Delivering safe, high-quality patient care is a central goal of health care institutions [1] and evidence-based practice (EBP) plays a key role in achieving this [2]. Despite strong advocacy, the integration of scientific evidence into everyday nursing practice remains inconsistent [3]. Studies report that barriers such as insufficient EBP knowledge and skills, lack of mentors and facilitators, perceptions that EBP takes too much time, unsupportive organizational cultures, and environments hinder nurses from using evidence at the point of care [2,3]. At the same time, there is an exponential growth in the body of evidence-based knowledge, which needs to be accessed and integrated into daily nursing practices in a timely and contextually relevant manner [4].

To address these challenges, the concept of knowledge management, widely used in other industries, is gaining traction in health care settings [5]. Knowledge management refers to programs or systems to create, capture, store, organize, and share knowledge and information effectively within organizations [6]. In health care settings, knowledge management has the potential to strengthen nursing performance [7] by facilitating access to both scientific knowledge and the expertise or practice knowledge of team members [5]. However, effective knowledge management in nursing practice requires more than just access; it requires integration into clinical workflows, supportive leadership, and a culture of continuous learning [6,8].

Knowledge management systems (KMSs), as a technological solution, offer a way to embed both evidence-based and practice-based knowledge directly into the nursing process [4]. KMSs are designed to support and enhance organizational processes for creating, storing, retrieving, transmitting, and applying knowledge [9]. When effectively designed and implemented, KMSs can support nurses in making informed decisions, promote EBP, and improve the quality of nursing care [9,10]. Despite this potential, research shows that such systems are rarely used in health care, especially in nursing contexts. To date, there are few descriptions of the development, implementation, and evaluation of KMSs in nursing practice [4]. There is a need to investigate factors on the adoption of a KMSs that are integrated into the nursing process in hospitals from different perspectives [11].

In a prior study, Ranegger et al [12] demonstrated the theoretical feasibility of linking evidence-based knowledge to standardized nursing interventions through a mapping project. While this work provided an essential foundation for embedding evidence in structured nursing documentation, it did not explore how such a system could meet the practical and contextual needs of nurses in clinical settings. Consequently, little is known about what nurses expect from a KMS, how they envision it supporting their workflow, and which organizational factors are required for successful implementation [12].

Building on this gap, our study focuses on advancing current research on KMSs in the health care sector by adding a user-centered perspective to support nurses at the point of care.

Therefore, the aim of this study was to qualitatively explore nurses’ perspectives on the requirements for a KMS that supports EBP at the point of care, with a focus on usability, process integration into the electronic nursing care plan and patient chart, and implementation challenges and benefits. By identifying these requirements, this study contributes to the development of a KMS that is not only theoretically feasible but also contextually relevant, usable, and sustainable in clinical practice.

An exploratory qualitative study design based on inductive thematic analysis was conducted to gain an in-depth understanding of nurses’ perspectives, expectations, and experiences related to the development and implementation of a KMS to support EBP at the point of care. The study followed the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines to ensure methodological rigor and transparency [13]. The study was underpinned by a pragmatic theoretical orientation, which assumes that knowledge is constructed through experience and that research should focus on understanding real-world problems and generating practical solutions. This framework guided the exploration of nurses’ expectations of a KMS, emphasizing the practical relevance of the findings for system design and implementation.

Two researchers collected the data. The first researcher was a female research associate with expertise and training in nursing and health sciences. She holds a master’s degree in public health, is specialized in EBP, and has worked as a nurse previously. The second researcher was a male research associate with a master’s degree in information systems with research experience in digital health. The researchers were not known to the participants before the study. Participants were informed about the researchers’ professional backgrounds, institutional affiliations, and the aim of the study. They also knew about the researchers’ roles within the project and that participation was voluntary and anonymous. The researchers were aware that their professional backgrounds could influence how they collected and analyzed data. They therefore reflected these potential biases throughout the analysis to support a balanced understanding of the data.

