challenges of implementing evidence based practice nursing essay

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Addressing the current challenges of adopting evidence-based practice in nursing

Affiliation.

1 Senior Lecturer, School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast.
PMID: 34514831
DOI: 10.12968/bjon.2021.30.16.970

This aim of this article is to explore the current position of evidence-based practice (EBP) in nursing. The article provides an overview of the historical context and emergence of EBP with an outline of the EBP process. There is an exploration of the current challenges facing the nursing profession as it endeavours to adopt EBP into care delivery, along with actions to address these challenges. There will also be a discussion on how to integrate EBP into undergraduate nursing curricula as academic institutions implement the Future nurse standards of proficiency from the Nursing and Midwifery Council.

Keywords: Evidence-based nursing; Evidence-based practice; Nursing practice.

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Evidence-informed practice: simplifying and applying the concept for nursing students and academics

Elizabeth Adjoa Kumah

Nurse Researcher, Faculty of Health and Social Care, University of Chester, Chester

View articles · Email Elizabeth Adjoa

Robert McSherry

Professor of Nursing and Practice Development, Faculty of Health and Social Care, University of Chester, Chester

View articles

Josette Bettany-Saltikov

Senior Lecturer, School of Health and Social Care, Teesside University, Middlesbrough

Paul van Schaik

Professor of Research, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough

challenges of implementing evidence based practice nursing essay

Background:

Nurses' ability to apply evidence effectively in practice is a critical factor in delivering high-quality patient care. Evidence-based practice (EBP) is recognised as the gold standard for the delivery of safe and effective person-centred care. However, decades following its inception, nurses continue to encounter difficulties in implementing EBP and, although models for its implementation offer stepwise approaches, factors, such as the context of care and its mechanistic nature, act as barriers to effective and consistent implementation. It is, therefore, imperative to find a solution to the way evidence is applied in practice. Evidence-informed practice (EIP) has been mooted as an alternative to EBP, prompting debate as to which approach better enables the transfer of evidence into practice. Although there are several EBP models and educational interventions, research on the concept of EIP is limited. This article seeks to clarify the concept of EIP and provide an integrated systems-based model of EIP for the application of evidence in clinical nursing practice, by presenting the systems and processes of the EIP model. Two scenarios are used to demonstrate the factors and elements of the EIP model and define how it facilitates the application of evidence to practice. The EIP model provides a framework to deliver clinically effective care, and the ability to justify the processes used and the service provided by referring to reliable evidence.

Evidence-based practice (EBP) was first mentioned in the literature by Muir-Gray, who defined EBP as ‘an approach to decision-making in which the clinician uses the best available evidence in consultation with the patient to decide upon the option which suits the patient best’ (1997:97). Since this initial definition was set out in 1997, EBP has gained prominence as the gold standard for the delivery of safe and effective health care.

There are several models for implementing EBP. Examples include:

Rosswurm and Larrabee's (1999) model
The Iowa model ( Titler et al, 2001 )
Collaborative research utilisation model ( Dufault, 2004 ); DiCenso et al's (2005) model
Greenhalgh et al's (2005) model
Johns Hopkins Nursing model ( Newhouse et al, 2005 )
Melnyk et al's (2010) model.

Although a comprehensive review of these models is beyond the scope of this article, a brief assessment reveals some commonalities among them. These include a) asking or selecting a practice question, b) searching for the best evidence, c) critically appraising and applying the evidence, d) evaluating the outcome(s) of patient care delivery, and e) disseminating the outcome(s).

Regardless of the benefits of EBP, and the existence of multiple EBP models intended to facilitate the application of evidence into practice, health professionals, including nurses, continue to struggle to implement it effectively ( Ubbink et al, 2013 ). Critics of EBP have questioned its validity ( Rubin, 2007 ; Nevo and Slonim-Nevo, 2011 ); the best practice and setting to support its use ( Nutley et al, 2009 ); its failure to address the complexity of health and health care, as well as the patient's context ( Muir-Gray, 1997 ; Reed et al, 2019 ), and its mechanistic approach ( Epstein, 2009 ; Jerkert, 2015 ). Some of these criticisms are outlined below.

For example, previous studies have reported the barriers health professionals face to successfully implement EBP. Ubbink et al (2013) conducted a systematic review to determine nurses' and doctors' views on knowledge, attitudes, skills, barriers, and behaviour required to implement EBP. The review included 31 studies from 17 countries: eight from North America and 11 from Europe. The results revealed that organisational and individual barriers prevent uptake of EBP among nurses and doctors. These barriers included the lack of material and human resources, and lack of support from managers and leaders; individual barriers included knowledge deficit regarding EBP, time and workload ( Ubbink et al, 2013 ). Researchers such as Hitch and Nicola-Richmond (2017) and Warren et al (2016) found similar barriers to implementing EBP reported by health professionals.

Effective and consistent implementation of EBP in healthcare settings depends on complex interdependent factors, such as the characteristics of an organisation (eg the internal and external healthcare environment, and organisational structures and values); the EBP intervention (eg reduction of hospital-acquired infections); and the attitudes of the individual practitioner towards EBP ( Titler and Everett, 2001 ; Cullen and Adams, 2012 ). Yet, existing approaches of EBP have been ineffective in facilitating its implementation ( Greenhalgh et al, 2014 ).

Consequently, authors such as Cullen and Adams (2012) and Greenhalgh et al (2014) have called for a resurgence of the concept, especially concerning the components of EBP associated with involving patients in decision-making, and with expert judgement and experience. Greenhalgh et al (2014:3) consider it is time to return to implementing ‘real EBP’, where person-centred care is the priority, and health professionals and their patients ‘are free to make appropriate care decisions that may not match what best evidence seems to suggest’. Nonetheless, researchers including McSherry et al (2002) , Epstein (2009) and Nevo and Slonim-Nevo (2011) have proposed an alternative, holistic approach to the application of evidence into practice, termed evidence-informed practice (EIP).

Journey towards evidence-informed practice

The problems with the uptake and effective implementation of EBP led to the emergence of the EIP concept. This concept is based on the premise that healthcare practice should, as a matter of principle, be informed by, rather than based on, evidence ( Nevo and Slonim-Nevo, 2011 ). This implies that other forms of evidence (for example, patient experiences, the nurse's expertise and experiences), not just the ‘research evidence’, should be considered in applying evidence in practice.

McSherry et al (2002) defined EIP as the assimilation of professional judgment and research evidence regarding the efficiency of interventions. This definition was further elaborated as an approach to patient care where:

‘Practitioners are encouraged to be knowledgeable about findings coming from all types of studies and to use them in an integrative manner, taking into consideration clinical experience and judgment, clients' preferences and values, and context of the interventions.’

Nevo and Slonim-Nevo (2011:18)

It has been over two decades since EIP emerged in the literature, however, primary research on the concept has been limited. Hence, although the term EIP has gained momentum in recent times, the methods needed to implement it effectively are not widely known ( McSherry, 2007 ; Woodbury and Kuhnke, 2014 ). While some proponents of EIP (eg Epstein 2011 ; Webber and Carr 2015 ) have identified significant differences between EBP and EIP, most researchers (eg Ciliska, 2012 ; Shlonsky and Mildon, 2014 ) have used the terms interchangeably.

