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

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.