The field of critical care medicine stands at the forefront of patient survival and recovery, necessitating precise and evidence-informed practices. However, a significant challenge within this dynamic environment is the persistence of traditional practices that often overshadow or undermine evidence-based interventions [1]. This phenomenon is particularly evident in critical care nursing, where institutional inertia and deep-rooted customs frequently delay the adoption of scientifically validated approaches. One such example is the Trendelenburg positioning, a practice historically employed to manage hypotension but now considered potentially harmful based on recent evidence. Similarly, restrictive visiting policies, once thought to reduce infection risks and alleviate staff burden, have come under scrutiny for their detrimental impact on patient and family satisfaction, psychological well-being, and recovery. These instances underscore the pressing need to systematically challenge and reform outdated practices, ensuring alignment with contemporary evidence to optimize patient outcomes. The reliance on tradition over evidence can be traced to several factors, including a lack of awareness about current research, resistance to change among healthcare professionals, and institutional barriers [2]. In this context, the study Overcoming Practice Traditions sought to illuminate this issue by critically analyzing seven key areas in critical care where outdated traditions prevail. These areas include Trendelenburg positioning, restricted visiting policies, routine use of physical restraints, traditional handover practices, reliance on subjective pain assessment, outdated weaning protocols for mechanical ventilation, and non-standardized approaches to pressure injury prevention. By evaluating these areas, the study aimed to provide a blueprint for fostering evidence-based practices in critical care settings.

One of the most pervasive traditional practices addressed in the study is the use of the Trendelenburg position. Historically implemented to treat hypotension by increasing venous return, this position has been shown to compromise respiratory mechanics and increase intracranial pressure [3]. Despite such evidence, its continued use reflects a broader issue of cognitive dissonance among practitioners who prioritize long-standing norms over emerging research. Nurses, in particular, are at the forefront of implementing or challenging such practices, highlighting the need for continuous education and active engagement with evidence-based guidelines [4]. Restrictive visiting policies in critical care units provide another compelling example of tradition-driven practices. Initially adopted to maintain sterile environments and reduce staff workload, these policies have inadvertently contributed to adverse psychological outcomes for patients and their families. Research demonstrates that open visiting policies enhance patient satisfaction, reduce anxiety, and foster a supportive environment conducive to recovery. Despite these benefits, resistance to change persists, often justified by concerns over infection control and staff efficiency. Such resistance underscores the importance of integrating evidence into institutional policies and fostering a culture that prioritizes patient-centered care. The study also highlights the routine use of physical restraints as a critical area for improvement. While restraints are traditionally used to prevent self-harm or interference with medical devices, evidence suggests they may exacerbate delirium, increase stress, and prolong recovery times [5]. Transitioning away from restraint-dependent practices requires not only evidence-based training for nursing staff but also systemic changes in resource allocation to support alternative methods of ensuring patient safety. Traditional handover practices, often characterized by verbal exchanges and limited documentation, represent another area ripe for innovation. These practices are prone to miscommunication and errors, potentially jeopardizing patient safety. Evidence supports the implementation of structured handover tools, such as the Situation-Background-Assessment-Recommendation (SBAR) framework, which has been shown to enhance clarity and accuracy in information transfer. However, adopting such tools requires overcoming resistance rooted in habitual reliance on unstructured and variable communication methods.

Subjective pain assessment, another traditional approach, is particularly concerning given its implications for patient comfort and recovery. Pain is often underreported or mismanaged in critical care settings, with practitioners relying on patient self-reports or observational cues that can be influenced by bias or misunderstanding [6]. Evidence-based pain assessment tools, such as the Critical-Care Pain Observation Tool (CPOT), offer a standardized and reliable alternative. Yet, their integration into practice requires sustained training and reinforcement to ensure consistent application. Outdated weaning protocols for mechanical ventilation also exemplify the pitfalls of tradition-driven practices. Evidence-based protocols emphasize gradual weaning and daily spontaneous breathing trials to reduce ventilation duration and associated complications. However, adherence to rigid or outdated protocols can prolong mechanical ventilation, increasing the risk of ventilator-associated pneumonia and other complications. Encouraging the adoption of evidence-based weaning strategies necessitates both education and systemic support to address barriers such as staffing shortages and time constraints.

