Table 2 Total scores from both ranking tasks (A - acceptability and F - feasibility) across the two nominal groups, and the decision to include or exclude the BCT/application from the intervention with brief rationale

1a

Prompts/cues

Attach laminated signs to vital signs monitoring equipment to prompt the desired behaviour +

10 (16)

46 (71)

0 (0)

14 (40)

70

12

3

✓

Highest scoring application for this BCT from nominal group participants

1b

Prompts/cues

Use best practice advisory ‘pop-ups’ on the Electronic Health Record to prompt the desired behaviour ∆

9 (16)

3 (5)

0 (0)

6 (17)

18

6

2

✓

Alternative (1a) application of this BCT favoured by nominal group participants

2a

Re-structuring the physical environment

Add vital signs monitoring equipment to the environment +

34 (62)

20 (31)

9 (30)

0 (0)

63

14

2

✓

High scoring from nominal group/s

2b

Re-structuring the physical environment

Add a visual marker on the floor to signal where the vital signs monitoring equipment should stand ∆

13 (24)

30 (46)

N/A

N/A

43

13

N/A

✓

High scoring from nominal group/s

2c

Re-structuring the physical environment

Add clocks with second hands to the ward to enable monitoring of respiratory rate ∆

2 (4)

15 (23)

3 (10)

11 (31)

31

7

3

✓

High scoring from nominal group/s

2d

Re-structuring the physical environment

Add more digital thermometers with timers for 15 s, 30s, 60s etc. to enable monitoring of respiratory rate ∅

N/A

N/A

3 (10)

9 (26)

12

N/A

4

✓

To ensure coverage of all target behaviours

3

Anticipated regret

Workshop based – ask RN/HCA to consider the degree of regret that they might feel if the desired behaviour was not enacted, and a patient came to harm +

4 (7)

0 (0)

4 (13)

0 (0)

8

1

1

✓

To ensure coverage of all TDF domains of high importance and all target behaviours

4

Pros/cons

Workshop based – ask RN/HCA to list and compare pros and cons of enacting the desired behaviour +

8 (15)

1 (2)

0 (0)

0 (0)

9

3

0

✓

To ensure coverage of all TDF domains of high importance and all target behaviours

5a

Re-structuring the social environment

Set the expectation that HCAs attend ward safety huddles alongside RNs to facilitate escalation of deteriorating patients +

7 (13)

3 (5)

5 (17)

3 (9)

18

3

2

✓

Highest scoring application for this BCT from nominal group participants

5b

Re-structuring the social environment

Proactively roster HCAs who will attend the safety huddles ∆

9 (16)

4 (6)

N/A

N/A

13

4

N/A

✓

Decision made that all HCAs should be encouraged to attend the safety huddle

5c

Re-structuring the social environment

Formalise a ‘HCA in-charge role’ and ensure clear expectations/training ∅

N/A

N/A

8 (27)

1 (3)

9

N/A

3

✓

Alternative (5a) application of this BCT favoured by nominal group participants

5d

Re-structuring the social environment

Use clinical cases during safety huddles as a stimulus for conversation ∆

8 (15)

0 (0)

0 (0)

9 (26)

17

3

2

✓

High scoring from nominal group/s

6

Comparative imagining of future outcomes

Workshop based – prompt HCAs to imagine and compare likely or possible outcomes following immediate escalation of a deteriorating patient to the RN versus no escalation or delayed escalation +

2 (4)

4 (6)

2 (7)

0 (0)

8

2

1

✓

To ensure coverage of all TDF domains of high importance and all target behaviours

7a

Salience of consequences

Workshop based – show videos of patients speaking emotively about the consequences of delayed escalation and timely escalation +

7 (13)

0 (0)

11 (37)

5 (14)

23

3

4

✓

High scoring from nominal group/s

7b

Salience of consequences

Workshop based – show videos of patients speaking emotively about the consequences of timely escalation ∅

N/A

N/A

11 (37)

5 (14)

16

N/A

6

✓

Could be easily delivered alongside 7a

8a

Social support and encouragement

Deploy deteriorating patient champions (HCA and RN level) and ensure clear expectations/training +

8 (15)

4 (6)

8 (27)

17 (49)

37

6

9

✓

Highest scoring application for this BCT from nominal group participants

8b

Social support and encouragement

Allocate junior HCAs a senior HCA mentor ∆

11 (20)

4 (6)

3 (10)

0 (0)

18

7

1

✓

Alternative (8a) application of this BCT favoured by nominal group participants

9a

Modelling or demonstrating

Workshop based – provide a video of a senior and respected staff member enacting the desired behaviour/s +

6 (11)

4 (6)

1 (3)

4 (11)

15

4

3

✓

The relevant target behaviours would be difficult to model using this application i.e. not practical.

9b

Modelling or demonstrating

Senior nurse/s return to clinical practice and model the desired behaviours e.g., monitoring the vital signs and using NEWS appropriately ∆

10 (18)

10 (15)

2 (6)

5 (14)

27

5

3

✓

Unlikely to be sustained (not practical), may be expensive and could have negative side effects.

10

Commitment

Workshop based – use “I will” statements to affirm an intention e.g., the intention to monitor respiratory rate with every set of vital signs +

2 (3)

0 (0)

0 (0)

0 (0)

2

1

0

✓

May be viewed by clinical staff as patronising – difficult to deliver in a meaningful way

11

Identification of self as a role model

Workshop based –ask RNs to picture themselves enacting the desired behaviour/s and then ask them to consider who might be learning from their good practice +

2 (3)

0 (0)

0 (0)

0 (0)

2

1

0

✓

To ensure coverage of all TDF domains of high importance and all target behaviours

12

Action planning

Workshop based - develop “if … then” statements to link a cue to the desired behaviour +

3 (5)

3 (5)

0 (0)

0 (0)

6

1

0

✓

To ensure coverage of all TDF domains of high importance and all target behaviours

13

Social reward

Senior staff on the ward praise junior staff when they enact the desired behaviour +

4 (7)

7 (11)

2 (6)

2 (6)

15

5

3

✓

To ensure coverage of all TDF domains of high importance and all target behaviours

14a

Information about others’ approval

Workshop based – show a video of senior and credible nursing staff describing the behaviours that they approve of +

0 (0)

2 (3)

5 (17)

0 (0)

7

1

2

✓

To ensure coverage of all TDF domains of high importance and all target behaviours

14b

Information about others’ approval

CCOT nurses to provide feedback to ward staff on their approval of appropriate escalation. Feedback should be given as soon after the escalation event as possible ∅

N/A

N/A

11 (36)

14 (40)

25

N/A

9

✓

Highest scoring application for this BCT from nominal group participants