243 Summary A identified self-reported use, adherence, and barriers and facilitators. This study showed a variability in the use of the smart functions and identified reliability issues as a barrier. The most frequently used feature was the weighing function, but these measured weights were probably unreliable due to calibration issues. Other barriers included poor ease of use and lack of connectivity with the nurse call system, indicating a need for integration of technology within existing digital infrastructures. Facilitators were the availability of the smart functions, expectations of increased patient safety, and experienced reduced physical burden among nurses. The value of smart functions was often underestimated, highlighting the need for better promotion and continuous evaluation to maintain confidence in the technology. Chapter 5 reports the development and process evaluation of a pilot implementation strategy, encompassing 13 implementation strategies divided over six domains, focusing on the continuous evaluation of pressure ulcers risks, supported by an AIrisk prediction model. The acceptability and feasibility of the Decubitus Risk Prediction Alert based on AI (DRAAI) were assessed among nurses in three general wards of our tertiary hospital. The mixed methods study explored nurses' perceptions through questionnaires and field notes. Nurses valued DRAAI's risk predictions in the context of pressure ulcer prevention, And most nurses found it feasible to integrate DRAAI into their workflow. DRAAI’s high-risk predictions were addressed within 48 hours in 65% of cases. We concluded that ongoing involvement and clear communication are crucial for successful AI integration in nursing workflows, and while DRAAI shows promise for PU prevention, further research is needed to assess its clinical impact. The second part of this thesis is dedicated to de-implementation of low-value care practices. The systematic review and meta-analysis reported in chapter 6 aimed to explore effective de-implementation strategies in all health care settings where nurses are present. The included papers covered diverse topics like restraint use and unnecessary urinary catheter use. Unfortunately, it was not possible to indicate which de-implementation strategies are most effective for reducing low-value nursing care due to a high level of heterogeneity. Future studies should prioritize improving the quality of reporting on de-implementation strategies and conducting process evaluations to assess their implementation success and effectiveness. Chapter 7 presents a survey study among 304 healthcare professionals from three hospitals on the potentially inappropriate use of intravenous fluid therapy, their knowledge and self-reported practices were inventoried. In addition, a retrospective chart review was performed to gain insights in documentation practices. A knowledge gap regarding the composition and appropriate indications for intravenous fluids was
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