Finally, non-standardized approaches to pressure injury prevention reflect a critical gap between tradition and evidence. Traditional practices often involve reactive rather than proactive measures, leading to suboptimal outcomes [7]. Evidence supports the use of risk assessment tools like the Braden Scale, coupled with preventive interventions such as repositioning schedules and advanced pressure-relieving devices. Overcoming resistance to these practices requires not only demonstrating their efficacy but also addressing logistical challenges, such as resource limitations and competing priorities in care delivery. The study concludes by emphasizing the pivotal role of nurses in bridging the gap between tradition and evidence. As primary caregivers, nurses are uniquely positioned to influence practice patterns and advocate for evidence-based approaches. However, achieving this requires a multifaceted strategy encompassing continuous education, robust institutional support, and a culture of critical inquiry. Additionally, fostering interprofessional collaboration and engaging stakeholders at all levels of care delivery can facilitate the adoption of evidence-based practices and ensure their sustainability.

Aims and Objective

The primary aim of this study was to identify and critically evaluate traditional practices in critical care, such as Trendelenburg positioning and restrictive visiting policies, which persist despite evidence of harm. The objective was to propose evidence-based strategies to improve patient outcomes, enhance care quality, and foster adherence to modern clinical guidelines

Trendelenburg Positioning

The Trendelenburg position, characterized by placing the patient in a supine position with the feet elevated above the head, was historically employed to manage hypotension and shock. Introduced in the late 19th century by Friedrich Trendelenburg, it was initially designed to improve surgical field visualization. Over time, its application expanded to non-surgical settings under the assumption that it enhanced venous return and cardiac output. However, contemporary research has revealed its adverse effects, including compromised respiratory mechanics, increased intracranial pressure, and reduced cerebral perfusion. Despite these findings, studies indicate that 40–60% of critical care nurses continue to use this position for hypotensive patients [8]. The enduring use of this outdated practice underscores the inertia within clinical settings, where long-standing habits outweigh scientific evidence.

Restricted Visiting Policies

Restricted visiting policies were historically introduced to reduce infection risks, minimize staff disruptions, and maintain sterile environments in critical care units. These policies were rooted in assumptions rather than evidence, reflecting a paternalistic approach to patient care [9]. Recent studies challenge these assumptions, demonstrating that restrictive policies contribute to increased patient anxiety, family dissatisfaction, and poor psychological outcomes. Conversely, open visiting policies have been associated with improved patient-family communication, reduced patient stress, and enhanced overall satisfaction. Despite this evidence, resistance to change persists, often justified by staff workload concerns and unfounded fears of higher infection rates.

Impact of Traditional Practices on Patient Outcomes

The continued reliance on traditional practices has significant implications for patient outcomes in critical care. Studies on the Trendelenburg position reveal that its inappropriate use is associated with higher incidences of respiratory complications, including reduced oxygenation and atelectasis [10]. Similarly, restrictive visiting policies have been linked to adverse psychological effects on patients and families, including heightened stress and delayed recovery. Physical restraints, another widely debated practice, have been shown to increase the risk of delirium and prolong hospital stays. The broader implications of these practices extend beyond individual outcomes, affecting overall care quality and healthcare costs. For example, prolonged ventilator use due to outdated weaning protocols increases the risk of ventilator-associated pneumonia. Similarly, non-standardized approaches to pressure injury prevention contribute to higher rates of hospital-acquired complications, leading to increased treatment costs and longer recovery times. These findings underscore the urgent need for systemic changes to align critical care practices with current evidence.

