242 Appendix SUMMARY Nurses comprise nearly half of the global healthcare workforce and are crucial in enhancing care quality through a team-based approach. They collaborate with other healthcare professionals, patients' families, and informal caregivers across various settings. Nursing care is built on three key fundamental dimensions: addressing patients' psychosocial needs, fostering relational actions such as active listening and showing empathy. And focusing on patients' physical needs, with their extensive direct patient care, nurses are well-positioned to identify and prevent complications. This thesis is structured in two parts. The first part focuses on the third dimension – particularly preventing complications, by examining two critical outcomes: in-hospital falls and pressure ulcers. In-hospital falls are common adverse events with significant injury rates, while pressure ulcers remain prevalent and lead to pain, discomfort, and extended hospital stay, despite available preventive measures. We, therefore, explored effective strategies for implementing nursing guidelines to prevent these complications. In the second part, we explored effective de-implementation strategies to reduce lowvalue care practices. Additionally, the current state of intravenous fluids administration and the knowledge gaps among physicians and nurses were examined. To gain more insights in effective implementation strategies for integrating nursing guidelines and fall prevention interventions into practice, two systematic reviews were performed (Chapters 2 and 3). Chapter 2 provides an overview of implementation strategies for nursing guidelines across various settings, evaluating their effects on patient-related outcomes and guideline adherence. The review includes 54 studies covered diverse topics such as skin care and infection prevention, mainly conducted in hospitals and nursing homes. Chapter 3 examines the implementation strategies for fall prevention interventions in hospitals, analyzing 48 studies. In the studies in both reviews, educational strategies were most commonly used; however, no single strategy or combination consistently led to successful implementation with regard to patient-related outcomes or guideline adherence. The findings highlight the need for a multifaceted approach. Future research should focus on standardized reporting to enhance reproducibility and comparing the effectiveness of various implementation strategies. Chapter 4 presents a case study among nurses and patients exploring determinants associated with the implementation of technical improvements in medical beds – with smart functions like weighing, an exit alarm, and a chair position – one and four years after the introduction of these smart beds. The actual use of smart functions was evaluated through observations, while semi-structured interviews and questionnaires
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