Evidence-based nursing care in intensive care units: current practices, challenges and future directions

Ivan Abhishek Prakash; Pauline Sharmila; Samruddhi Suresh Bhakare; Yoshita Sood; Mohammed Irshad Rathore; Tamanna Koley; Regina P. F.; N. Prabha; S. P. Subashini; Balamurugan E.; Lakshimi K.; Mohammed Umar

doi:10.18203/2320-6012.ijrms20263549

Authors

Ivan Abhishek Prakash Department of Medical Surgical Nursing, Apex College of Nursing, Varanasi, Uttar Pradesh, India
Pauline Sharmila Department of Pediatric Nursing, Tagore College of Nursing, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
Samruddhi Suresh Bhakare Department of Child Health Nursing, Sadhu Vaswani College of Nursing, Maharashtra, University of Health Sciences, Pune, Maharashtra, India
Yoshita Sood Department of Mental Health Nursing, Akal College of Nursing, Eternal University, Sirmaur, Himachal Pradesh, India
Mohammed Irshad Rathore Department of Child Health Nursing (Paediatric), Laganshah Memorial Nursing College, Makrana, Rajasthan University of Health Sciences (RUHS), Jaipur, Rajasthan, India
Tamanna Koley Department of Nursing, ESIC Hospital, Bihta, Patna, Bihar, India
Regina P. F. Department of Obstetrics and Gynaecological Nursing, P. K. Das College of Nursing, Palakkad, Kerala University of Health Sciences, Kerala, India
N. Prabha Department of Medical Surgical Nursing, Karuna College of Nursing, Kerala University of Health Sciences, Palakkad, Kerala, India
S. P. Subashini Department of Medical Surgical Nursing, Teerthanker Mahaveer College of Nursing, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
Balamurugan E. Department of Nursing, SAHS, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry, India
Lakshimi K. Department of Medical Surgical Nursing, Akash Institute of Nursing, Devanahalli, Bengaluru, Karnataka, India
Mohammed Umar Department of Nursing, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263549

Keywords:

Critical care nursing, Evidence-based nursing, Intensive care unit, Nursing intervention, Patient safety, Quality improvement, Systematic review

Abstract

Nurses form the clinical backbone of every intensive care unit and the evidence they draw on at the bedside shapes how safely critically ill patients recover. This systematic review set out to bring together what is currently known about evidence-based nursing (EBN) in adult intensive care units (ICUs): the interventions in active use, the obstacles and enablers that decide whether these interventions actually take hold in practice, their measurable effect on patients and organizations and where the field appears to be heading. Seven databases (PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, Cochrane Library and Google Scholar) were searched for studies published between January 2015 and December 2025, following PRISMA 2020 methodology. Quantitative, qualitative and mixed-methods studies conducted in adult ICU settings were appraised using design-appropriate quality tools and synthesized narratively. Seventy-eight studies met the inclusion criteria. Interventions such as infection-prevention bundles, ventilator-care protocols, early mobilization, sedation optimization, delirium prevention, structured assessment and family-centered care were repeatedly linked to fewer healthcare-associated infections, shorter ventilation and ICU stays and stronger interdisciplinary teamwork. Understaffing, heavy workloads, limited research skills and weak organizational backing remained the main obstacles, while leadership, mentorship, standardized protocols and ongoing education helped interventions stick. Artificial intelligence, predictive analytics and tele-ICU services showed real promise but worked best alongside, rather than instead of, nursing judgment. Sustained investment in leadership, professional development and technology integration is needed to move evidence-based nursing further into everyday ICU care.

Metrics

Metrics Loading ...

References

Romero Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):825-73. DOI: https://doi.org/10.1097/CCM.0000000000003299

Balas MC, Weinhouse GL, Denehy L, Chanques G, Rochwerg B, Nydahl P, et al. Interpreting and implementing the 2018 PADIS clinical practice guideline. Crit Care Med. 2018;46(9):1464-70. DOI: https://doi.org/10.1097/CCM.0000000000003307

Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, et al. Caring for critically ill patients with the ABCDEF bundle: Results of the ICU liberation collaborative. Crit Care Med. 2019;47(1):3-14. DOI: https://doi.org/10.1097/CCM.0000000000003482

Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in critical care. Crit Care Clin. 2017;33(2):225-43. DOI: https://doi.org/10.1016/j.ccc.2016.12.005