Barriers to Evidence-Based Practice

The persistence of tradition-driven practices can be attributed to a complex interplay of individual, institutional, and systemic barriers. At the individual level, cognitive biases, fear of change, and limited awareness of current evidence often prevent healthcare professionals from adopting new practices. For example, a study by Spallek et al. found that over 50% of critical care nurses were unaware of recent guidelines discouraging the Trendelenburg position for hypotension management [11]. Institutional barriers, such as inadequate training, lack of resources, and hierarchical decision-making structures, further hinder the adoption of evidence-based practices. For instance, restrictive visiting policies are often perpetuated by hospital policies that prioritize operational efficiency over patient-centered care. Similarly, the absence of standardized tools for pain assessment and handover processes creates variability in care delivery, increasing the risk of errors and suboptimal outcomes. Systemic barriers, including fragmented care models, insufficient research dissemination, and resistance to policy changes, also play a significant role. For example, the lack of incentives for evidence-based practice adoption and the slow integration of research findings into clinical guidelines contribute to the persistence of outdated practices. Addressing these barriers requires a multi-faceted approach that combines education, collaboration, and policy reform.

STRATEGIES FOR FOSTERING EVIDENCE-BASED PRACTICES

Education and Training

Education is a cornerstone of evidence-based practice. Studies emphasize the importance of continuous professional development programs to equip healthcare professionals with the knowledge and skills needed to implement evidence-based interventions [12]. For example, workshops on alternative positioning techniques, such as the semi-Fowler’s position, can reduce the reliance on the Trendelenburg position. Similarly, training on the benefits of open visiting policies and non-restraint methods can empower nurses to advocate for patient-centered care.

Standardization of Practices

Standardized protocols and tools play a critical role in reducing variability and promoting evidence-based practices. For instance, structured handover frameworks like SBAR (Situation-Background-Assessment-Recommendation) have been shown to enhance communication and reduce errors in critical care settings. Similarly, the adoption of standardized pain assessment tools, such as the Critical-Care Pain Observation Tool (CPOT), ensures consistent and accurate evaluation of pain levels, enabling timely interventions [13].

Policy Reform and Leadership

Institutional policies must align with evidence-based guidelines to drive systemic change. Hospital leaders and policymakers have a crucial role in fostering a culture of inquiry and accountability. For example, revising restrictive visiting policies to incorporate family-centered care principles can improve patient and family satisfaction without compromising infection control [14]. Additionally, leadership initiatives that reward adherence to evidence-based practices can motivate healthcare professionals to embrace change.

Interprofessional Collaboration

Collaboration among healthcare professionals is essential for the successful implementation of evidence-based practices. Studies highlight the benefits of interdisciplinary teams in fostering shared decision-making, improving communication, and ensuring consistent care delivery [15]. For example, joint efforts between nurses, physicians, and respiratory therapists can streamline weaning protocols, reducing ventilator duration and associated complications.

Technology and Innovation

Advancements in technology offer new opportunities for integrating evidence-based practices into critical care. For example, electronic health records (EHRs) can be programmed to provide real-time alerts and reminders, guiding practitioners towards evidence-based interventions. Similarly, decision-support systems can facilitate adherence to protocols, such as pressure injury prevention measures, by providing actionable insights based on patient data [16].

Study Design

This prospective observational study was conducted over a one-year period from January to December 2011 in a critical care inpatient unit. The study aimed to analyze seven traditional practices in critical care, such as Trendelenburg positioning and restrictive visiting policies, and evaluate their impact on patient outcomes. A total of 118 patients and 50 nurses participated, with data collected through structured surveys, observational audits, and patient outcome records. The study design emphasized the practical implementation of evidence-based practices and the identification of barriers to their adoption. Baseline data were collected to assess the prevalence of traditional practices, followed by interventions promoting evidence-based alternatives. Outcomes were measured in terms of patient safety, psychological well-being, family satisfaction, and nurse adherence to evidence-based protocols. The study used quantitative and qualitative approaches to ensure comprehensive data collection and analysis.

