De-implementation in Nursing: A Systematic Review of Strategies to Stop Low-Value Care to Improve Patient Safety and Workload Reduction
Abstract
Background: Continued delivery of low-value nursing care—practices outdated, ineffective, or even harmful—compromises patient safety and contributes to unnecessary nursing workload. While the new implementation of evidence is the focus, the systematic process of removing such practices, known as de-implementation, is needed for healthcare quality improvement.
Aim: The aim of this review study is to synthesize current evidence on de-implementation in nursing, present its theoretical basis, enumerate typical low-value practices, and identify effective ways to stop them for improved patient outcomes and optimal workflow in nursing.
Methods: An integrated literature review was conducted by combining results from current empirical studies, systematic reviews, and quality improvement reports on de-implementation and low-value care in nursing and interprofessional settings.
Results: Routine Foley catheterization, unnecessary vital sign monitoring, and liberal physical restraint use are strong de-implementation candidates, the review implies. Successful strategies are multifaceted, including audit and feedback, clinical decision support in electronic health records, nurse-initiated protocols, and sending out professional campaigns like Choosing Wisely. Success is highly dependent on strong clinical leadership, a psychological safety culture, and interprofessional collaboration to counter cognitive inertia and embedded professional norms.
Conclusion: De-implementation is an ethical and pragmatic imperative to nursing. Systematically eliminating low-value care is essential to sustain patient safety, reduce iatrogenic harm, and allow nurses to focus their skills on high-value, individualized care.
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References
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Authors
Copyright (c) 2025 Masheal Masoud Alyami, Haila Hussain Alshaiban, Maryam Mohammed Alnaji, Maryam Ali Yahya Jarah, Afiyah Mousa Ahmed Tawashi, Hanan Mohammed Ahmed Sharahili, Amany Modhaya Ali Omair, Shaima Jubran Alyami, Amani Ageel Muhanna, Ghrop Yhia Ahmad Mobtti, Meshael Suliman Saeed Alotaibi, Nujood Ali saad Al Shahrani, Joud Abdullah Aldossary, Alanoud Ali Siddiq
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