://doi.org/10.1016/j.enfcle.2025.502217\u003c/li\u003e\n\u003cli\u003eGreenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A’Court C, et al. 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Health Serv Manage Res [Internet]. 2017;30:34–46. https://doi.org/10.1177/0951484816682396\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Evidence-based practice, implementation competence, vascular access, nurse competence, professional capability","lastPublishedDoi":"10.21203/rs.3.rs-8650806/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8650806/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003e: Evidence-based practice (EBP) is central to high-quality nursing care and patient safety, yet its effective adoption and sustainability depend on nurses\u0026rsquo; capability to translate evidence into routine practice. Vascular access specialist teams (VASTs) play a key role in implementing evidence-based interventions to reduce complications associated with intravenous therapy, but little is known about their capability to enact and sustain EBP in complex organisational contexts.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo assess the implementation competencies for EBP among VAST nurses in Spain, exploring their experiences, attitudes, and knowledge related to implementing and sustaining EBP, as well as their role as facilitators of practice change.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA two-stage, mixed-methods study was conducted in 2023. The quantitative stage involved a national cross-sectional survey of VAST nurses using an adapted, validated questionnaire informed by behavioural frameworks relevant to EBP adoption. The qualitative stage consisted of in-depth semi-structured interviews with a purposive sample of participants. Quantitative data were analysed using descriptive and multivariate methods, and qualitative data through thematic analysis and integrated using triangulation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFifty-one VAST nurses completed the questionnaire, reporting high self-perceived competence in domains such as social/professional role and identity (mean 4.7/5), knowledge (4.3), and collective context (4.2) for EBP. Lower scores were observed in contextual and organisational domains (mean 3.9), reflecting structural barriers to sustained EBP. Knowledge correlated positively with beliefs about capabilities (ρ\u0026thinsp;=\u0026thinsp;0.574), and behavioural regulation (ρ\u0026thinsp;=\u0026thinsp;0.591). Qualitative findings revealed five themes: expanded professional roles, experiential learning of implementation skills, context-sensitive strategies, organisational barriers, and enabling conditions. Participants described intuitive engagement with EBP despite lacking formal training, highlighting a gap between individual motivation and organisational support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eVAST nurses in Spain show strong intrinsic motivation and emerging capability to lead and support EBP, but limited formal training and weak organisational infrastructure restrict their ability to enact and sustain implementation activities. Strengthening nurses\u0026rsquo; EBP capability through structured implementation training, alongside organisational strategies that formalise and support the VAST role, may improve the adoption and sustainability of evidence-based vascular access care.\u003c/p\u003e","manuscriptTitle":"Implementation Competence for Evidence-based Practice Among Vascular Access Specialist Team Nurses: A Mixed-method Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 17:29:07","doi":"10.21203/rs.3.rs-8650806/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-14T05:06:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-11T05:21:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T07:41:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44315090121467683333634538526670555281","date":"2026-03-26T08:20:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118873131308214029230285528574866113510","date":"2026-03-22T23:39:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-02T13:26:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-28T07:13:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-28T07:09:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-01-20T14:42:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6cc00bdb-0d25-4a07-b88f-07432513355a","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T06:25:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 17:29:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8650806","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8650806","identity":"rs-8650806","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}