Inclusion Criteria

Participants were selected based on specific inclusion criteria to ensure the study's relevance and reliability. Patients aged 18 years and older admitted to the critical care unit for a minimum of 48 hours were included. Only patients diagnosed with conditions requiring interventions such as Trendelenburg positioning, mechanical ventilation, or pain management were considered. Additionally, patients with intact cognitive abilities or reliable family members for consent and feedback were included. For nurses, inclusion criteria comprised active involvement in patient care in the critical care unit for at least six months prior to the study. Nurses willing to participate and provide consent for surveys and interviews were included. Family members who were primary caregivers and actively involved in decision-making were also included for feedback related to visiting policies and patient satisfaction. This comprehensive inclusion strategy ensured the collection of diverse yet targeted data relevant to the research objectives.

Exclusion Criteria

Exclusion criteria were established to minimize confounding variables and ensure data quality. Patients younger than 18 years, those with cognitive impairments or without reliable family members, and those admitted to the critical care unit for less than 48 hours were excluded. Patients receiving palliative or end-of-life care were excluded to avoid skewing results related to interventions such as ventilator weaning or restraint use. Additionally, patients with pre-existing conditions unrelated to the study focus, such as chronic neurological disorders or long-term psychiatric illnesses, were excluded to maintain homogeneity. Nurses who had less than six months of experience in the critical care unit or who were on extended leave during the study period were excluded. Family members unwilling to provide feedback or participate in structured surveys were excluded. These exclusion criteria were rigorously applied to ensure the study population accurately reflected the target group impacted by the identified critical care practices.

Data Collection

Data were collected systematically using a combination of methods to capture comprehensive information. Patient outcomes were recorded from electronic health records (EHRs) and included metrics such as ventilator duration, pressure injury incidence, and complications related to Trendelenburg positioning. Structured surveys were administered to nurses to assess their knowledge, attitudes, and practices regarding evidence-based interventions. Observational audits were conducted during routine care to document the prevalence and application of traditional practices. Family satisfaction and psychological impact were assessed using validated questionnaires, such as the Critical Care Family Needs Inventory (CCFNI). Data collection occurred in two phases: baseline data to establish the prevalence of traditional practices and post-intervention data to evaluate the impact of evidence-based alternatives. All data were anonymized and securely stored to ensure confidentiality. The use of multiple data sources ensured a robust and multidimensional analysis of the research objectives.

Data Analysis

Data were analyzed using SPSS version 20.0 to perform statistical evaluations of the collected data. Descriptive statistics, including means, medians, and standard deviations, were used to summarize demographic information and baseline prevalence rates of traditional practices. Chi-square tests assessed associations between categorical variables, such as the use of Trendelenburg positioning and respiratory complications. Paired t-tests evaluated pre- and post-intervention differences in patient outcomes, including ventilator duration and pressure injury rates. For psychological metrics, such as patient anxiety and family satisfaction scores, Wilcoxon signed-rank tests were used to compare baseline and post-intervention medians. Multivariate logistic regression was applied to identify factors influencing nurse adherence to evidence-based practices, with independent variables including education level, years of experience, and exposure to training programs. Statistical significance was set at p < 0.05. The results were presented in tabular and graphical formats for clarity. The comprehensive use of SPSS allowed for detailed analysis of both primary and secondary outcomes, ensuring the reliability and validity of the findings.

Ethical Considerations

Ethical approval for the study was obtained from the Institutional Review Board (IRB) prior to data collection. All participants, including patients, nurses, and family members, provided written informed consent after being briefed about the study's objectives, procedures, and potential risks. Participation was voluntary, and participants had the right to withdraw at any stage without any consequences. Patient anonymity was ensured by assigning unique identifiers, and data were stored in encrypted files accessible only to authorized research personnel. The study adhered to the Declaration of Helsinki principles, prioritizing the safety, rights, and dignity of participants. Special care was taken to minimize any additional burden on patients or families, and interventions were designed to align with routine care practices. Any psychological distress identified during the study, such as increased anxiety due to feedback sessions, was addressed through counseling services provided by the hospital. The findings were shared with stakeholders to promote transparency and contribute to evidence-based policy development. Ethical considerations were integral to every stage of the study to ensure compliance with regulatory standards and to uphold the integrity of the research process.

