Journal of Advanced Nursing

Contextual Factors Affecting Evidence‐Based Practice in Orthopaedic Nursing and Rehabilitation: A Mixed Methods Study

ABSTRACT

Aim

To better understand what enables evidence-based practice, this study investigated contextual factors influencing evidence-based practice in general, and in relation to the implementation of bladder-monitoring guidelines in orthopaedic care.

Design

Convergent parallel mixed method.

Methods

This study was part of a hybrid research project across 17 Swedish orthopaedic sites. The data collection (2021–2023) included interviews with orthopaedic staff and patients post-hip surgery, patient survey free-text responses, and a staff survey on organisational context. Data were analysed with deductive content analysis and descriptive statistics, later integrated using a mixed methods approach.

Results

Evidence-based practice was supported by context factors such as staff collaboration and multiprofessional engagement. Staff addressed patient safety and equality by using evidence-based guidelines, but rarely involved the patients. Orthopaedic fast-track procedures positioned patients as passive recipients, while staff voiced a call for a more person-centred context. Positive attitudes, leadership engagement, use of champions, and adequate staffing enabled evidence-based practice, though a shortage in evaluation and high staff turnover hindered its implementation.

Conclusion

Orthopaedic context is characterised by several enabling organisational context factors for evidence-based practice, although patients lacking recognition of their needs and queries justify greater focus on person-centredness and mutual information exchange. Audit and feedback are crucial for improvements, but were lacking in the orthopaedic care context.

Implications for the Profession and/or Patient Care

Assessments of efforts made to implement evidence-based practice and its outcomes should incorporate nursing care. Slimmed care processes require attention to ensure patient participation.

Impact

The orthopaedic care context is enabling for evidence-based practice, although staff are challenged by fast-track procedures with extensive information exchange and insufficient person-centredness.

Reporting Method

The Mixed Methods Reporting in Rehabilitation & Health Sciences checklist.

Patient or Public Involvement

No patient or public contribution.

Trial Registration

Identifier: NCT 04700969