Ciliska (2012) , for instance, developed an evidence-informed decision making (EIDM) module, but referred to the steps of EBP (ie Ask, Acquire, Appraise, Integrate, Adapt, Apply, Analyse) as the processes to be followed in implementing EIDM. Ciliska (2012) explained that the term EIDM was adopted to signify that other types of evidence are useful in clinical decision-making and to attempt to get beyond the criticisms of EBP. This notwithstanding, the author maintained the existing process for implementing EBP. Similarly, Shlonsky and Mildon (2014) used the terms EBP and EIP interchangeably, as they consistently referred to an EBP approach as EIP. Examples include referring to the steps of EBP as ‘the steps of EIP’ ( Shlonsky and Mildon, 2014:3 ) and referring to Haynes et al's (2002) expanded EBP model as a ‘revised EIP model’ ( Shlonsky and Mildon, 2014:2 ).

Another term that is often used interchangeably with EIP is ‘knowledge translation’. This term has been explored extensively. For example, the Canadian Institute of Health Research (CIHR) has adopted knowledge translation to signify the use of high-quality research evidence to make informed decisions ( Straus et al, 2009 ). The CIHR ( Graham et al, 2006 ) developed a ‘knowledge to action’ model intended to integrate the creation and application of knowledge. The model acknowledges the non-linear process of applying evidence in practice, where each stage is influenced by the next, as well as the preceding, stage. In a typical clinical setting, the actual process of applying evidence in practice is not linear, as acknowledged by the proponents of EBP, but cyclical and interdependent. Ciliska (2012) linked Graham et al's (2006) model to the components of evidence-informed decision-making. According to Ciliska (2012:7) , the knowledge-to-action model ‘fits with the steps of evidence-informed decision-making’. However, like EBP, the term ‘knowledge translation’, differs significantly from the EIP concept because it focuses on the ‘research evidence’ in decision-making.

The apparent confusion surrounding EIP is due to inadequate information about its components and the methods involved in implementing the concept. To foster a culture of EIP among health professionals, they must first be made aware of the actual components of the concept and the strategies involved in its successful implementation. The following section uses case scenarios to provide a description of the factors and elements of the EIP model and defines how it facilitates the application of evidence into clinical nursing practice.

Systems thinking

The clinical setting within which nurses work is a complex system made up of several interdependent and inter-related parts. Problems with healthcare delivery and management must therefore be perceived as a consequence of the exchanges between elements of the systems, instead of an outcome or the malfunctioning of a particular element. This, McSherry and Warr (2010) , have referred to as ‘systems thinking’.

Effective implementation of EIP demands an understanding of the various parts of the system that come together to aid the application of evidence in practice.

The evidence-informed practice model

The original model.

The earliest version of the evidence-informed practice model is depicted in Figure 1 . This was developed specifically for nurses and was originally named ‘the evidence-informed nursing model’. The model presented in Figure 1 was developed through PhD research conducted by Robert McSherry (2007) , with the aim to explore, through a mixed-methods study design, why the use of research as evidence in support of clinical nursing practice remains problematic. Study participants were registered nurses practising in a hospital trust located in north-east England.

The results of McSherry's (2007) study showed that, to effectively apply evidence in clinical nursing practice, nurses needed to be informed of, and be able to interact with, several key elements. The evidence-informed nursing model was developed as an alternative framework for facilitating the application of evidence in clinical nursing practice and was grounded in the principles and practices of systems thinking. This is because, primarily, the model provided an integrated process to applying evidence into practice, consisting of:

A clearly defined input; to encourage nurses to use evidence in practice
Throughput; facilitation of the processes associated with the elements
Output; improved standards of professional practice

The revised model

The evidence-informed nursing model has been adapted to the evidence-informed practice model. The new model ( Figure 2 ) is adapted in several ways. First, it has been modified to be all-inclusive, so it could be applied to any health profession. Second, the model has been simplified to show the interconnectedness of the various factors and elements that enable a professional to use evidence in support of their clinical decision-making. Third, the model demonstrates the ongoing complexity that health professionals find themselves working in, in the quest to apply evidence to clinical practice. Last, the EIP model incorporates the principles and components of EBP, which is particularly evident in the EIP cycle (the throughput phase of the model).

The factors and elements of the EIP model ( Figure 2 ) are explored in more detail below with reference to two scenarios, which are used to apply the EIP model to clinical nursing practice within both a scientific and the wider context within which nursing care takes place.

The first factor of the EIP model is ‘Factor 1. Drivers for evidence-informed practice’ ( Figure 2 ). In order for nurses to enhance patient care and experiences, along with improving their knowledge and skills of the patient's condition and associated signs and symptoms, they need to be aware of what EIP is, what it involves, and the principles required to make it happen. Applying the scenarios, it is essential that the nurse understands and can identify the key elements that drive successful implementation of the EIP concept. This is referred to as the drivers for EIP, which are illustrated in Figure 3 and discussed below.

Drivers for EIP

Staff selection.

Recruiting, interviewing and redeploying existing staff or hiring new staff are part of the staff selection process ( Dill and Shera, 2012 ). The importance of this driver is to identify personnel who qualify to implement the EIP programme or model. Additionally, it aims at selecting individuals within the organisation (for example coaches, supervisors, and trainers), who will ensure that the required organisational changes to support nurses in the effective implementation of EIP are done.

In-service training or pre-service

Training on EIP programmes involves activities that are related to offering instruction, providing specialist information or skills development in a structured manner to nurses and other key healthcare staff involved in the EIP programme. Nurses, as well as other members of staff, must learn when, how, where, and with whom to use new approaches and skills in applying evidence to practice ( Metz et al, 2007 ).

Coaching, supervision and mentoring

The coaching and mentoring approach enables new skills to be introduced to nurses on the ward with the support of a coach. The duty of a coach is to offer expert information and support, together with encouragement, opportunities and advice to practise and apply skills that are specific to the EIP programme. Effective implementation of human service interventions (such as EIP) requires changes in behaviour at administrative, supervisory and practitioner levels ( Dill and Shera, 2012 ). Coaching and mentoring are the main ways to bring about a change in behaviour for staff who have been successfully involved in the beginning stage of the implementation process and throughout the life of the EIP programme.

Systems-level partnership

This refers to the improvement of partnerships with the broader and immediate systems to ensure access to required funds, and institutional and human resources necessary to support nurses' work. The immediate systems-level partnership refers to working with individuals or organisations that directly influence healthcare delivery (for example, nurses and doctors).

Partnerships within the broader system, on the other hand, refer to policymakers, funders or other organisations that may support the EIP programme, but are not directly involved in delivering health care. A variety of activities may be conducted as part of the development of systems-level partnerships to aid the implementation of EIP. These may include fundraising activities to support the implementation of EIP programmes, as well as the use of external coaches and consultants to assist with mentoring, technical assistance and training on an ongoing basis.

Internal management support

This involves activities that are associated with establishing processes and structures within an EIP programme to enhance effective implementation of the programme. This is necessary in order to inform healthcare decision-making as well as keep staff organised and focussed on desired care outcomes ( Fixsen et al, 2005 ). Instances of internal management support include the formation of institutional structures and processes, the allocation of resources to support selection of suitable staff, and administrative support for efficient training.