Table 1: Demographic Characteristics

The demographic data revealed that 59.32% of participants were male (p = 0.05), and 40.68% were female (p = 0.10). The majority (50.85%) were aged 31-50 years, with significant differences observed across age groups (p ≤ 0.20). Marital status analysis showed a higher proportion of married individuals (67.80%, p = 0.01) compared to single participants (32.20%, p = 0.03). These findings highlight the diverse composition of the study population, emphasizing significant demographic influences on critical care practices.

Table 2: Prevalence of Traditional Practices

The analysis revealed that restricted visiting policies were the most prevalent traditional practice, affecting 84.75% of patients (p = 0.01), followed by unstructured handovers (67.80%, p = 0.02) and Trendelenburg positioning (58.47%, p = 0.02). Physical restraints were used in 48.31% of cases (p = 0.03), while subjective pain assessment occurred in 52.54% of patients (p = 0.01). Non-standardized pressure injury prevention affected 33.90% of patients (p = 0.04). These findings underscore the widespread reliance on traditional practices, highlighting the need for evidence-based interventions to improve care quality and patient outcomes.

Table 3: Patient Outcomes Associated with Traditional Practices

The outcomes revealed that prolonged ventilator use affected 23.73% of patients, showing the most significant association (p = 0.01). Increased patient anxiety was prevalent in 29.66% of cases (p = 0.03), while respiratory complications were observed in 18.64% (p = 0.04). Pressure ulcers occurred in 21.19% of patients (p = 0.02), and delirium affected 16.95% (p = 0.05). These findings highlight the adverse impacts of traditional practices, emphasizing the need for evidence-based strategies to mitigate these complications and improve patient outcomes.

Table 4: Impact of Evidence-Based Interventions

The implementation of evidence-based interventions significantly improved patient outcomes. Respiratory complications decreased from 18.64% to 12.71% (p = 0.01), and patient anxiety dropped from 29.66% to 20.34% (p = 0.02). Delirium incidence reduced substantially from 16.95% to 10.17% (p = 0.01), while pressure ulcers declined from 21.19% to 15.25% (p = 0.02). Ventilator use also decreased from 23.73% to 18.64% (p = 0.03). These results demonstrate the effectiveness of evidence-based practices in reducing complications and enhancing patient recovery.

Table 5: Adherence to Evidence-Based Practices

The adoption of evidence-based practices led to significant improvements across all domains. Evidence-based positioning increased from 41.53% to 70.34% (p = 0.01), and open visiting policies rose dramatically from 15.25% to 67.80% (p = 0.01). Structured handover practices improved from 32.20% to 78.81% (p = 0.02), while standardized pain assessment adherence increased from 47.46% to 79.66% (p = 0.01). Pressure injury prevention practices nearly doubled, improving from 33.90% to 65.25% (p = 0.02). These findings underscore the transformative impact of targeted interventions in aligning critical care practices with evidence-based standards.

Figure 1: Analysis of Family Satisfaction Before and After Interventions

The implementation of evidence-based interventions significantly enhanced family satisfaction metrics. Emotional support improved from 65% to 85% (p = 0.01), while communication quality rose from 58% to 82% (p = 0.02). Access to information showed a substantial increase, from 60% to 88% (p = 0.01), and family involvement in care improved from 50% to 78% (p = 0.03). These improvements highlight the positive impact of patient- and family-centered care strategies on overall satisfaction and engagement.

Figure 2: Breakdown of Complications by Patient Demographics

The analysis revealed significant variations in complications across age groups. Patients aged 18-30 exhibited the lowest rates of respiratory complications (10%), anxiety (20%), delirium (5%), and pressure ulcers (8%) (p = 0.03). Those aged 31-50 experienced moderate rates of complications, including anxiety (30%) and respiratory issues (15%) (p = 0.02). The highest rates were observed in the 51+ age group, with 25% experiencing respiratory complications, 40% reporting anxiety, 20% developing delirium, and 28% suffering from pressure ulcers (p = 0.01). These findings indicate a clear trend of increasing complication rates with advancing age, underscoring the need for tailored interventions in older populations.

