De-implementation of tradition-based practices in critical care: A qualitative study
De-implementation of tradition-based practices in critical care: A qualitative study
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DOI：
10.1111/ijn.12723
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发表时间：
2019-04-01
影响因子：
1.9
通讯作者：
Upvall, Michele J.
中科院分区：
文献类型：
--
作者：
Bourgault, Annette M.;Upvall, Michele J.
目的探讨重症监护护士反传统实践的过程。背景仪式和常规做法被描述为神圣的奶牛或TBP。许多临床实践证据不足或没有证据，可能导致患者结局不佳。取消（终止）可能有害、无效或不具成本效益的TBP是促进临床循证实践（EBP）的必要条件。研究设计：描述性质性研究。方法22名来自佛罗里达中部一家急诊医院的重症监护护士参加了研究。2016年3月至7月进行了个人和焦点小组访谈，并使用主题分析进行了分析。结果确定了三个主题：（a）不确定性，（B）想知道的愿望，（c）准备实践的变化。护士对日常临床实践的科学基础不确定，并且难以区分TBP和EBP。取消执行的进程和战略似乎是重复执行进程。结论需要更多的研究来评估取消执行的过程和策略。重点应放在确保护士了解基本的EBP技能，以鼓励临床实践的评估，以支持研究证据。认识和理解贸易壁垒将有助于采取更全面的办法，实现电子商务的黄金标准。
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.