Bourgault Annette M, Upvall Michele J
Department of Nursing Systems, College of Nursing, Academic Health Sciences Center, University of Central Florida, USA.
Center for Nursing Research, Orlando Health, Orlando, Florida, USA.
Int J Nurs Pract. 2019 Apr;25(2):e12723. doi: 10.1111/ijn.12723. Epub 2019 Jan 17.
To explore the process of tradition-based practice (TBP) de-implementation by critical care nurses.
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.
Descriptive qualitative inquiry guided this study.
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.
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.
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.
探讨重症监护护士摒弃基于传统的实践（TBP）的过程。
仪式性和常规性实践被描述为神圣不可侵犯的事物或基于传统的实践。许多临床实践缺乏足够的证据或根本没有证据，可能导致患者预后不良。摒弃潜在有害、无效或不具有成本效益的基于传统的实践（终止）对于在临床环境中促进循证实践（EBP）是必要的。
本研究采用描述性定性研究方法。
来自佛罗里达州中部一家急症医院的22名重症监护护士参与了研究。于2016年3月至7月进行了个人访谈和焦点小组访谈，并采用主题分析法进行分析。
确定了三个主题：（a）不确定性，（b）求知欲，以及（c）为实践变革做准备。护士们对日常临床实践的科学依据感到不确定，难以区分基于传统的实践和循证实践。摒弃过程和策略似乎在重复实施过程。
需要更多研究来评估用于摒弃的过程和策略。应强调确保护士掌握循证实践的基本技能，以鼓励对临床实践进行评估以支持研究证据。对基于传统的实践的认识和理解将有助于采取更全面的方法来实现循证实践的黄金标准。
