Background: Changes in healthcare delivery, particularly in primary care, have resulted in changes to practice nurses’ (PNs) roles. Macro-level policy has focused increasingly on standardisation of care within the primary care environment, specifically in relation to management of chronic/long term conditions. Practice nurses have additionally taken on roles that include diagnostic and treatment elements for which they were not prepared for in their initial training.

Objectives: Do practice nurses make use of evidence-based guidelines (written and/or interactive) to inform the clinical encounter?
What other information sources do PNs use and what rationale do they provide?
How does context, specifically cultural and organisational issues influence knowledge utilisation?

Methods: Ethnographic data were generated relating to meso-level organisation of knowledge utilisation in 2 study sites. Interviews, observation and documentary analysis of available knowledge sources including guidelines and protocols were used to generate data relating to how knowledge is accessed and subsequently used at the micro level of the clinical patient encounter.

Results: Findings illustrated that a mixture of organisational and individual factors impacted on knowledge utilisation. Practice nurses used a combination of knowledge which they applied within the context of the individual patient encounter. This was accessed partly through their ‘mindlines’ developed from education, clinical experience and social learning, and partly through accessing a ‘bricolage’ of knowledge which included seeking advice from a variety of sources.

Conclusions: Social learning influences the growth and development of knowledge, development of more formal multidisciplinary networks or communities of practice has the potential to enhance dissemination. Strengthened networking would encourage horizontal dissemination and provide the opportunity for all parties to discuss externally received information and translate it into a form that is useful for practice. Primary care practices should increase the opportunity for horizontal networking between members of the primary care team.