“去实施”的概念分析及研究现状

doi:10.3761/j.issn.0254-1769.2023.17.017

摘要/Abstract

摘要：

目的分析“去实施”的定义和内涵，为“去实施”的研究和临床实践提供理论基础。方法系统检索PubMed、ProQuest、CINAHL、中国知网、中国生物医学文献服务系统、维普数据库、万方数据库中“去实施”的相关文献，检索时限为建库至2022年7月。最终纳入文献40篇。采用Walker和Avant概念分析法进行概念分析，从“去实施”的定义属性、前置因素、后置影响等方面进行分析和整合。结果 “去实施”包括以低价值护理为对象、使用相应的策略、包含4种类型和过程复杂4个定义属性；前置因素包含低价值护理因素、卫生保健服务系统因素、患者因素、伦理因素和社会因素；后置影响包括对患者的影响和对卫生保健系统的影响。结论目前“去实施”研究仍处于初级阶段，尚缺少相关测量工具，未来应基于“去实施”的内涵进行研究和开展临床实践。

关键词: 去实施, 概念分析, 卫生保健系统, 护理

Abstract:

Objective To analyze the definition of de-implementation，and provide a theoretical basis for research and clinical practice. Methods Pubmed，ProQuest，CINAHL，CNKI，Wanfang，VIP，and China Biomedical Literature Service System databases were searched. The search time limit was from the establishment of the database to July 2022. As a result，40 articles were selected for analysis. Walker and Avant′s methods were used to perform concept analysis of de-implementation in terms of its definition，pre-factors，post-results. Results De-implementation can be classified into 4 defined attributes：low-value care as the subjects；strategies to apply；4 types of removing，replacing，reducing，restricting；complicated process. The pre-factors can be discussed from the aspects of low-value care，health care systems，patients，ethical and social factors. De-implementation can impact to patients and health care systems. Conclusions The research on de-implementation is still at an early stage. There is a lack of relevant measurement tools for the accurate determination of de-implementation. In the future，research and clinical practice should be carried out based on the concept of de-implementation.

Key words: De-Implementation, Concept Analysis, Health Care System, Nursing Care

李加敏, 李学靖, 张小艳, 孙湘雨, 白云锋, 郝玉芳, 吴欣娟. “去实施”的概念分析及研究现状[J]. 中华护理杂志, 2023, 58(17): 2171-2176.

LI Jiamin, LI Xuejing, ZHANG Xiaoyan, SUN Xiangyu, BAI Yunfeng, HAO Yufang, WU Xinjuan. Concept analysis and research progress of de-implementation[J]. Chinese Journal of Nursing, 2023, 58(17): 2171-2176.

