Hanrahan Kirsten, Wagner Michele, Matthews Grace, Stewart Stephanie, Dawson Cindy, Greiner Joseph, Pottinger Jean, Vernon-Levett Paula, Herold Debra, Hottel Rachel, Cullen Laura, Tucker Sharon, Williamson Ann
Associate Research Scientist, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Worldviews Evid Based Nurs. 2015 Feb;12(1):3-11. doi: 10.1111/wvn.12072. Epub 2015 Jan 28.
Sacred cows (SC) are old habits in practice, considered routine and above dispute, regardless of evidence to the contrary.
This is the first known report that aims to conduct a systematic evaluation of practices that have been described in the literature as SC and strategies for planned implementation of evidence-based practices (EBP).
A large, complex, academic medical center department of nursing compared SC to EBP. Nurses systematically reviewed and rated the degree to which current practices adhered to best-evidence versus SC. This initiative, "Sacred Cow: Gone to Pasture," was developed, structured, and implemented according to the Iowa Model of Evidence-Based Practice to Promote Quality Care, as well as Everett Rogers' Diffusions of Innovations Theory. Implementation of EBP followed a phase plan using the Implementation Strategies for Evidence-Based Practice to help to support adoption and integration.
Review of organization-specific policies and procedures and reports of actual practices revealed that SC persist, even in a center internationally recognized as a leader in EBP. The SC initiative caught the attention of busy clinicians, and raised awareness of SC and the importance of adherence to EBP. The SC initiative resulted in policy and practice changes and sparked new EBP and research, resulting in numerous improvements, including a significant decline in catheter-associated urinary tract infections and shifting from basins to commercially prepared cloths for patient bathing.
A strategic approach is crucial to eliminating SC and integrating EBP. This report calls nurses globally to action, to identify and abandon ineffective healthcare practices. Further research should compare and test the efficacy of implementation strategies, in particular how to sustain EBP in clinical settings.
神圣牛（SC）是实践中的旧有习惯，被视为常规且无可争议，无论有无相反证据。
这是首篇旨在对文献中描述为神圣牛的实践以及循证实践（EBP）的计划实施策略进行系统评估的已知报告。
一家大型、复杂的学术医疗中心的护理部门将神圣牛与循证实践进行比较。护士们系统地回顾并评定了当前实践遵循最佳证据而非神圣牛的程度。这项名为“神圣牛：走向牧场”的举措是根据促进优质护理的循证实践爱荷华模式以及埃弗雷特·罗杰斯的创新扩散理论来制定、构建和实施的。循证实践的实施遵循一个阶段计划，采用循证实践实施策略来帮助支持采用和整合。
对特定组织的政策和程序以及实际实践报告的审查表明，神圣牛依然存在，即便在一个国际公认的循证实践领先中心也是如此。神圣牛举措引起了忙碌的临床医生的关注，并提高了对神圣牛以及坚持循证实践重要性的认识。神圣牛举措带来了政策和实践的改变，并引发了新的循证实践和研究，带来了诸多改进，包括导管相关尿路感染显著下降，以及从使用盆改为使用商业制备的布为患者洗澡。
一种战略方法对于消除神圣牛和整合循证实践至关重要。本报告呼吁全球护士行动起来，识别并摒弃无效的医疗保健实践。进一步的研究应比较和测试实施策略的效果，特别是如何在临床环境中维持循证实践。
