Implementing evidence-based practice in critical care nursing: an ethnographic case study of knowledge use

Aim: To explore how critical care nurses access, negotiate and apply knowledge in high-pressure clinical environments, focusing on organisational, cultural and leadership factors influencing evidence-based practice implementation in acute hospital settings. Design: A focused ethnographic collective case study was conducted across two contrasting critical care units in England. Methods: Methods included non-participant observation (56 sessions), semi-structured interviews (36 participants) and document review. Spradley's Developmental Research Sequence guided data generation and analysis. Data were collected over an eight-month period (February to September 2022). Findings: Five major themes were identified: sources of knowledge and acquisition strategies; institutional and hierarchical influences on knowledge use; role of experiential knowledge and clinical intuition; challenges to evidence-based practice implementation; and strategies for integrating knowledge into practice. Organisational structures, leadership engagement, mentorship and access to updated digital resources were key enablers of evidence-based practice. Barriers included workload pressures, inconsistent guideline dissemination and hierarchical cultures. Adaptive blending of formal evidence, clinical experience and intuition characterised effective knowledge negotiation at the bedside. Conclusion: Knowledge use in critical care nursing is a dynamic, relational process shaped by leadership, organisational culture and systemic pressures. The availability of evidence alone is insufficient; visible leadership, peer learning, protected educational time and valuing of experiential knowledge are critical to embedding evidence-based practice into routine practice. Implications for Patient Care: Strengthening organisational systems, investing in nurse manager development, expanding simulation-based learning and legitimising experiential knowledge are vital strategies to enhance evidence-based critical care. Impact: This study provides actionable insights for healthcare leaders, educators and policymakers seeking to optimise evidence-based practice adoption in high-acuity clinical environments and improve patient outcomes. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research checklist guided reporting. No Patient or Public Involvement: Patients and the public were not involved in the design, conduct, reporting or dissemination of this research.