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

Area of Science:

• Nursing
• Healthcare Quality
• Clinical Practice Improvement

Background:

• Tradition-based practices (TBPs) in healthcare often lack sufficient evidence and can negatively impact patient outcomes.
• De-implementation of ineffective or potentially harmful TBPs is crucial for advancing evidence-based practice (EBP).
• Critical care settings frequently encounter challenges in distinguishing and replacing TBPs with EBP.

Purpose of the Study:

• To explore the process and challenges critical care nurses face when de-implementing tradition-based practices.
• To understand nurses' perspectives on the barriers and facilitators involved in moving away from established, non-evidence-based routines.
• To identify strategies that can support the transition from TBP to EBP in critical care.

Main Methods:

• A descriptive qualitative inquiry was employed to investigate the phenomenon.
• Data were collected through individual and focus group interviews with 22 critical care nurses.
• Thematic analysis was used to identify key themes in the qualitative data.

Main Results:

• Nurses expressed uncertainty regarding the scientific basis of many routine clinical practices.
• A significant challenge identified was the difficulty in differentiating between tradition-based practices and evidence-based practices.
• The processes and strategies used for de-implementation often mirrored those used for implementing new practices.

Conclusions:

• Further research is essential to evaluate the effectiveness of de-implementation strategies in nursing.
• Enhancing nurses' knowledge of fundamental evidence-based practice skills is vital for assessing and updating clinical practices.
• Increased awareness and understanding of tradition-based practices are necessary to fully embrace evidence-based practice.