Mart MF, Brummel NE, Ely EW. The ABCDEF bundle for the respiratory therapist. Respir Care. 2019;64(12):1561-73. DOI: https://doi.org/10.4187/respcare.07235

Sosnowski K, Lin F, Chaboyer W, Ranse K, Heffernan A, Mitchell M, et al. The effect of the ABCDEF bundle on delirium, functional outcomes and quality of life in critically ill patients: A systematic review and meta-analysis. Int J Nurs Stud. 2023;138:104410. DOI: https://doi.org/10.1016/j.ijnurstu.2022.104410

Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet. 2009;373(9678):1874-82. DOI: https://doi.org/10.1016/S0140-6736(09)60658-9

Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370-9. DOI: https://doi.org/10.1097/00003246-200107000-00012

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707-10. DOI: https://doi.org/10.1007/BF01709751

Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-32. DOI: https://doi.org/10.1056/NEJMoa061115

Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(8):915-36. DOI: https://doi.org/10.1086/677144

O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):162-93. DOI: https://doi.org/10.1093/cid/cir257

Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471-7. DOI: https://doi.org/10.1056/NEJM200005183422002

Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: A quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536-42. DOI: https://doi.org/10.1016/j.apmr.2010.01.002

Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: The MENDS randomized controlled trial. JAMA. 2007;298(22):2644-53. DOI: https://doi.org/10.1001/jama.298.22.2644

Girard TD, Kress JP, Fuchs BD, Thomason JWW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): A randomised controlled trial. Lancet. 2008;371(9607):126-34. DOI: https://doi.org/10.1016/S0140-6736(08)60105-1

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637. DOI: https://doi.org/10.1097/CCM.0b013e31827e83af

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304-77. DOI: https://doi.org/10.1007/s00134-017-4683-6

Vincent JL, Marshall JC, Namendys-Silva SA, François B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: The Intensive Care Over Nations (ICON) audit. Lancet Respir Med. 2014;2(5):380-6. DOI: https://doi.org/10.1016/S2213-2600(14)70061-X

Chaboyer W, Lin F, Foster M, Retallick L, McCallum J. Redesigning ICU bedside nursing handover: A pilot study. Int J Nurs Pract. 2009;15(6):548-53.

Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: A 1-day point-prevalence study in Germany. Crit Care Med. 2014;42(5):1178-86. DOI: https://doi.org/10.1097/CCM.0000000000000149

Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658. DOI: https://doi.org/10.1186/s13054-014-0658-y

Barnes-Daly MA, Phillips G, Ely EW. Improving hospital survival and reducing brain dysfunction at seven California community hospitals: Implementing PAD guidelines via the ABCDEF bundle. Crit Care Med. 2017;45(2):171-8. DOI: https://doi.org/10.1097/CCM.0000000000002149

Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management and Early Exercise/Mobility bundle. Crit Care Med. 2014;42(5):1024-36. DOI: https://doi.org/10.1097/CCM.0000000000000129

Kleinpell R, Aitken L, Schorr CA. Implications of the new international sepsis guidelines for nursing care. Am J Crit Care. 2013;22(3):212-22. DOI: https://doi.org/10.4037/ajcc2013158

Moss M, Nordon-Craft A, Malone D, Van Pelt D, Frankel SK, Warner ML, et al. A randomized trial of an intensive physical rehabilitation program for acute respiratory failure patients. Am J Respir Crit Care Med. 2016;193(10):1101-10. DOI: https://doi.org/10.1164/rccm.201505-1039OC

Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders' conference. Crit Care Med. 2012;40(2):502-9. DOI: https://doi.org/10.1097/CCM.0b013e318232da75

Blackwood B, Alderdice F, Burns KEA, Cardwell CR, Lavery GG, O'Halloran P, et al. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adults and children. Cochrane Database Syst Rev. 2014;(11):6904.

Kane-Gill SL, Rincon F. Expansion of telemedicine services: Tele-ICU and nursing implications. Crit Care Nurs Clin North Am. 2018;30(2):175-84.

van Sluisveld N, Oosterheert JJ, Vermeulen H, Westert GP, Wollersheim H, Zegers M. Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge: A systematic review. Intensive Care Med. 2015;41(4):589-604. DOI: https://doi.org/10.1007/s00134-015-3666-8

Mackey A, Bassendowski S. The history of evidence-based practice in nursing education and practice. J Prof Nurs. 2017;33(1):51-5.