参考文献 37

[1]	李加敏, 李学靖, 杨丹, 等. 低价值护理的概念分析及研究现状[J]. 中华护理杂志, 2022, 57(17):2171-2176. DOI
	Li JM, Li XJ, Yang D, et al. Concept analysis and research progress of low-value care[J]. Chin J Nurs, 2022, 57(17):2171-2176. DOI
[2]	Wammes JJ, van den Akker-van Marle ME, Verkerk EW, et al. Identifying and prioritizing lower value services from Dutch specialist guidelines and a comparison with the UK do-not-do list[J]. BMC Med, 2016, 14(1):196. PMID
[3]	van Bodegom-Vos L, Davidoff F, Marang-van de Mheen PJ. Im-plementation and de-implementation:two sides of the same coin?[J]. BMJ Qual Saf, 2017, 26(6):495-501. DOI PMID
[4]	Walker L, Avant K. Concept analysis[M]// Strategies for theory construction in nursing. 5th ed. Upper Saddle River, NJ: Pearson-Prentice Hall, 2011:151-179.
[5]	Niven DJ, Mrklas KJ, Holodinsky JK, et al. Towards understan-ding the de-adoption of low-value clinical practices:a scoping review[J]. BMC Med, 2015, 13:255. DOI URL
[6]	Gnjidic D, Elshaug AG. De-adoption and its 43 related terms:harmonizing low-value care terminology[J]. BMC Med, 2015, 13:273. DOI URL
[7]	Prasad V, Ioannidis JP. Evidence-based de-implementation for contradicted,unproven,and aspiring healthcare practices[J]. Im-plement Sci, 2014, 9:1.
[8]	van Achterberg T, Schoonhoven L, Grol R. Nursing implemen-tation science:how evidence-based nursing requires evidence-based implementation[J]. J Nurs Scholarsh, 2008, 40(4):302-310. DOI URL
[9]	Gunderman RB, Seidenwurm DJ. De-adoption and un-diffusion[J]. J Am Coll Radiol, 2015, 12(11):1162-1163. DOI PMID
[10]	Upvall MJ, Bourgault AM. De-implementation:a concept analy-sis[J]. Nurs Forum, 2018:1-6.
[11]	Levinson W, Born K, Wolfson D. Choosing wisely campaigns:a work in progress[J]. JAMA, 2018, 319(19):1975-1976. DOI PMID
[12]	Norton WE, Chambers DA. Unpacking the complexities of de-implementing inappropriate health interventions[J]. Implement Sci, 2020, 15(1):2. DOI PMID
[13]	吕晓燕, 申林, 夏京花, 等. 肠内营养指南中鼻胃管位置判断方法的质量评价[J]. 中华护理杂志, 2018, 53(9):1115-1121.
	Lü XY, Shen L, Xia JH, et al. Clinical guidelines on methods for identifying the position of nasogastric tube in enteral nutrition:a systematic review[J]. Chin J Nurs, 2018, 53(9):1115-1121.
[14]	Proctor EK, Powell BJ, McMillen JC. Implementation strategies:recommendations for specifying and reporting[J]. Implement Sci, 2013, 8:139. DOI PMID
[15]	Cochrane Effective Practice and Organization of Care. EPOC taxonomy[EB/OL].(2015-01-01)[2022-07-12]. https://epoc.co-chrane.org/epoc-taxonomy.
[16]	Rietbergen T, Spoon D, Brunsveld-Reinders AH, et al. Effects of de-implementation strategies aimed at reducing low-value nursing procedures:a systematic review and meta-analysis[J]. Implement Sci, 2020, 15(1):38. DOI PMID
[17]	Tanner J, Melen K. Preoperative hair removal to reduce surgi-cal site infection[J]. Cochrane Database Syst Rev, 2021, 8(8):CD004122.
[18]	于书慧, 王为, 车新艳, 等. 泌尿外科患者短期留置导尿管的循证护理研究[J]. 护理学杂志, 2020, 35(17):93-97.
	Yu SH, Wang W, Che XY, et al. Evidence-based nursing prac-tice of short-term urinary catheterization in department of urology[J]. J Nurs Sci, 2020, 35(17):93-97.
[19]	Ubel PA, Asch DA. Creating value in health by understanding and overcoming resistance to de-innovation[J]. Health Aff (Mill-wood), 2015, 34(2):239-244.
[20]	Scott IA, Elshaug AG. Foregoing low-value care:how much evi-dence is needed to change beliefs?[J]. Intern Med J, 2013, 43(2):107-109. DOI PMID
[21]	Ho VP, Dicker RA, Haut ER, et al. Dissemination,implementa-tion,and de-implementation:the trauma perspective[J]. Trauma Surg Acute Care Open, 2020, 5(1):e000423. DOI URL
[22]	Patey AM, Hurt CS, Grimshaw JM, et al. Changing behaviour’ more or less’-do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis[J]. Implement Sci, 2018, 13(1):134. DOI
[23]	Elshaug AG, Rosenthal MB, Lavis JN, et al. Levers for addres-sing medical underuse and overuse:achieving high-value health care[J]. Lancet, 2017, 390(10090):191-202. DOI PMID
[24]	Patey AM, Grimshaw JM, Francis JJ. Changing behaviour,‘more or less’:do implementation and de-implementation interven-tions include different behaviour change techniques?[J]. Implement Sci, 2021, 16(1):20. DOI
[25]	Montini T, Graham ID. “Entrenched practices and other bia-ses”:unpacking the historical,economic,professional,and social resistance to de-implementation[J]. Implementation Sci, 2015, 10(1):24. DOI URL
[26]	Helfrich CD, Rose AJ, Hartmann CW, et al. How the dual process model of human cognition can inform efforts to de-implement ineffective and harmful clinical practices:a pre-liminary model of unlearning and substitution[J]. J Eval Clin Pract, 2018, 24(1):198-205. DOI URL
[27]	Niven DJ, Leigh JP, Stelfox HT. Ethical considerations in the de-adoption of ineffective or harmful aspects of healthcare[J]. Healthc Manage Forum, 2016, 29(5):214-217. DOI URL
[28]	Thakker A, Briggs N, Maeda A, et al. Reducing the rate of post-surgical urinary tract infections in orthopedic patients[J]. BMJ Open Qual, 2018, 7(2):e000177. DOI URL
[29]	徐燕, 石卫琳, 郎黎薇, 等. 减少ICU患者身体约束的循证护理实践[J]. 中华护理杂志, 2019, 54(1):19-24.
	Xu Y, Shi WL, Lang LW, et al. Evidence-based nursing prac-tice and evaluation of effects for reducing physical restraint among patients in ICUs[J]. Chin J Nurs, 2019, 54(1):19-24.
[30]	Colla CH, Mainor AJ, Hargreaves C, et al. Interventions aimed at reducing use of low-value health services:a systematic review[J]. Med Care Res Rev, 2017, 74(5):507-550. DOI URL
[31]	Bauchner H, Fontanarosa PB. Waste in the US health care system[J]. JAMA, 2019, 322(15):1463-1464. DOI PMID
[32]	Elshaug AG, Watt AM, Mundy L, et al. Over 150 potentially low-value health care practices:an Australian study[J]. Med J Aust, 2012, 197(10):556-560. PMID
[33]	Verkerk EW, Huisman-de Waal G, Vermeulen H, et al. Low-value care in nursing:a systematic assessment of clinical practice guidelines[J]. Int J Nurs Stud, 2018, 87:34-39. DOI PMID
[34]	Proctor E, Silmere H, Raghavan R, et al. Outcomes for imple-mentation research:conceptual distinctions,measurement chal-lenges,and research agenda[J]. Adm Policy Ment Health, 2011, 38(2):65-76. DOI PMID
[35]	Prusaczyk B, Swindle T, Curran G. Defining and conceptuali-zing outcomes for de-implementation:key distinctions from im-plementation outcomes[J]. Implement Sci Commun, 2020, 1:43. DOI
[36]	Ng W, Alexander D, Kerr B, et al. A hairy tale:successful pa-tient education strategies to reduce prehospital hair removal by patients undergoing elective Caesarean section[J]. J Hosp Infect, 2013, 83(1):64-67. DOI PMID
[37]	Parker G, Shahid N, Rappon T, et al. Using theories and fra-meworks to understand how to reduce low-value healthcare:a scoping review[J]. Implement Sci, 2022, 17(1):6. DOI