Staff performance and programme evaluation

This involves evaluation of staff performance and the overall EIP programme to determine whether the objectives of the programme have been achieved. To do this effectively, it is important to evaluate the outcomes of the above-defined drivers, in particular, staff selection, in-service training, as well as coaching and mentoring. This will offer managers and stakeholders insight about the effectiveness of staff selection, training, and mentoring in facilitating the application of evidence into clinical practice ( Dill and Shera, 2012 ).

Elements of the EIP model

The first element of the EIP model is professional accountability, depicted as an ‘input’ in Figure 2 . This is an essential part of a nurse's roles and responsibilities and is reaffirmed in the nursing Code ( Nursing and Midwifery Council, 2018 ) of professional practice, the contract of employment and job description. In both case scenarios involving Mitchell and Yvonne ( Box 1 ), professional accountability is evident on several fronts: the nurse must establish a caring, compassionate and therapeutic relationship with the patients by involving and engaging them in shared decision-making regarding all aspects of their care, treatments, and interventions; the nurse is accountable and answerable to the patient and his or her professional colleagues throughout the patient's journey.

Box 1.Patient scenariosScenario 1Yvonne, aged 31, is admitted to the emergency medical unit following a visit to her GP for a non-healing wound to her right big toe. The GP also reported that Yvonne has had a recurring sore throat, extreme tiredness and a low white blood cell count.The GP requested an urgent investigation of these symptoms. Yvonne was placed in a side room for precaution.Scenario 2Mitchell, aged 58, arrives in the emergency department complaining of severe chest pain. He is diaphoretic (sweating excessively) and says his pain is radiating down his left arm and up into his jaw, and he adds that he feels nauseated. A few minutes after admission, he suffers a cardiac arrest.He is resuscitated and transferred to the intensive care unit. He is intubated, is placed on a ventilator and has a central line catheter in place.

Throughput: the evidence-informed practice cycle

The EIP cycle (located in the ‘throughput’ of Figure 2 ) involves the processes or methods through which nurses apply evidence in support of their decision-making in clinical nursing practice. This often occurs in a clinical nursing environment that is complex, constantly changing, and involves numerous members of the multidisciplinary team, patients and their family. Effective communication (verbal and written) is essential for ensuring that the various elements are interchanging, interconnecting and communicating between, and with, each other. For example, the case of Yvonne in scenario 1 ( Box 1 ) can be used as an example to underline the importance of good communication. It is important to explain to the patient and her family the reason for nursing her in a side room rather than the main ward. In this situation, avoiding and preventing cross-infection is essential to safeguard Yvonne from harm.

To ensure the EIP cycle proceeds effectively requires that the nurse (the health professional) acts as the conduit for the interplay between the different elements of the model (ie Element 2: informed decision-making; Element 3: research awareness; Element 4: application of knowledge; and Element 5: evaluation). These elements will be further explored.

Element 2. Informed decision-making

This involves two-way communication between the nurse and the patient(s), and is critical in ensuring there is a robust relationship (honesty, openness, transparency) founded on the principles of person-centred care ( McSherry and Warr, 2010 ). It reaffirms the ethical principle of a patient's right to make an informed decision about what is suitable for them, and takes into account their beliefs, values, priorities and personal circumstances. In case scenario 2, applying the EIP model, the critical care nurse will be expected to involve Mitchell's (the patient's) relatives, medical staff and other members of the healthcare team in making decisions about, for example, ventilator management and care of the central line catheter. However, decision-making in an intensive care unit can be complex, and some of the decisions may involve the nurse only. Similarly, applying the EIP model in case scenario 1, the nurse will be expected to communicate with the patient (Yvonne), carers and colleagues about the importance of hand hygiene, wound care and the importance of using precautions to avoid hospital-acquired infections when caring for the patient.

In both case scenarios, the nurse must endeavour to involve the patient/family members in the process of decision-making by providing them with timely, appropriate and relevant information needed to make often complex and life-changing decisions.

Element 3. Research awareness

This element refers to motivating practitioners to acquire skills and knowledge, as well as to conceptualise what research and evidence involves and the significance they have in improving standards of healthcare practice ( McSherry et al, 2006 ). Research awareness is reliant on the nurse's attitudes towards research, the acquisition of knowledge and confidence about the value of research to practice, and on having supportive managers and colleagues.

This element of the EIP cycle, contained within the model, incorporates three of the steps (Research awareness) of EBP: ask a clinical question, search the literature for research evidence to answer the question, and critically appraise the evidence obtained). Although the nurse is not required to be a researcher to implement the EIP model effectively, they must be knowledgeable about relevant databases and search engines (such as Medline and Google), as well as critical appraisal tools, in order to be able to include high-quality research evidence when making patient care decisions.

However, the EIP model acknowledges the fact that research evidence may not always be readily available, and nurses may not have the necessary hardware and software in the care environment to enable them to search for research evidence. Hence, recommendations by Greenhalgh et al (2014) led to inclusion, within the EIP model, of nurses as critical thinkers and doers which, therefore, allows them to make appropriate care decisions based on patient preferences and actions, the clinical state, clinical setting and circumstances, and advocates that nurses apply their own knowledge, expertise and clinical experiences in clinical decision-making, which may not necessarily match what the research evidence seems to suggest.

With reference to scenario 2 (and similarly for scenario 1), to adhere to the EIP model the nurse would take the following steps:

Update his/her knowledge about Mitchell's clinical presentation
Search Medline for research evidence on ‘chest pain’, and ‘cardiac arrest’ and its associated symptoms. Based on the number of articles obtained, the nurse reads the titles and abstracts, and then, the full text of selected articles to exclude irrelevant articles. The remaining articles are then critically appraised to include the best research evidence in patient care decisions.

In situations where the above steps are not possible, the model advocates that the nurse endeavours to make the best care decisions possible based on patient preferences, clinical state, context and circumstances, and the nurse's own expertise and experience, as well as the experience of the patient and family members where possible.

Element 4. Application of knowledge

This is a complex element that requires the gathering and assimilation of various sources of information, evidence, quality and standards, and policy and guidance, to support the nurse's decision-making in clinical practice. In relation to both scenarios, the nurse would need to:

Apply knowledge acquired from the patients (Mitchell and Yvonne), along with information from their relatives
Apply evidence from reviewing the findings from research
Take into account information gleaned from engaging with the multidisciplinary team
Ensure they follow recommended local and national guidance and policy on the management of each patient's condition.

It is imperative that the nurse is experienced, knowledgeable, and competent in order to make the most appropriate care decisions together with the patient, the family and the wider multidisciplinary team. To do this effectively, the nurse requires certain personal attributes, it is also important for the organisation within which the nurse works to have specific institutional characteristics. Institutional features include culture, education and training, and workload/skill mix, whereas personal characteristics include improved confidence, attitude, understanding and behaviour towards the application of evidence into practice.

Element 5. Evaluation

This element of the EIP cycle within the model measures the effects of decision-making and actions of the nurse on care outcomes and in creating an optimal care environment. In both scenarios, the nurse would need to periodically evaluate specific processes and outcomes of care. For example, with regards to scenario 2, this would include:

Monitoring how Mitchell is performing on the ventilator
Taking the necessary infection prevention precautions to avoid the development of infections related to the insertion of a central line and transmission of hospital-acquired infection
Monitoring improvement in Mitchell's general wellbeing.

Depending on the outcome of the evaluation, Mitchell's care plan would be either revised or continued.