Table 6: Length of ICU Stay Comparisons

The analysis showed that patients subjected to traditional practices had longer ICU stays and higher ventilator dependency rates. Trendelenburg users had an average ICU stay of 10.5 days and a ventilator dependency rate of 23.73% (p = 0.01), compared to non-Trendelenburg users with 7.2 days and 12.71% dependency (p = 0.02). Similarly, restrained patients had significantly prolonged ICU stays (12.1 days) and a ventilator dependency rate of 25.00% (p = 0.01), whereas non-restrained patients had shorter stays (8.3 days) and lower dependency rates (15.25%, p = 0.02). These findings highlight the detrimental impact of traditional practices on patient recovery and resource utilization.

Prevalence of Traditional Practices

The high prevalence of traditional practices in our study mirrors findings from other investigations. For example, 58.47% of our patients were subjected to Trendelenburg positioning, a figure comparable to the 60% reported in Robertson et al. [17]. Despite evidence highlighting its potential harm, this practice remains common, reflecting a gap between knowledge and implementation. Similarly, our observation that restrictive visiting policies affected 84.75% of cases aligns with the findings of Davidson et al., who reported similar rates across ICUs in the United States [9]. Physical restraint use in our study (48.31%) was consistent with the findings of a similar study who documented usage rates ranging from 40% to 50% in critical care settings. The reliance on subjective pain assessment (52.54% in our study) also echoes prior research, which found that up to 60% of nurses rely on subjective methods despite the availability of validated tools such as the Critical-Care Pain Observation Tool.

Impact on Patient Outcomes

The adverse outcomes associated with traditional practices in our study are well-supported by existing literature. For example, we found that respiratory complications occurred in 18.64% of patients subjected to Trendelenburg positioning. Pelosi et al. similarly reported increased respiratory complications, including compromised oxygenation, in patients placed in this position [3]. This practice also contributed to prolonged ICU stays in our study (10.5 days vs. 7.2 days for non-users), aligning with findings from a similar study. Restrictive visiting policies in our study were associated with heightened patient anxiety (29.66%) and lower family satisfaction scores. These findings parallel Truog et al., who demonstrated that restrictive policies exacerbate psychological distress among patients and families, whereas open policies improve satisfaction and communication [18]. The high incidence of delirium (16.95%) and pressure ulcers (21.19%) in our study highlights the broader risks associated with traditional practices. Studies by Sharp et al. and Blackwood et al. similarly identified these complications as prevalent among patients exposed to outdated weaning protocols and non-standardized pressure injury prevention methods [7, 15].

Effectiveness of Evidence-Based Interventions

Our evidence-based interventions yielded significant improvements, including reductions in respiratory complications (from 18.64% to 12.71%), anxiety (29.66% to 20.34%), and delirium (16.95% to 10.17%). These findings are consistent with Hannes et al., who reported similar outcome improvements following the implementation of EBPs in critical care [10]. Open visiting policies, introduced in our study, increased family satisfaction from 60% to 88%. Davidson et al. documented similar benefits, with open policies reducing patient stress and enhancing family involvement in care [9]. Similarly, structured handover practices improved communication and reduced errors in our study, echoing the findings of Woodhall et al., who demonstrated the efficacy of the SBAR framework in ICU settings [19]. The shift to standardized pain assessment tools, which improved adherence from 47.46% to 79.66%, aligns with a similar study, which reported better pain management and patient outcomes with validated tools like the CPOT. Additionally, implementing pressure injury prevention protocols reduced the incidence of pressure ulcers from 21.19% to 15.25%, consistent with Baharestani et al., who emphasized the importance of evidence-based preventive measures [20].

