Promoting evidence-based nursing through collaboration, autonomy, and agency: A qualitative case study

Area of Science:

• Nursing
• Healthcare Management
• Organizational Behavior

Background:

• Evidence-based practice (EBP) is crucial for high-quality nursing care but faces inconsistent integration in acute settings.
• Nurses' ability to lead and sustain EBP is often limited by organizational hierarchies, time constraints, and interprofessional collaboration challenges.
• This study investigates how nurses implement, adapt, and promote EBP through collaboration, leadership, and professional development.

Purpose of the Study:

• To explore the multifaceted ways nurses enact, adapt, and promote evidence-based practice (EBP) within acute care settings.
• To identify facilitators and barriers influencing nurses' EBP integration, focusing on interprofessional collaboration and leadership.
• To understand the role of continuing professional development in supporting nurses' EBP initiatives.

Main Methods:

• An embedded comparative case study design utilizing interpretive and ethnographic principles.
• Conducted in two large English hospitals with distinct leadership structures.
• Data collected over six years from 25 participants (nurses, nurse managers, physicians) via interviews, observations, and document analysis; analyzed using reflexive thematic analysis.

Main Results:

• Key themes included leadership, organizational support, professional identity, interprofessional collaboration, structural barriers, and capacity building.
• Nurses demonstrated EBP through informal leadership, peer mentorship, and innovation, despite facing barriers like limited time and unequal access to professional development.
• Fragmented collaboration and resource constraints significantly impeded EBP implementation.

Conclusions:

• Nurses are active leaders in EBP, driven by relationships, judgment, and commitment to care quality, but organizational systems significantly shape their efforts.
• Recommendations include strengthening interprofessional collaboration, distributed leadership, EBP mentoring roles, and equitable access to continuing professional development.
• Hospital managers and policymakers should invest in team-based learning, inclusive governance, and digital access to promote consistent and inclusive evidence use.