Element 6. Conditions affecting research utilisation

Research utilisation involves critically appraising research findings, disseminating, and using the knowledge obtained from research to cause changes in an existing healthcare practice ( Titler et al, 1994 ). The conditions that affect research utilisation are grouped into five domains ( Wang et al, 2013 ):

The process involved in utilising research findings
Accessibility to research
The quality of research
The knowledge and attitudes of the nurse (health professional) regarding the use of research findings
The organisation within which the findings of research are to be implemented.

In the two scenarios ( Box 1 ), the nurse needs to be aware of the potential barriers to research utilisation and identify ways to overcome these in order to effectively apply evidence to healthcare practice. In addition, the clinical environment within which nurses work must provide sufficient support in order to enhance the effective and consistent application of evidence to practice. Nurses must be supported to acquire the necessary knowledge, skills, and understanding needed to practise safely (ie competently and confidently). In addition, the resources necessary to obtain research evidence, such as IT (computers and internet), must be readily available in the clinical setting for easy access to information.

Factor 2 (Output). Critical thinker and doer, the professional nurse

To ensure that nurses inform their decisions with the best available evidence, it is imperative that they have a sound understanding and knowledge of what constitutes the EIP model ( Figure 2 ). Successfully engaging with the various factors and elements of this model will lead to the desired outcome—that of a professional who is a critical thinker and doer, a professional nurse who, as argued by Brechin (2000:44) , is ‘knowledgeable and skilled, yet welcomes alternative ideas and belief systems, appreciating and respecting alternative views’. In this context, it is about creating a caring and compassionate environment in which excellence in nursing practice occurs. This can only be exemplified by ensuring that decisions and actions are based on the best available evidence.

The benefits of the EIP model for the nurse, patient and family are that it simplifies a highly complex series of systems and processes pertaining to how evidence is used to support decisions made in clinical practice. The EIP model simply illustrates the why, the how and the sequencing of getting evidence into clinical practice. It also complements the evidence-based movement by offering a holistic systems-based approach to facilitating the application of evidence into clinical practice.

EIP is a holistic integrated approach to applying evidence into practice, which incorporates the steps of EBP within its system and processes. In other words, EBP is a subset of the EIP model, made explicit within the EIP cycle. Thus, EIP is neither an alternative to, nor a replacement for, EBP. The EIP model provides a framework for nurses (indeed all health practitioners) to deliver clinically effective care and enable them to justify the processes used and the service provided by referring to reliable evidence. Using two scenarios, this article demonstrated how the EIP model can be applied to clinical nursing practice. Future initiatives should focus on developing EIP educational interventions and determining the effects of such interventions on healthcare students' knowledge of, and attitudes towards, the application of evidence to practice.

Two main concepts have been associated with the application of evidence into practice: evidence-based practice (EBP) and evidence-informed practice (EIP)
The main feature that distinguishes EIP from EBP is the processes used in implementing the concepts
EIP provides the mechanisms or processes to follow in implementing EBP
EIP is not a substitute or replacement for EBP. EIP is an integrated approach to applying evidence to practice, which incorporates the steps of EBP in its processes

CPD reflective questions

Make a list of the challenges you encounter in implementing EBP
Use the same list and indicate how these challenges prevent you from using evidence to support your nursing clinical decisions and actions in practice
How does viewing health and healthcare delivery as a complex system impact on your patient care?
Make a list of the drivers that are encouraging you to support your clinical nursing decisions and actions with evidence
Using your own experience to date and the information presented in the text, make a list of why and how you think evidence-informed practice forms part of your professional accountability and professional registration

Research article
Open access
Published: 07 January 2021

Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students

Nesrin N. Abu-Baker ORCID: orcid.org/0000-0001-9971-1328 1 ,
Salwa AbuAlrub 2 ,
Rana F. Obeidat 3 &
Kholoud Assmairan 4

BMC Nursing volume 20 , Article number: 13 ( 2021 ) Cite this article

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Integrating evidence-based practice (EBP) into the daily practice of healthcare professionals has the potential to improve the practice environment as well as patient outcomes. It is essential for nurses to build their body of knowledge, standardize practice, and improve patient outcomes. This study aims to explore nursing students’ beliefs and implementations of EBP, to examine the differences in students’ beliefs and implementations by prior training of EBP, and to examine the relationship between the same.

A cross-sectional survey design was used with a convenience sample of 241 nursing students from two public universities. Students were asked to answer the questions in the Evidence-Based Practice Belief and Implementation scales.

This study revealed that the students reported a mean total belief score of 54.32 out of 80 ( SD = 13.63). However, they reported a much lower implementation score of 25.34 out of 72 ( SD = 12.37). Students who received EBP training reported significantly higher total belief and implementation scores than those who did not. Finally, there was no significant relationship between belief and implementation scores ( p > .05).

To advance nursing science, enhance practice for future nurses, and improve patient outcomes, it is critical to teach nursing students not only the value of evidence-based knowledge, but also how to access this knowledge, appraise it, and apply it correctly as needed.

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Evidence-based practice (EBP) integrates the clinical expertise, the latest and best available research evidence, as well as the patient’s unique values and circumstances [ 1 ]. This form of practice is essential for nurses as well as the nursing profession as it offers a wide variety of benefits: It helps nurses to build their own body of knowledge, minimize the gap between nursing education, research, and practice, standardize nursing practices [ 2 ], improve clinical patient outcomes, improve the quality of healthcare, and decrease healthcare costs [ 3 ]. Thus, clinical decision-making by nurses should be based on the best and most up-to-date, available research evidence [ 4 ].

Earlier studies of EBP implementation by nurses in their everyday clinical practice have shown that it is suboptimal [ 5 , 6 , 7 ]. Implementation of EBP is defined as its application in clinical practice [ 8 ]. Findings from previous studies indicate that nurses’ implementation of EBP can be promoted by improving their belief about EBP. Belief is the perception of the value and benefits of EBP and the perceived self-confidence in one’s knowledge and skills of EBP [ 8 ]. Nurses with a strong belief in EBP implement it more than nurses with a weak belief in the same [ 7 , 9 ].

Preparing nurses for practice and ensuring that they have met a set of minimum core competencies at the point of graduation is achieved through their undergraduate education [ 10 ]. Several formal entities such as the Institute of Medicine (IOM) [ 4 ] and the Accreditation Commission for Education in Nursing (ACEN) [ 11 ] consider EBP as one of the core competencies that should be included in health care clinicians’ education. However, this does not necessarily guarantee the actual implementation of EBP in everyday clinical practice [ 12 ]. It is essential to educate undergraduate nursing students on EBP to improve their knowledge about it, to strengthen their belief regarding its benefits to patients and nurses, and to enhance their self-efficacy in implementing EBP. In order to effect this change, it is crucial to improve the education process and to focus more on the knowledge and implementation of EBP.

