13 General introduction 1 The thesis is structured in two parts. The first part focuses on studies related to effective implementation strategies in nursing care. Chapter 2 presents a systematic review examining effective implementation strategies to implement nursing guidelines in daily practice. Nursing guidelines from all healthcare sections were considered for inclusion to get a broader sense of the implementation strategies used in the nursing field. Chapter 3 encompasses a systematic review of implementation strategies aimed to reduce in-hospital falls, one of the most common complications in hospitalized patients. Chapter 4 the identification of determinants that may impact the use of technological innovations in medical beds were explored. These smart beds are equipped with smart functions, such as a fall-detection function [33]. This part concludes with Chapter 5, which includes a process evaluation study of a pilot implementation of an AI-based pressure ulcer risk prediction model. This study investigates the proposed implementation strategies, the adaptations to the AI-based prediction model, as well as the follow-up actions based on its risk predictions. The second part of the thesis focuses on the de-implementation of low-value care in nursing. Chapter 6 presents a systematic review and meta-analysis evaluating the effects of de-implementation strategies in reducing low-value nursing procedures. As in chapter 2, studies from all healthcare sectors in which nurses are employed were considered for inclusion. Chapter 7 addresses low-value nursing care related to intravenous fluid therapy in hospitalized patients. The study presented here includes a survey study among nurses and prescribers from three hospitals to assess their knowledge and self-reported practices. Additionally, a retrospective chart review examined documentation practices to provide further insights. Chapter 8 concludes this thesis with a general discussion on the findings and methods, followed by a scenario envisioning healthcare in 2040.
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