Theme	Contexts	Mechanisms	Outcomes
Nurses' Clinical Skills	Predominance of junior nurses with high turnover rates impacting MSD awareness and confidence Task‐oriented approach focused on routine duties rather than holistic patient care	Training and skill development programs to improve MSD assessment and escalation Multidisciplinary collaboration to build confidence and competence	Enhanced clinical skills for MSD management Increased staff confidence in escalation processes Improved patient outcomes through timely responses
MSD Timely Assessment	Reliance on intuition for identifying MSD risks Challenges integrating MSM tools into workflows Limited training on tools like MSM	Raising awareness and training for MSM tool usage Improving documentation through EMR integration	Timely and consistent MSM assessments Enhanced identification of patient MSD risks Reduced ambiguity in decision‐making
Timely Escalation	Hierarchical ward structures influencing escalation roles Junior nurses deferring decisions to senior staff. Reactive rather than proactive escalation practices	Empowering all healthcare team members to share escalation responsibilities Leadership involvement and structured protocols for proactive risk assessment	Timely DIvERT activation Proactive risk management Multidisciplinary collaboration reducing critical incidents
Timely Response	Scheduling conflicts for DIvERT meetings due to workload pressures and ward rounds Limited availability of key personnel like psychiatrists and medical staff	Flexible scheduling of DIvERT meetings Integration of DIvERT into existing multidisciplinary handovers Encouraging remote participation for wider inclusion	Increased participation in DIvERT meetings Early interventions ensuring patient safety More effective risk assessments
Organisational Support	Collaborative culture prioritising safety and teamwork Limited formal training for new staff. Outdated protocols impacting staff confidence and competence	Open communication and peer support to handle workload challenges Regular training and updated guidelines for standardisation	Improved collaboration and transparency Enhanced confidence in MSD management Increased attendance in DIvERT processes
MSD Incident Reporting	Low RiskMan reporting rates due to unclear protocols, time constraints and knowledge gaps Complexity of forms discouraging completion	Simplified reporting protocols and user‐friendly systems Training staff on efficient documentation practices	Higher reporting rates and improved documentation quality Quality data for clinical governance and incident trend analysis