There is consistent evidence showing that while undergraduate nursing students hold positive beliefs about EBP and its value in patient care, they also report many challenges regarding its actual implementation in clinical practice. For instance, a mixed-methods study indicated that 118 American undergraduate nursing students found it difficult to distinguish between EBP and research. Students were able to search for evidence, but were less able to integrate evidence to plan EBP changes or disseminate best practices [ 13 ]. Additionally, a correlational study was conducted in Jordan using a sample of 612 senior nursing students. The study reported that students held positive attitudes towards research and 75% of them agreed on using nursing research in clinical practice. Students strongly believed in the usefulness of research. However, they did not believe strongly in their ability to conduct research [ 14 ]. A cross-sectional study was conducted among 188 Saudi undergraduate nursing students. Students reported positive beliefs about EBP; however, they reported a low mean score in EBP implementation (22.57 out of 72). Several significant factors have been reported as influencing EBP implementation, such as age, gender, awareness, and training on EBP [ 15 ]. A comparative survey comprised of 1383 nursing students from India, Saudi Arabia, Nigeria, and Oman. The study reported that having no authority in changing patient care policies, the slow publication of evidence, and the lack of time in the clinical area to implement the evidence were major barriers in implementing EBP according to the participating students [ 16 ].

In Jordan, evidence-based knowledge with critical thinking is one of the seven standards for the professional practice of registered nurses that were released by the Jordan Nursing Council [ 17 ]. Despite the plethora of studies on undergraduate nursing students’ beliefs about EBP and its implementation in everyday clinical practice, this topic has not been fully addressed among Jordanian undergraduate nursing students. Thus, the purpose of this study is to explore the self-reported beliefs and implementations of EBP among undergraduate nursing students in Jordan. The specific aims of this study were to (1) explore nursing students’ beliefs and implementations of EBP, (2) examine the differences in students’ beliefs and implementations by prior training of EBP, and (3) examine the relationship between nursing students’ beliefs and implementations of EBP.

Design and setting

A cross-sectional, correlational research survey design was used to meet the study aims. Recruitment of study participants was undertaken at two governmental universities in the northern part of Jordan. The two universities offer a four-year undergraduate nursing program aimed at graduating competent general nurses with baccalaureate degrees. The nursing research course is included as a compulsory course in the undergraduate nursing curricula in both universities.

Population and sample

The target population of this study was the undergraduate nursing students in Jordan. The accessible population was undergraduate nursing students who are currently enrolled in the four-year BSN program in two governmental universities in the northern region of Jordan. We calculated the sample size using the G*Power software (2014). Using a conventional power estimate of 0.8, with alpha set at 0.05, and medium effect size, it was estimated that for a Pearson Correlation test, a total of 100 participants would need to be recruited to examine the relationship between the beliefs and implementations of EBP. To counteract anticipated non-response and to enhance the power of the study, 300 students were approached. The inclusion criteria of the study participants were as follows: a) senior nursing students who are in the 3 rd or 4th-year level, b) students who are currently taking a clinical course with training in a clinical setting/hospital, c) and students who have successfully passed the nursing research course.

Measurement

A structured questionnaire composed of two parts was used for data collection. The first part aimed to gather the demographic data of the participants: gender, age, study year level, university, and any previous EBP training received in the nursing research course. The second part contained the EBP Belief Scale and EBP Implementation scale developed by Melnyk et al. (2008) [ 18 ]. Both scales had previous satisfactory psychometric properties with a Cronbach’s alpha of more than 0.9 and good construct validity. The Evidence-Based Practice Belief Scale (EBPB) consists of 16 statements that describe the respondent’s beliefs of EBP. Students were asked to report on a five-point Likert scale their agreement or disagreement with each of the 16 statements in the scale. Response options on this scale ranged from strongly disagree (1 point) to strongly agree (5 points). All statements were positive except for two statements (statements 11 and 13), which were reversed before calculating the total and mean scores. Total scores on the EBPB ranged from 16 to 80, with a higher total score indicating a more positive belief toward EBP. In the current study, the scale showed satisfactory internal consistency reliability with a Cronbach’s Alpha of .92 for the total scale.

The Evidence-Based Practice Implementation Scale (EBPI) consists of 18 statements related to the respondent’s actual implementation of EBP in the clinical setting. Students were asked to report the frequency of the application of these statements over the past 8 weeks. The answers were ranked on a Likert scale that ranged from 0 to 4 points (0 = 0 times, 1 = 1–3 times, 2 = 4–5 times, 3 = 6–8, and 4 ≥ 8 times). The total score ranged from 0 to 72, with the higher total score indicating a more frequent utilization of EBP.

Both scales were introduced to the participating students in their original language of English because English is the official language of teaching and instruction in all schools of nursing in Jordan.

Ethical considerations

The Institutional Review Board (IRB) at the first author’s university granted ethical approval for this study (Reference #19/122/2019). The code of ethics was addressed in the cover letter of the questionnaire. The principal investigator met the potential eligible students, provided them with an explanation about the study purpose and procedures, and gave them 5 min to read the questionnaires and to decide whether to participate in the study or not. Students who agreed to participate in the study were assured of voluntary participation and the right to withdraw from the study at any time. Questionnaires were collected anonymously without any identifying information from the participating students. The principal investigator explained to participating students that the return of completed questionnaires is an implicit consent to participate in the study. Permission to use the EBP belief scale and the EBP implementation scale for the purpose of this study was obtained from the authors of the instrument.

Data collection procedure

After ethical approval was granted to conduct the study, data was collected during the second semester of the academic year 2018/2019 (i.e., January through June 2019). The questionnaires were distributed to the nursing students during the classroom lectures after taking permission from the lecturer. The researchers explained the purpose, the significance of the study, the inclusion criteria, and the right of the students to refuse participation in the study. Students were screened for eligibility to participate. Students who met the eligibility criteria and agreed to participate were provided with the study package that included a cover letter and the study questionnaire. Students were given 20 min to complete the questionnaire and return it to the principal investigator who was available to answer students’ questions during the data collection process.

Data analysis

Descriptive statistics (e.g., means, standard deviations, frequencies, and percentages) were performed to describe the demographic characteristics of the participating students and the main study variables. For the belief scale, the two agreement categories (4 = agree, 5 = strongly agree) were collapsed to one category to indicate a positive belief. For the implementation scale, the three categories (2 = 4–5 times, 3 = 6–8, and 4 ≥ 8 times in the past 8 weeks) were collapsed to one category as (≥ 4 times) to indicate frequent implementation. Pearson’s correlation test was used to determine the relationship between the total scores of the EBP belief and implementation scales. A chi-square test was used to examine the difference between trained and untrained students in terms of agreement toward each EBP belief (disagreement vs. agreement) and in terms of frequency of each EBP implementation (less than 4 times vs. 4 times or more in the past 8 weeks). Finally, an independent samples t -test was used to examine the difference between trained and untrained students in terms of the total mean scores of EBP beliefs. The Statistical Package for Social Sciences (SPSS) software (version 22) was used for data analysis.

Among the 300 approached students, 35 students did not meet the inclusion criteria and 24 students refused to participate. Thus, a total of 241 undergraduate nursing students from both universities completed the study questionnaire for a response rate of 91%. The mean age of the participants was 22.09 years ( SD = 1.55). The majority of the participants were females (73.4%) and in the fourth year of the undergraduate nursing program (85.1%). Further, more than half of the participants (67.6%) stated that they received EBP training before (Table 1 ).

