De‐implementation of tradition‐based practices in critical care: A qualitative study

Abstract

Aim To explore the process of tradition‐based practice (TBP) de‐implementation by critical care nurses. Background Ritualistic and routine practices have been described as sacred cows or TBPs. Many clinical practices have insufficient or no evidence and may lead to poor patient outcomes. De‐implementation (termination) of potentially harmful, ineffective, or non cost‐effective TBP is necessary to facilitate evidence‐based practice (EBP) in the clinical setting. Design Descriptive qualitative inquiry guided this study. Methods Twenty‐two critical care nurses from an acute care hospital in central Florida participated. Individual and focus group interviews were performed March to July 2016 and analysed using thematic analysis. Results Three themes were identified: (a) uncertainty, (b) desire to know, and (c) preparing for practice change. Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating TBP from EBP. De‐implementation processes and strategies appeared to replicate implementation processes. Conclusion More research is needed to evaluate de‐implementation processes and strategies used for de‐implementation. An emphasis should be placed on ensuring that nurses are knowledgeable about fundamental EBP skills to encourage assessment of clinical practices for supporting research evidence. Awareness and understanding of TBPs will facilitate a more comprehensive approach towards achieving the gold standard of EBP.

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis

“…The next step is to translate these 'Choosing Wisely' lists into action [13]. To actually reduce the use of low-value nursing procedures, awareness should be created for the 'Choosing Wisely' lists and effective de-implementation strategies need to be developed and executed [7,14,15]. These deimplementation strategies should be theory-and evidencebased and informed by analysis of barriers and facilitators that influence the use of low-value care, since this is expected to increase the adherence, adoption, and effectiveness of these de-implementation strategies [5,16,17].…”

Anticipated nursing care as perceived by nursing students: Findings from a qualitative study

“…To the best of our knowledge, this is the first study that attempts to describe ANC, together with its antecedents and consequences, as experienced by students during their clinical rotations. Prior to recent studies (Bottega & Palese, 2020 ), ANC was reported mainly through anecdotal evidence as an expression of routines, traditions and rituals of nursing practice, and a potential issue of the theory–practice gap (Bourgault & Upvall, 2019 ; Rytterstrom et al., 2011 ; Shoghi et al., 2019 ), mostly from the perspective of nurses. However, the clinical environment permeates nursing education, enabling students to develop skills (Papastavrou et al., 2016 ).…”

Barrierer mot etterlevelse av retningslinjer for helsepersonell i sykehus

“…En lege beskrev det slik: «Når det gjelder å ta retningslinjer i bruk, tenker jeg at det er viktig med informasjon, at man skjønner hvorfor, at de Manglende faglige begrunnelse, eller det informantene oppfattet som ulogiske begrunnelser, hindret etterlevelse. Resultatet samsvarer med en kvalitativ studie blant sykepleiere på akuttmottak i USA, som beskriver hvordan kliniske anbefalinger uten tilstrekkelig faglig begrunnelse skaper usikkerhet (15).…”

“…Ifølge Fixsen og medarbeideres modell påvirker organisasjonsstruktur og kultur alle delene i implementeringsprosessen (9). Implementeringsstrategier bør fokusere mer på hvilke konsekvenser nye retningslinjer kan få for avdelingens eksisterende praksis (15). Klinisk helsepersonell kan bevisstgjøres på organisasjonens fagtradisjoner og verdier, og på hvordan disse kan påvirke etterlevelsen.…”