12 Chapter 1 De-implementation Generated evidence commonly focuses on new interventions or innovations, and less frequently focusses on reducing unnecessary care, also called low-value care. De-implementation of low-value care concerns minimizing healthcare practices that provide minimal or no health benefit, low-value care is defined as: I. ineffective care which causes more harm than good II. ineffective care, which is not as effective as it could be, is continued for an extensive period, is administered too frequently, or could be replace by a care aid III. unwanted care, which does not improve patients’ condition or align with their preferences [28]. De-implementation of low-value care aligns with the principle of providing appropriate care, which highlights the need to discourage medicalization [29]. Not every carerelated issue requires a medical solution; sometimes, support from the social domain, peer assistance, physical activity, or a combination of these alternatives may be more appropriate than providing medical care [30]. Overuse of care is an important issue, particularly given the rising healthcare costs, the increasing demand for care due to populations with higher life-expectancies, and the shortage of nurses [31]. An example of overuse includes applying physical restraints in cases of delirium or following stroke or brain surgery [32]. Aims and outline thesis The objective of this thesis is to explore the role of implementation science in improving clinical nursing practice, with a particular focus on evaluating strategies for effective implementation or de-implementation. It particularly addresses the implementation of nursing guidelines to prevent complications such as falls and pressure ulcers. Additionally, it explores determinants influencing the reduction of low-value nursing care practices, within the use-case of intravenous fluids administration and prescription in hospitalized patients. The following research questions are addressed: I. Is it possible to identify effective implementation strategies to incorporate fundamental nursing care into practice? II. Is it possible to identify effective de-implementation strategies for reducing lowvalue care in nursing?
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