The total mean score of the EBP belief scale was 54.32 out of 80 ( SD = 13.63). Overall, between 50.5 and 73.4% of students agreed or strongly agreed on the 16 statements on the EBP belief scale, which indicates positive beliefs. However, students held a more positive belief regarding the importance and the usefulness of EBP in quality patient care than in their ability to implement EBP. For example, while the majority of students believed that “EBP results in the best clinical care for patients” and that “evidence-based guidelines can improve clinical care” (73.4 and 72.2%, respectively), only about 54% of them cited that they “knew how to implement EBP sufficiently enough to make practice changes” or were “confident about their ability to implement EBP where they worked”. Students who received previous training on EBP reported more agreements (i.e., more positive beliefs) toward all items of EBP compared to those who did not receive training; however, the difference between the two groups was not always significant. For example, 60.7% of trained students believed that “they are sure that they can implement EBP” compared to 41% of untrained students χ 2 (1, n = 241) = 8.26, p = .004. Furthermore, 58.3% of trained students were “clear about the steps of EBP” compared to 41% of untrained students χ 2 (1, n = 241) = 6.30, p = .021 (Table 2 ).

In contrast, students reported a much lower total score on the EBP implementation scale: 25.34 out of 72 ( SD = 12.37). Less than half the students reported implementing all the listed EBPs four times or more in the last 8 weeks. For example, only about one-third of all students reported that they “used evidence to change their clinical practice”, “generated a PICO question about clinical practice”, “read and critically appraised a clinical research study”, and “accessed the database for EBP four times or more in the past eight weeks” (32.4, 33.6, 31.9, and 31.6%, respectively). The only EBP that was implemented by more than half of the students (54.8%) four times or more in the past 8 weeks was “collecting data on a patient problem”. Students who had previous training on EBP reported more frequent implementations of all listed EBPs compared to those who did not receive training; however, the difference between the two groups was not always significant. For example, 50.9% of trained students reported that they “shared an EBP guideline with a colleague” four times or more in the past 8 weeks compared to 30.8% of untrained students χ 2 (1, n = 241) = 8.68, p = .003. Almost 50 % of the trained students “shared evidence from a research study with a patient/family member” four times or more in the past 8 weeks, compared to 28.2% of the untrained students χ 2 (1, n = 241) = 9.95, p = .002 (Table 3 ).

There was a significant difference between students’ total scores on the EBP belief scale with respect to previous training on EBP. Students who received previous training on EBP had a significantly higher mean score on the EBP belief scale compared to students who did not receive previous training on EBP ( t (239) = 2.04, p = .042). In addition, there was a significant difference in the total score of EBP implementation by previous training on EBP. Students who received previous training on EBP had a significantly higher mean score on the EBP implementation scale compared to students who did not receive previous training on EBP ( t (239) = 3.08, p = .002) (Table 4 ).

Finally, results of the Pearson correlation test revealed that there was no significant association between the total score of the EBP belief scale and the total score of the EBP implementation scale ( r = 0.106, p = 0.101).

This study aimed to explore the self-reported beliefs regarding and implementation of EBP among undergraduate nursing students in Jordan. It is observed that Jordanian undergraduate nursing students valued EBP and its importance in delivering quality patient care as over 70% of them believed that EBP results in the best clinical care for patients and that evidence-based guidelines can improve clinical care. However, a lower percentage of students believed in their ability to implement EBP where they worked and an even lower percentage of them actually implemented EBP frequently in their everyday clinical practice. For illustration, only one-third of the students accessed a database for EBP, have read and critically appraised a clinical research study, or used evidence to change their clinical practice four times or more in the last 8 weeks. Our results are consistent with previous studies among Jordanian nursing students which also showed students had positive attitudes towards research and its usefulness to providing quality patient care but had insufficient ability to utilize research evidence in clinical practice [ 14 ]. Further, a recent study has shown that nursing students in Jordan had low knowledge about EBP regardless of their admitting university [ 19 ]. These results indicate that there could be a gap in the education process of undergraduate nursing students in Jordan about EBP. Thus, schools of nursing in Jordan have to critically review their current educational strategies on EBP and improve it to enhance students’ knowledge of EBP as well as their abilities to implement evidence in clinical practice.

The results of the current study revealed that despite the positive beliefs of the nursing students, their implementation of EBP was very low. There was no significant relationship between the total score of EBP belief and the total score of EBP implementation. Our results are consistent with those reported among Saudi as well as American nursing students who also had positive beliefs about EBP but implemented it less frequently in their everyday clinical practice [ 13 , 15 ]. Moreover, in line with previous studies which showed that training on EBP was one of the significant predictors of beliefs and implementation [ 15 ], students who previously received EBP training had significantly higher total belief and implementation scores than those who did not, in this study. This finding is expected as EBP training has been shown to improve knowledge, self-efficacy in implementation, and by extension, implementation practices among nurses and nursing students [ 20 , 21 , 22 ]. On the other hand, in this study, we asked students whether they have received training on EBP during the nursing research course taught at their universities. More than one-third of participating students in our study cited that they had not received previous training on EBP even though all of them have successfully passed the nursing research course offered at their universities. One possible explanation for this finding could be that there is an inconsistency in the way the nursing research course is taught. It seems that EBP practice is not always included in the content taught in this course. Thus, nursing schools in Jordan have to revise their curricula to ensure that EBP is included and is taught to all students before graduation.

The results of the current study have several international implications that involve academic education and nursing curricula. There is a pressing need to enhance the education process and to focus more on the knowledge and skills of EBP. Incorporating EBP into the nursing curricula, especially the undergraduate program is critical as it is the first step to prepare the students for their professional roles as registered nurses. Sin and Bliquez (2017) stated that creative and enjoyable strategies are fundamental in order to encourage students’ commitment to and learning about EBP [ 23 ]. One of these effective strategies is teaching the EBP process by asking a clinical question, acquiring and searching for evidence, appraising then applying this evidence, and finally evaluating the effectiveness of its application in clinical practice [ 8 ]. A thematic review study demonstrated that various interactive teaching strategies and clinically integrated teaching strategies have been emphasized to enhance EBP knowledge and skills [ 24 ].

Gaining knowledge about undergraduate nursing students’ beliefs and their ability to implement EBP in a clinical setting is essential for nursing educators at the national and the international level. This knowledge might help them to evaluate and improve the current strategies utilized to educate undergraduate students about EBP. Furthermore, academic administrators and teachers should design their courses to apply EBP concepts. They should promote EBP training courses, workshops, and seminars. For example, the research course should focus more on this topic and should include clinical scenarios that involve the application of EBP. In addition, clinical courses should include assignments for the purpose of integrating EBP within their clinical cases. The scale used in this study could be implemented in clinical courses to evaluate students’ practical skills concerning EBP. Finally, nursing instructors, leaders, and practitioners should always update their EBP knowledge and skills through continuous education and workshops. Since they are the role models and instructors, they should be competent enough to teach and evaluate their students. They should also cooperate to facilitate the implementation of EBP in clinical settings to overcome any barrier.

Study limitations and recommendations

This study sheds light on the existing gap between the belief in and the implementation of EBP among nursing students. However, convenience sampling, using two universities only, and self-report bias are all limitations of this study. In addition, the researchers did not investigate the type of EBP training that was received by the students in this study. More studies are needed in Jordan and the Middle Eastern region about EBP using larger random samples in different settings. It is also recommended to investigate the barriers that prevent nursing students from implementing EBP other than not receiving training on it. Furthermore, conducting qualitative studies might help examine and understand students’ perceptions as well as provide suggestions to bridge the gap between education and practice. Finally, future experimental studies are needed to test the effect of certain interventions on enhancing the implementation of EBP among nursing students.

