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

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. SUMMARY STATEMENT: What is already known about this topic? Research has been focused on the process of implementing evidence‐based practices but not on how to de‐implement tradition‐based practices that are found to be of little value or harmful to patients.The concept of de‐implementation is relatively new in health care and remains poorly understood.De‐implementation is a complex process and not simply the reverse of implementing evidence‐based practice.What this paper adds? Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating tradition‐based from evidence‐based practice.Barriers to de‐implementation of a tradition‐based practice included psychological biases related to loss of the practice and values previously placed on the practice.The implications of this paper: Nurses must question the origin of clinical practices and ensure that they are based on quality research evidence.Nurses should be able to identify a tradition‐based practice and know when it is appropriate to consider de‐implementation.More research is needed to understand de‐implementation processes and strategies used for de‐implementation. [ABSTRACT FROM AUTHOR]