The study was conducted in a hospital in Switzerland that is part of a private hospital group comprising 3 hospitals. The hospital group employs approximately 2500 staff and treats over 140,000 patients annually, including around 27,000 inpatients. At the time of the study, a new intranet was planned to centralize knowledge resources and improve search capabilities.

The study focused on nurses with diverse work experience and role profiles because the KMS was intended primarily for nursing practice. Additionally, 1 physician was included to provide an interprofessional perspective, as physicians are involved in the current system. Only 1 physician was included because the study primarily focused on nursing workflows and physician involvement in the planned KMS was limited during the recruitment period. A purposive sampling strategy was applied via the head of the nursing development department to recruit participants for observations, individual interviews, and focus group interviews. All participants were directly or indirectly involved in nursing-related knowledge management, either as users of or contributors to knowledge sources. Eligibility criteria included active involvement in nursing care or related managerial or educational functions within the hospital. The initial plan was to invite 15 to 20 participants, which was achieved, with 18 individuals confirming attendance.

Prior to data collection, an observation guide and a semistructured interview guide were developed based on a literature review. The researchers first conducted independently 4 hours of open, participatory observation on a ward in November 2023, focusing on the activities of 3 registered nurses during their shifts on a surgical and internal medicine ward and took field notes according to the observation guide. These 3 nurses were not further part of the interviews.

Subsequently, all interviews were conducted using the semistructured interview guide, which was adapted after the observations. The 2 authors held 2 face-to-face focus group interviews in the hospital, with participants grouped by professional hierarchy to encourage open discussion. The first focus group involved 9 advanced nurse practitioners (ANPs) with master’s degrees from different wards in the participating hospital (92 min). The second focus group comprised 3 registered nurses with a diploma degree from the surgical ward to capture another perspective (50 min). Three additional online interviews using Microsoft Teams (30 min each) were held with a head physician, a division manager in nursing care, and a co-nursing manager to include different viewpoints. Sociodemographic data from all participants were collected verbally (Table 1). All interviews were conducted between November 2023 and January 2024 and were audio-recorded. Field notes were taken during the interviews. No repeated interviews were carried out.

Observation notes were translated, summarized, and thematically clustered. The single and focus group interviews were audio-recorded and transcribed by hand. Data analysis took place in parallel with data collection. Data saturation was considered achieved after the third online interview. Consistency between the 2 data collectors was ensured through continuous discussion during data collection and analysis to align interpretation and maintain reflexivity.

Thematic analysis was conducted following the 6-phase approach described by Braun and Clarke [14]. In addition to the categories already formed a priori through a literature review and by developing the semistructured interview guide, 1 author performed the initial coding of all transcripts using MAXQDA 2022 [15]. Coding decisions and theme development were subsequently discussed with 2 additional authors to ensure analytic consistency and to confirm the relevance of identified categories. Disagreements were resolved through discussion until consensus was achieved. The analysis resulted in main categories and subcategories, which were then translated from German to English.

All participants were informed verbally about the purpose and procedures of the study, data confidentiality, and voluntary participation. Informed consent was obtained before participation, and withdrawal of consent was permitted at any stage, including after data collection. Audio recordings were transcribed verbatim, anonymized to remove any potentially identifiable information, and assigned participant codes before recordings were subsequently deleted. All data were stored securely on password-protected institutional servers in accordance with data protection regulations. No participants withdrew consent for the use of their data in this study. According to Swiss legislation, this study did not require approval by a cantonal ethics committee. In accordance with the Swiss Human Research Act (Humanforschungsgesetz, HFG), ethical approval is mandatory only for research involving human participants where health-related personal data are collected or where interventions are performed [16]. The present study focused exclusively on healthcare professionals’ perspectives on KMSs. No patients were involved, no health-related personal data were collected, and no interventions were performed. Therefore, the study does not fall within the scope of the Swiss Human Research Act and did not require formal ethical approval by a Swiss ethics committee.

However, the study was followed in accordance with the World Medical Association's Declaration of Helsinki.