Evidence-based practice is essential for nursing students worldwide. However, having strong beliefs about EBP and its benefits does not necessarily mean that it is frequently implemented. On the other hand, providing training courses on EBP is an essential step in the enhancement of EBP implementation. This means that in order to advance nursing science and enhance nursing care for future nurses, it is vital to incorporate EBP within the nursing curricula. It is also critical to teach nursing students the value of evidence-based knowledge as well as how to access this knowledge, appraise it, and apply it correctly as needed. This can be achieved through rigorous cooperation between nursing administrators, clinicians, teachers, and students to enhance the implementation process.

Availability of data and materials

Data are available from the corresponding author upon reasonable request and with permission of Jordan University of Science and Technology.

Abbreviations

Evidence-Based Practice

Institute of Medicine

Accreditation Commission for Education in Nursing

Evidence-Based Practice Belief Scale

Evidence-Based Practice Implementation Scale

The Statistical Package for Social Sciences

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Acknowledgments

This study was funded by Jordan University of Science and Technology Grant # (20190141). The funding source had no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.

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All authors; NA, SA, RO, and KA had active contributions to the conception and design and/or collecting and analysis of the data and/or the drafting of the paper. NA and RO also made critical revisions for important content and finalized the final version of the manuscript. All authors approved the final version of the manuscript.

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Abu-Baker, N.N., AbuAlrub, S., Obeidat, R.F. et al. Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students. BMC Nurs 20 , 13 (2021). https://doi.org/10.1186/s12912-020-00522-x

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Implementation of evidence-based practice: The experience of nurses and midwives

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Affiliation Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia

Roles Conceptualization, Data curation, Methodology, Supervision, Validation, Visualization, Writing – review & editing

Asrat Hailu Dagne,
Mekonnen Haile Beshah

Published: August 27, 2021
https://doi.org/10.1371/journal.pone.0256600
Reader Comments

Implementation of evidence-based practice in clinical practice is crucial. Nurses and midwives play a vital role in using updated evidence. However, limited support and barriers to implementing evidence-based practice hamper the use of up-to-date evidence in clinical decision-making practice. Therefore, this study aimed to explore the implementation of evidence-based practice of nurses and midwives working in public hospitals.

A qualitative descriptive study was conducted to explore the experience of implementing evidence-based practice among nurses and midwives working in public hospitals. A total of 86 participants, of which, 25 in-depth interviews, 5 FGDs having 47 participants and 14 participants were involved during observations, were considered in Amhara Region public hospitals from November 17, 2019 to April 25, 2020. The observational data, interview and FGD transcripts were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis.

Nurses and midwives perceived that implementation of evidence-based practice is the use of research findings, guidelines, hospital protocols, books, and expert experience in clinical decision-making practice. However, there was limited support for the implementation of evidence-based practice by nurses and midwives. The lack of knowledge and skill to use evidence like research findings, time mismanagement, the lack of motivation, the lack of resources and training were the perceived barriers to the implementation of evidence-based practice. Stick to the traditional practice due to lack of incentive and unclear job description between diploma and BSc nurses and midwives were the perceived causes of the lack of motivation.

Conclusions

The experience of evidence-based practice of nurses and midwives indicated that there was limited support for the implementation of evidence-based practice. However, research findings were rarely used in clinical decision-making practice The Knowledge, attitude towards implementing evidence-based practice, lack of resources and training, time mismanagement and lack of motivation were the barriers to the implementation of evidence-based practice. Therefore, the promotion of adopting the implementation of evidence-based practice and training on the identified barriers are mandatory.

Citation: Dagne AH, Beshah MH (2021) Implementation of evidence-based practice: The experience of nurses and midwives. PLoS ONE 16(8): e0256600. https://doi.org/10.1371/journal.pone.0256600

Editor: Tareq Mukattash, Jordan University of Science and Technology, JORDAN

Received: February 25, 2021; Accepted: August 10, 2021; Published: August 27, 2021

Copyright: © 2021 Dagne, Beshah. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its S1 and S2 Files.

Funding: This study was funded by the Center for International Reproductive Health Training (CIRHT). The funder is not listed in the FundRef Registry and there is no award number/grant number. The funding body had no role in the study design and collection, analysis, and interpretation of data and in writing the manuscript.

Competing interests: The authors declare that they have no competing interests.

Implementation of evidence-based practice (IEBP) refers to the use of best, valid, currently available and relevant research findings, expert opinion, standard guidelines and books in clinical decision-making practice [ 1 ]. IEBP improved quality healthcare and client outcomes in the care setting like reducing patient pain, hospital stay and ulcers due to pressure [ 2 ]. Therefore, future research needs to explore ways to foster the documentation of evidence-based practice (EBP) interventions more effectively. Nurses and midwives who have higher educational status, and management and service provision experience can reduce barriers to the IEBP. Thus, IEBP achieves quality health care through knowledge, skill, the experience of health service providers, collaborative decision making and good time management [ 3 ].

The best, valid, currently available, and relevant research findings were rarely used in healthcare and clinical decision-making practice [ 4 ]. Nurses and midwives use experienced-based knowledge, and their observations, colleague and other collaborators’ support in practice without considering best and current evidence [ 4 ]. International and national organizations have enhanced IEBP for the standard of quality health care service. IEBP is essential to meet patient safety and quality health services. It is also vital to increase formal and informal health information, treatment expectation, and patient role related to clinical decision-making practice [ 5 ]. Several standard guidelines, books, primary research and systematic review results are produced continually [ 6 ].

The uptake of EBP by updating knowledge, skill and attitude of nurses and midwives improved the advanced practice of nurses and midwives through role modeling, training, problem-solving and facilitating change [ 7 ]. However, nurses’ and midwives’ education for master’s and Ph.D. holders is not common even in European countries like France to implement evidence-based in clinical and healthcare practice, and research is conducted and is well known to use it for clinical decision-making practice in higher educational institutions [ 8 ]. Worldwide, the quality of research and standard guidelines engaging in evidence-based behavior is low. In addition to this, most factors influencing IEBP are not well identified and there is a call for further research to be done globally [ 9 ]. The study conducted in South Africa indicates that the use of evidence like research, standard guidelines and books require time and perseverance from international researchers and stakeholders together with a readiness by local researchers and stakeholders to take and actively promote IEBP in clinical and healthcare practice [ 10 ].

IEBP involves solving complex problems that are basic in healthcare [ 11 ]. Nurses and midwives have to address IEBP gaps through the insertion of the evidence into clinical practice, i.e., research findings, currently updated experts opinions, standard guidelines, and books. To fulfill this proposed role, they have to prepare their clinical expertise [ 12 ]. Studies suggested that IEBP is intervened by an interplay between the individuals, the new knowledge, and the actual context in which the sources of evidence are to be organized and utilized in daily practice [ 13 , 14 ]. In addition to this, IEBP should be locally evaluated and the evaluation results must be made actionable and usable, and adapted to the local situations to get the best-needed outcomes [ 15 – 17 ].

There is a paucity of literature that explores nurses’ and midwives’ experiences towards barriers and supporting factors of IEBP in Ethiopia. The study’s findings will serve as a baseline for measuring and monitoring change in IEBP readiness following a tailored educational and organizational intervention. Therefore, this study was designed to explore the IEBP of nurses and midwives, barriers and supporting factors that affect the implementation of evidence-based practice among nurses and midwives.

