Constructing situated evidence-based practice in acute frailty care: A grounded theory

Area of Science:

• Nursing
• Healthcare Management
• Evidence-Based Practice

Background:

• Acute frailty units present unique challenges for implementing evidence-based practice (EBP).
• Nurses navigate complex care environments requiring adaptation of EBP to daily routines.
• Understanding the nurse's role in constructing and enacting EBP is crucial for improving patient outcomes.

Purpose of the Study:

• To develop a grounded theory explaining how nurses in acute frailty units construct, negotiate, and enact evidence-based practice (EBP).
• To identify the core processes and contextual factors influencing EBP implementation in this setting.

Main Methods:

• Constructivist grounded theory design.
• 21 semi-structured interviews and 36 hours of focused observation in an English acute frailty unit.
• Analysis involved constant comparison, coding (initial, focused, theoretical), memoing, and situational mapping.

Main Results:

• The core process identified is 'constructing situated EBP', involving negotiating professional boundaries, integrating patient/family preferences, mediating organizational pressures, and sustaining professional identity.
• Credible EBP proposals gained traction through strategic timing, relational framing, visible warrants (tools, audits), and institutional language.
• Micro-facilitation, a distributed interactional work, enabled nurses to align patient goals with organizational imperatives and document acceptable rationales.

Conclusions:

• The developed theory explains how nurses translate shared evidence into situated action within fast-paced, multidisciplinary settings.
• Micro-facilitation is presented as routine interactional work, not a discrete role, supporting safe and acceptable decisions under pressure.
• The model is transferable to high-tempo services managing multimorbidity, emphasizing the use of legitimizing tools and rapid deliberation.