Nurses’ perception and experience on de-implementation of low-value care in China: a qualitative descriptive study

Low-value care refers to medical interventions or nursing practices that provide more harm than benefit to patients while increasing unnecessary costs. It remains prevalent worldwide, increasing healthcare costs and potential patient harm. De-implementation involves discontinuing ineffective or low-value practices. As the largest professional group in healthcare, nurses are well positioned to lead de-implementation, but they face substantial barriers. Prior research has largely focused on high-income countries and rarely incorporated nursing management perspectives. This study explored de-implementation of low-value care from the perspectives of nurses and nurse managers in China to inform practice and improve care quality and resource use. We employed a qualitative descriptive design and conducted semi-structured interviews with 16 nurses and 12 nurse managers from 11 departments across three acute care hospitals in China. Data were analyzed using a two-stage approach comprising inductive phenomenological analysis followed by deductive, theory-informed framework analysis. Three key findings were elicited from the data: factors influencing de-implementation, strategies to promote de-implementation, and the role of nurse managers in the de-implementation process. Nurse-led de-implementation was shaped by multilevel determinants, including patient-related factors (resistance and cost concerns), nurse-related factors (professional autonomy and research capacity), physician support, organizational and policy contexts, de-implementation processes, and perceived strength of evidence. Key strategies included education and training, ongoing evaluation and iterative refinement, organizational and platform support, interdisciplinary collaboration, and policy alignment. Nurse managers played a pivotal role by leading organizational change, acknowledging nurses’ contributions and empowering them to drive de-implementation, building collaborative problem-solving environments, providing tangible support for change, and fostering a caring and respectful culture. Together, these findings provide a theory-informed representation of the behavioral, organizational, and contextual factors influencing nurse-led low-value care de-implementation. Although nurse participants recognized the value of de-implementing low-value care, their actions were constrained by structural and professional barriers. We elicited the perspectives of nurses without prescribing authority and nurse managers in a low- and middle-income country, contributing to the international discourse on value-based healthcare and underscoring the pivotal role of nurses in advancing evidence-informed, efficient, and sustainable health systems.