Therapeutic inertia as a nurse-enacted behaviour toward adult patients: a scoping review protocol

Introduction: Therapeutic inertia is defined as the failure or delay of healthcare professionals to initiate, modify or escalate care despite clinical indications, patient deterioration or deviation from evidence- based therapeutic goals. While well- established among physicians, the concept remains theoretically underdeveloped and empirically fragmented within nursing. Although nurses’ expanding autonomy in patient care emphasises its relevance for care quality, existing studies address diverse contexts, definitions and measures, identifying nurses as mitigators of physician inertia rather than examining it as a nurse- enacted behaviour. This scoping review aims to systematically map the literature on therapeutic inertia exhibited by nurses towards adult patients across healthcare settings. It will examine its definitions, measurement approaches, determinants categorised using the Theoretical Domains Framework (TDF), outcomes and reduction strategies. Methods and analysis: The review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses extension for Scoping Reviews guidelines. Using the Population- Concept- Context framework, this review will include studies involving nurses exhibiting therapeutic inertia towards adult patients across healthcare settings. Quantitative, qualitative, mixed- methods studies and reviews published in English or Italian, from database inception to April 2026, will be considered. A three- step search will target multiple databases and grey literature sources. Two independent reviewers will perform study selection and data extraction. Findings will be presented using narrative and thematic synthesis and deductive TDF domain mapping, summarised in tables and charts with an accompanying narrative summary. Ethics and dissemination: No ethical approval is required for this scoping review since it does not include primary data collection or human or animal participants. Findings will be disseminated through peer- reviewed publication and presentations at relevant conferences. Moreover, results will be shared with stakeholders to support interventions within care settings. Trial registration details This protocol was prospectively registered on Open Science Framework (https://doi.org/10. 17605/OSF.IO/3M8TR)