Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 1, 2026
Date Accepted: Sep 8, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Nursing Implementation Complexity Tool (NICT): Operationalizing the NASSS Framework for Digital Technology Implementation in Nursing
ABSTRACT
Background:
This study aimed to develop and evaluate the Nursing Implementation Complexity Tool (NICT), a theory-informed, practice-oriented implementation tool designed to support the implementation of digital technologies in nursing.
Objective:
This study aimed to develop and evaluate the Nursing Implementation Complexity Tool (NICT), a theory-informed, practice-oriented implementation tool designed to support the implementation of digital technologies in nursing.
Methods:
A Design Science Research approach, conceptually grounded in the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, guided the development and evaluation of the NICT through four iterative phases: (1) conceptual grounding based on an umbrella review, three mixed-methods case studies, and the NASSS framework; (2) iterative development and refinement of the tool; (3) formative evaluation through workshops with nursing professionals, prospective nursing leaders, and nursing students; and (4) summative mixed-methods evaluation comprising an online survey (n=28) and think-aloud interviews (n=8) with nursing professionals. Quantitative data were analyzed descriptively, and qualitative data were analyzed using qualitative content analysis.
Results:
The NICT comprises three complementary components: a guideline, a visual canvas, and a pocket card, structured around four reflection domains: care recipients, technology, users, and organizational context. Across formative evaluations, participants perceived the tool as useful, comprehensible, and relevant for supporting structured reflection on implementation processes. Feedback from the formative and summative evaluations informed iterative refinements, including clearer guidance and additional practical examples. In the summative evaluation, 92.3% of participants agreed that the NICT had a logical structure (mean 4.27/5, SD 0.69) and effectively supported the identification of implementation barriers and facilitators (mean 4.38/5, SD 0.75). Qualitative findings indicated that the NICT facilitated communication, promoted a shared understanding of implementation complexity, and supported implementation planning. Participants additionally identified complementary digital formats as a promising direction for future development.
Conclusions:
The NICT is a theory-informed, practice-oriented reflection tool that operationalizes the NASSS framework to support nursing professionals in addressing the complexity of implementing digital technologies. By facilitating structured reflection, communication, and consideration of context-specific factors, it provides an accessible approach to making implementation processes more transparent and discussable in nursing practice.
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