Saunders H, Gallagher-Ford L, Kvist T, Vehviläinen-Julkunen K. Practicing healthcare professionals' evidence-based practice competencies: An overview of systematic reviews. Worldviews Evid Based Nurs. 2019;16(3):176-85. DOI: https://doi.org/10.1111/wvn.12363

Majid S, Foo S, Luyt B, Zhang X, Theng YL, Chang YK, et al. Adopting evidence-based practice in clinical decision making: Nurses' perceptions, knowledge and barriers. J Med Libr Assoc. 2011;99(3):229-36. DOI: https://doi.org/10.3163/1536-5050.99.3.010

Shayan SJ, Kiwanuka F, Nakaye Z. Barriers associated with evidence-based practice among nurses in low- and middle-income countries: A systematic review. Worldviews Evid Based Nurs. 2019;16(1):12-20. DOI: https://doi.org/10.1111/wvn.12337

Warren JI, McLaughlin M, Bardsley J, Eich J, Esche CA, Kropkowski L, et al. The strengths and challenges of implementing evidence-based practice in healthcare systems. Worldviews Evid Based Nurs. 2016;13(1):15-24. DOI: https://doi.org/10.1111/wvn.12149

Alqahtani N, Oh KM, Kitsantas P, Rodan M. Organizational factors associated with evidence-based practice knowledge, attitudes and implementation among nurses in Saudi Arabia. Int J Environ Res Public Health. 2022;19(14):8407. DOI: https://doi.org/10.3390/ijerph19148407

Pereira F, Pellaux V, Verloo H. Beliefs and implementation of evidence-based practice among community health nurses: A cross-sectional descriptive study. J Clin Nurs. 2018;27(9-10):2052-61. DOI: https://doi.org/10.1111/jocn.14348

Stavor DC, Zedreck-Gonzalez J, Hoffmann RL. Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital. J Nurs Adm. 2017;47(1):56-61. DOI: https://doi.org/10.1097/NNA.0000000000000437

Fu Y, Wang C, Hu Y, Muir-Cochrane E. The barriers to evidence-based nursing implementation in mainland China: A qualitative content analysis. Nurs Health Sci. 2020;22(4):1038-46. DOI: https://doi.org/10.1111/nhs.12763

Šabanė E, Vimantaitė R, Jakuška P. Application of evidence-based practice in intensive and critical care nursing. Open Nurs J. 2022;16:1160.

Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 4th ed. Philadelphia: Wolters Kluwer. 2023.

Titler MG. The evidence for evidence-based practice implementation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality. 2008;3:672.

Mathieson A, Grande G, Luker K. Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Prim Health Care Res Dev. 2019;20:96. DOI: https://doi.org/10.1017/S1463423618000488

O'Connell MB, Jensen PS andersen SL, Fernbrant C, Nørholm V, Petersen HV. Stuck in tradition. A qualitative study on barriers for implementation of evidence-based nutritional care perceived by nursing staff. J Clin Nurs. 2018;27(4):705-14. DOI: https://doi.org/10.1111/jocn.14020

Al-Lenjawi B, Kunjavara J, Hassan N, Fares M, Stefan M, Ibrahim R, et al. Evidence-based practice among critical care nurses and midwives in Qatar. Open J Nurs. 2022;12(1):42-59. DOI: https://doi.org/10.4236/ojn.2022.121004

McEvoy MP, Williams MT, Olds TS. Development and psychometric testing of a trans-professional evidence-based practice profile questionnaire. Med Teach. 2010;32(9):373-80. DOI: https://doi.org/10.3109/0142159X.2010.494741

Degu A, Teshome A, Beshir M, Yitayeh A, Azene A, Fekadu G, et al. Evidence-based practice and associated factors among nurses: A cross-sectional study. BMC Nurs. 2022;21:312.

Yang R, Gu Q, Chen F, Zhang L, Wang H, Li X, et al. Effect of evidence-based nursing management on protocol compliance in anticancer drug clinical trials. Asia Pac J Oncol Nurs. 2022;9(10):1114. DOI: https://doi.org/10.1016/j.apjon.2022.100114

Šabanė E, Vimantaitė R, Jakuška P. Application of evidence-based practice in intensive and critical care nursing. Open Nurs J. 2022;16:160. DOI: https://doi.org/10.2174/18744346-v16-e221124-2022-66

Mackey A, Bassendowski S. The history of evidence-based practice in nursing education and practice. J Prof Nurs. 2017;33(1):51-5. DOI: https://doi.org/10.1016/j.profnurs.2016.05.009