All 18 participants were nurses with different degrees and roles, except 1 was a head physician. The participants from the observations and interviews had at least 1 year of professional experience and worked in different roles and fields in the hospital (Table 1).

The thematic analysis resulted in 4 main categories with 10 subcategories, each of which will be discussed in the following sections (Table 2).

This study explored nurses’ expectations and needs for a KMS integrated into the electronic nursing care plan and patient chart. Participants found the existing hospital information system fragmented and time-consuming. In-house nursing instructions were well-structured but difficult to access due to a confusing filing system and poor search functionality. Nurses often relied on colleagues or ANPs for quick answers, especially under time pressure. Nurses expressed a strong need for a KMS that was integrated into the electronic nursing care plan and patient chart. They envisioned context-sensitive information access, such as clickable links or icons, at each step of the nursing process, from assessment through intervention to evaluation. The system should offer a simplified structure, powerful search functions, and information presented in practical, user-friendly formats like checklists, videos, or brief summaries. To support safe and efficient care, nurses emphasized that information must be both easily retrievable and always up to date. They saw clarity about responsibilities for maintaining the system as essential. Ultimately, they imagined that a well-designed KMS would enhance care quality, streamline workflows, and strengthen nurses’ professional confidence at the point of care.

Our results show that the current system does not adequately support quick and reliable access to nursing-relevant information at the point of care. Nurses reported relying on team members or navigating complex document systems, often under time pressure. This aligns with findings that emphasize the importance of integrating knowledge tools directly into clinical workflows to reduce search time and cognitive load [4]. Existing help buttons and intranet instructions were appreciated; however, they were not sufficient for efficient knowledge access during daily work. This underscores the importance of embedding knowledge directly into digital workflows. Chorney et al [9] recommended this because they found that integrating KMS into clinical systems significantly improved access and usage. Knowledge embedded in systems not only reduces variation of information and nursing interventions but also supports EBP, given that the content is reliable and up to date [17]. This resonates with the Technology Acceptance Model, which emphasizes perceived usefulness and ease of use as key predictors of usage [18]. The desire for an intuitively designed, workflow-integrated KMS illustrates that these dimensions are central to successful use and implementation.

Nurses described variability in their ability to retrieve and apply information, especially among new staff, part-time workers, or those returning from leave. This reflects a broader challenge of information and digital literacy in nursing practice. Training was seen as critical to ensuring consistent access to and use of available knowledge resources. These findings are consistent with earlier studies that show age and experience influence confidence with electronic clinical systems [10] and that tailored onboarding and continued training support more effective system use [17]. Moreover, nurses’ literacy influences their attitudes towards and intentions to use KMS [19]. While technical solutions are necessary, they must be accompanied by accessible training formats and support structures to ensure equitable use across roles and experience levels [17].

Our study revealed a distinct division of tasks around knowledge sources: while nurses primarily relied on in-house nursing instructions and team members, ANPs engaged with external evidence sources. This distinction reflects the layered process of knowledge use, translation, and transfer outlined by Shahmoradi et al [4]. ANPs acted as translators, adapting external evidence to the hospital’s context, while nurses at the point of care used this adapted knowledge. In addition to the application of nursing instructions, information was also transferred via other communication channels such as direct exchange, emails, or newsletters. This confirms findings from Al-Busaidi [20], who emphasized that knowledge transfer in health care often depends on informal systems that are neither systematic nor easily evaluated.

A consistent theme in the interviews was the desire for a system that was intuitive, accessible, and available throughout the nursing process. This aligns with previous findings that ease of access and integration into clinical routines are critical success factors for KMS adoption [9]. Participants suggested that its functionalities should include a logical filing system, powerful search capabilities, and support for multiple content formats. This reflects a need for information to be both concise and adaptable to diverse learning preferences [9].

The absence of AI use among participants in the period before and during data collection in 2023 and 2024 also reflects broader hesitations in clinical environments. While AI integration was not expected by participants, its future role in enhancing clinical KMS remains a promising area for development [4]. Regardless of the technology used, the success of the KMS depends on its ability to fit seamlessly into the existing workflow and meet users’ needs for quick and trustworthy information [20].

