230 Chapter 8 Overall, I think that strategies addressing a combination of ERIC strategies: assessing for readiness and identifying barriers and facilitators, build a coalition and facilitation, and gathering trust in the innovation among the team, ease of use, and connectivity are key to success. As suggested by van der Zanden, Helder [31], innovation champions can promote implementation of an innovation in four ways: (1) disseminating information; (2) synthesizing information; (3) mediating between strategy and daily routines; and (4) promoting adoption of the innovation. De-implementation in nursing care This thesis lays a foundation for future research on de-implementation in nursing care. Our systematic review (chapter 6) examined commonly used strategies for reducing lowvalue care practices. While we aimed to identify effective approaches, the heterogeneity of practices and strategies – similar to the systematic reviews on implementation – posed a challenge. Additionally, few studies incorporated determinants analysis or used FMTs to guide their strategy selection. De-implementation falls into three categories: 1) completely eliminate care, 2) partly eliminate care, and 3) replace care [32]. Future research should investigate whether different strategies are more effective for each category. Most process models for de-implementation start with exploring and prioritizing current low-value care practices. In chapter 7 we explored current practices of intravenous fluid administration and physicians’ and nurses’ knowledge of intravenous fluids. This study identified a shared responsibility, a knowledge gap, and limited documentation of intravenous fluids administration. Prescribers expect nurses to intervene without first consulting a physician, which they think is a nursing task, although nurses are not authorized in this respect. Nurses intervening without official authorization is a broader issue, seen in cases like unnecessary intravenous or urinary catheter use [33]. Given that not all patients likely require intravenous fluids, we should investigate determinants impacting both nurses’ and physician’s behavior. These insights can then inform tailored de-implementation strategies. A randomized cluster de-implementation study could compare several de-implementation strategies to reduce unnecessary intravenous fluids administration across wards and hospitals. The first cluster would assess feasibility and necessary adaptations, strengthening the trial’s robustness. The study would ideally offer valuable insights on effective de-implementation strategies for reducing unnecessary intravenous fluids administration across different contexts. De-implementing low-value health care is a global priority across countries and health systems, due to the negative impacts of low-value care on patient outcomes, health workers, and health systems [34]. There is a paucity of research examining low-value health care and
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