Evidence-based nursing in action: A focused ethnographic study of knowledge use in acute care

Evidence-based practice (EBP) plays a crucial role in improving care outcomes in critical care settings. However, its integration into nursing practice remains challenging due to organisational hierarchies, workload pressures, and uneven access to formal knowledge. This study explores how critical care nurses access, use, and integrate knowledge, with a focus on how organisational culture, leadership, and team dynamics influence EBP implementation across two acute care sites in England. The study adopted a focused ethnographic design, guided by Spradley’s Developmental Research Sequence. Data were collected over eight months through 210 hours of non-participant observation, 36 semi-structured interviews, and document analysis. Analysis was supported using NVivo 12, applying iterative thematic coding. Reflexivity and member checking were used to ensure analytical rigour and trustworthiness. Five central themes were identified: access to formal guidelines, the role of peer learning, organisational culture and hierarchy, the value of experiential knowledge, and barriers to EBP. While both sites demonstrated reliance on blended sources of knowledge, they differed in how organisational factors shaped access and engagement. Site A showed stronger support through mentorship, simulation-based learning, and active leadership. In contrast, Site B was marked by rigid structures and informal, inconsistent communication of evidence. Critical care nurses draw on both formal evidence and informal knowledge, but the conditions of their work environment influence how and when this knowledge is used. Investment in leadership, protected learning time, and inclusive communication practices is essential to support sustainable engagement with EBP in high-pressure settings.