Participants proposed a range of indicators to evaluate a future KMS, including efficiency gains, time savings, and perceived improvements in quality of care. These are consistent with indicators described by Al-Busaidi [20], who emphasized both organizational and individual-level outcomes such as improved learning, collaboration, and job satisfaction. Nurses in the interviews also framed evaluation in terms of emotional and ethical relief, particularly the idea that linked and validated instructions could reduce their burden of manually searching the “right” document. This does not imply a reduction in professional responsibility but highlights how a well-maintained KMS can support nurses in fulfilling their responsibilities more safely and confidently. This emotional dimension adds a new perspective in understanding trust in digital systems. Trust is shaped not only by technical reliability but also by how systems redistribute responsibility and reduce the risk of error [11]. When knowledge is institutionalized within a centrally maintained KMS, nurses can rely on the organization rather than the individual for ensuring accuracy. This shift reflects a rebalancing of cognitive and ethical responsibility, which can enhance professional confidence and perceived safety in clinical decision-making [21,22].

From the point of view of the head physician, division manager in nursing care, and co-nursing manager interviewed, organizational support emerged as an important factor for KMS success. They highlighted the need for leadership support, funding, and clear roles. These themes are confirmed across multiple studies, which identify infrastructure, staffing, policy support, and leadership engagement as critical to implementation success [1,20]. The findings also align with the Normalization Process Theory, which highlights the processes through which new interventions become embedded in everyday practice [23]. The constructs of shared understanding, cognitive participation, and practical integration are evident in participants’ emphasis on collaboration and institutional backing. Organizational culture also plays a key role, as collaborative and open cultures have been found to facilitate KMS adoption more effectively than hierarchical, profit-driven environments [11]. Interviewed ANPs acknowledged the potential value of a KMS, particularly in terms of reducing redundant work and saving time. These findings support the statement from Chorney et al [9], that the success of a KMS is not only a technical or clinical matter, but also a strategic one. For sustainable implementation, the system must align with institutional priorities, demonstrate clear value, and receive long-term support from decision-makers in the setting [20].

The main strength of the study was the inclusion of nurses with different levels of work experience and role profiles. This approach allowed for the consideration of multiple perspectives in the implementation of a KMS that was grounded in practical nursing requirements. The interdisciplinary research team balanced clinical and technical expertise but acknowledged that professional backgrounds might have influenced interpretation. Reflexivity was maintained through ongoing discussion to ensure balanced representation of participants’ views. Conducting the study in a single hospital allowed for detailed observation of local workflows and knowledge management practices but limits the transferability of findings to other settings with different structures or digital maturity. Another limitation concerns the conceptual nature of the topic, as the study explored expectations for a KMS that has not yet been developed. Finally, the data were collected in German and then translated into English. These translations were rigorously checked by authors fluent in both languages.

Our findings underscore the importance of designing a KMS that supports nurses’ real-time information needs at the point of care. Seamless integration into the electronic nursing care plan and patient chart, intuitive navigation, and access to up-to-date, evidence-based instructions in various formats were seen as essential. Nurse managers should prioritize training, onboarding processes, and continuous support, especially for new, part-time, or returning staff.

There is a need for further research on the design and usability of KMS tools, especially those that leverage emerging technologies such as AI for knowledge synthesis and decision support. Future studies should also explore the implementation and effects of KMS at the point of care. Further investigation into the quality indicators identified by nurses for measuring KMS impact could support the development of validated evaluation frameworks. Future projects from the authors focus on developing and piloting an AI-supported KMS. It aims to provide personalized, evidence-based recommendations tailored to nurses’ skill levels and workflows, thereby enhancing safety, quality, and efficiency at the point of care.

Participants expressed a clear need for a KMS that is user-friendly, seamlessly integrated into clinical workflows, and supports quick, reliable access to evidence-based knowledge. A well-designed KMS may have the potential to not only improve care quality and efficiency but also to enhance nurses’ confidence and sense of safety in their daily work.