Comparison with Global Practices

Our study's findings resonate with global trends in critical care but also highlight unique challenges. For instance, the reliance on Trendelenburg positioning and restrictive policies is more prevalent in low-resource settings, where institutional barriers and limited access to training exacerbate the problem [21]. In contrast, high-resource settings have shown greater progress in EBP adoption, partly due to better infrastructure and access to continuing education programs.

However, even in high-resource settings, the translation of evidence into practice remains inconsistent. Weinert et al. observed that up to 50% of critical care nurses in the United States were unaware of recent guidelines discouraging Trendelenburg positioning [2]. This highlights the universal nature of the knowledge-practice gap, emphasizing the need for targeted interventions regardless of geographic or resource-related differences.

Barriers to Evidence-Based Practice

Our findings underscore several barriers to EBP adoption, including lack of training, resistance to change, and institutional inertia. Nurses in our study cited inadequate access to educational resources as a major barrier, a finding echoed by Brown et al. [4]. Resistance to change, particularly among senior staff, was another significant challenge, consistent with Gurses et al., who identified hierarchical dynamics as a key obstacle [22]. Institutional barriers, such as rigid policies and insufficient staffing, further hindered EBP implementation in our study. These issues align with a similar study, which emphasized the role of organizational culture in perpetuating traditional practices. Addressing these barriers requires a multi-faceted approach that combines education, leadership support, and policy reform.

Implications for Clinical Practice

The improvements observed in our study demonstrate the potential of EBPs to enhance patient outcomes and care quality. For example, the reduction in ICU stays (from an average of 10.5 days to 7.2 days) has significant implications for resource utilization and healthcare costs. Blackwood et al. similarly highlighted the cost-saving benefits of evidence-based weaning protocols, which reduce ventilator-associated complications and associated expenses [15]. The adoption of open visiting policies, which increased family satisfaction and reduced anxiety in our study, underscores the importance of patient- and family-centered care. Davidson et al. advocate for integrating family involvement into routine care as a core component of critical care practice [9]. Additionally, the success of structured handovers and standardized pain assessment tools highlights the role of communication and consistency in improving care quality. These findings reinforce the need for ongoing training and the development of user-friendly tools to facilitate EBP adoption [23].

Recommendations for Future Research

While our study provides valuable insights, several areas warrant further investigation. First, longitudinal studies are needed to assess the sustainability of EBP adoption and its long-term impact on patient outcomes. Second, research should explore the role of technology, such as electronic health records and decision-support systems, in bridging the knowledge-practice gap. Third, comparative studies across different healthcare settings can identify context-specific barriers and solutions, enhancing the generalizability of findings. Finally, qualitative research exploring the perspectives of patients, families, and healthcare providers can provide a deeper understanding of the factors influencing EBP adoption and its perceived benefits.

This study highlights the detrimental effects of traditional critical care practices such as Trendelenburg positioning and restrictive visiting policies on patient outcomes. The implementation of evidence-based interventions significantly improved respiratory outcomes, reduced anxiety and delirium rates, and increased patient and family satisfaction. Despite these advancements, barriers such as institutional inertia, lack of training, and resistance to change persist, hindering widespread adoption of evidence-based practices. Addressing these challenges requires targeted efforts to educate healthcare providers, reform policies, and foster a culture of innovation and collaboration in critical care. By prioritizing evidence-based approaches, healthcare systems can optimize patient outcomes and improve care quality.

Recommendations

Establish mandatory training programs for evidence-based practices in critical care.

Revise institutional policies to promote patient- and family-centered care.

Integrate evidence-based decision-support tools into daily practice.

Acknowledgment

We sincerely thank all participating patients, families, and healthcare professionals for their invaluable contributions to this research. Our gratitude extends to the critical care staff for their cooperation and commitment to improving patient care. We also acknowledge the support of Institution, which provided resources and funding necessary for the successful completion of this study.

Funding: No funding sources.

Conflict of interest: None declared

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