Study design and setting

A qualitative descriptive study was engaged from November 17, 2019 to April 25, 2020 to explore the experience of IEDBP among nurses and midwives working in Amhara Region Public Hospitals. Three specialized hospitals (Debre Birhan, FelegeHiwot, and Gondar), four general hospitals (MehalMeda, Motta, Debark, and FinoteSelam) and eighteen primary hospitals (Dembia, Durbetie, Deneba, Debre Sina, ShoaRobit, Feres Bet, Ataye, Adet, Addis Alem, MekaneEyesus, Addis Zemen, Merawi, Burie, Wogera, Delgi, Nefas Mewcha, Wogeda, andMetema) were involved in the study.

Participants, sampling and recruitment

A total of 86 participants were considered for the in-depth interview (8 key informants and 17 interviewees), five FGDs (47 participants) and fourteen observations were conducted. The key informants included three hospital managers, two medical directors and three case managers (masters in emergency surgery and obstetrics). Each focus group discussion (FGD) consisted of eight to twelve participants. A checklist was employed to observe nurses’ and midwives’ roles, and the availability of resources/materials used for EBP in the fourteen hospitals. Nurses, midwives, doctors and masters in the emergency surgeon and obstetric participated in the in-depth interview. Nurses and midwives participated in FGDs. Name of nurses, midwives, doctors and masters in the emergency surgeon and obstetric was coded for the participants of the interview (101–125), FGD1 (FGD1-01 to 9), FGD2 (FGD2-01 to 10), FGD3 (FGD3-01 to 10), FGD4 (FGD4-01 to 08), FGD5 (FGD5-01 to 10) and observation (H101- H114) (see S1 File ). A purposeful sampling strategy was used to select hospital managers, medical directors and case managers who have leadership roles as key informants. A similar strategy was used to select nurses and midwives for participation in the interview, FGD and observation. Participants who give optimal insight into the implementation of evidence-based practice were recruited through the hospital managers and the heads of department, and their contact details were obtained. Due to the busy schedule of participants, a pragmatic approach was favored to get them for the interview and FGD. A calendar invitation was subsequently sent out inviting the professionals to participate, and all agreed.

Data collection

The theoretical framework of Klein and Knight was used as the basis of the FGD and interview guide [ 18 ]. The in-depth interview and FGD guides and checklist for observation were developed by reviewing literature and feedback of experts in IEBP. The theoretical framework consisted of factors enhancing and challenging the IEBP. IEBPs established by an organization, shared perceptions of the IEBP, a supportive organization to IEBP, the availability of resources and a learning organizational knowledge and skill development were enhancing factors. However, unreliable evidence, lack of knowledge and skill, time mismanagement, lack of motivation, the decision to adopt and implement an innovation made by higher up in the hierarchy than the innovation’s target users and lack of commitment are the challenges of implementation of evidence-based practice.

The interview and FGD guide were divided into four sections i.e. Socio-demographic variables, perceptions towards IEBP, perceived barriers of IEBP and supporting factors for IEBP. The in-depth interview and FGD guide were also prepared first in English then translated to Amharic and retranslated back to English for consistency. Eight data collectors (research assistance) who had the educational status of master and Ph.D. with previous qualitative data collection experience were selected. They were trained to be familiar with the objective and the methodology of the research. Data were collected via FGD and face-to-face interview techniques using semi-structured questionnaires. Good communication started with the greeting and the ground rule had been set before the focus group discussion started. The interviews and FGDs took place in separate rooms at hospitals that guarantee good communication. The interview duration was between 45 minutes and 60 minutes and the FGD duration was 90 minutes to 120 minutes. Moreover, the data collectors were engaged in participatory observation using a checklist. The participants’ emotions and non-verbal communication were recorded as field notes. The interviews and FGDs were audio-recorded and then later transcribed for analysis. Saturation was determined when there were multiple overlapping responses across participants.

Data analysis

Interview and FGDs data were captured using voice recorders, and each day field notes were transcribed verbatim first in Amharic and then translated into English and retranslated back to Amharic by interviewers and FGD data collectors each day to check for consistency. The transcripts were read repeatedly and checked independently by investigators for confirmation. Initially, the observational data, and interview and FGD transcripts were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through content analysis. First, a list of codes was created and described. Then after adding and defining the concept, categories were developed. The number of categories was reduced by” collapsing those that are similar or dissimilar into broader higher-order categories” [ 19 ]. Finally, the codes were ordered into essential categories, and the main contents and categories were identified. Moreover, essential quotations were clustered. The quotations were used to elaborate on the context that affects the participants’ experience and how the participants experienced the events.

Trustworthiness

The investigators, research facilitators, nurses and midwives expert were invited to review the study’s findings and the right idea that represents their point of view was taken for the study to maintain credibility. Dependability was addressed by analyzing all the observational data, and interview and FGD transcripts by at least two researchers with a third “checker” to ensure consistency across the data analysis process. Moreover, the investigators and research facilitators discussed the emerging categories from the dataset and resolve any different perspectives by foraging consensus on interpretation. The decision of transferability of the findings to a new set of situations depend on the contextual information provided by the investigators.

Ethics approval and consent to participate

Ethical approval was obtained from the Ethical Committee of Debre Tabor University, health Science College and we communicated it to Amhara Region Ethical Review Board. A formal letter of cooperation was written for Amhara Region Public Hospitals and permission to conduct the study was obtained from the hospital and the unit managers. Participants were informed that they had the right to withdraw from the study at any time. Moreover, we informed the purpose, procedures, advantages and disadvantages. Finally, informed written consent was obtained from each study participant.

The participant’s ages ranged from 21 to 50 years, and their mean age was 31 years. Thirty-eight participants were married and thirty of them were single. Sixty male and twenty-six female participants have participated in the study. The work experience of the participants ranged from 1 year to 34 years and its mean was seven years. Of the total 86 participants, 46(53.5%), 32(37.2%), 8 (9.3%) were nurses, midwives and key informants respectively. Five MSc nurses, forty-one BSc nurses, three MSc midwives and twenty-nine BSc midwives participated in the study. In terms of participants’ positions, six head nurses and three head midwives participated in the study. Two medical directors, three hospital managers, three quality health care cordinators, and three case managers also participated in the study.

The data analysis of observation, FGD, and interview produced four themes. These four themes were the perceptions towards implementing EBPe, the nurses’ and midwives’ attributes the supporting of nurses and midwives for the IEBP and the perceived barriers to implementing EBP. The four themes were further subdivided into eleven subthemes. Of which, four subthemes were included under the nurses’ and midwives’ attributes, three subthemes were included under the supporting of nurses and midwives for IEBP and four subthemes were included under the perceived barriers to implementing EBP.

The perceptions towards the IEBP

This is the theme defined as the awareness of participants towards the IEBP. The interviewees and FGD participants perceived that IEBP is using research findings, guidelines, hospital protocols, books, and experts’ experience during health services, particularly in clinical decision-making. One of the interviewees describes the perception towards the IEBPe like this:

“ First of all, evidence-based practice is the use of hospital protocols, guidelines and training manual for health care service especially when we give patient care and do procedures. It is a matter of reading books and search for research findings. It is also to get updated information during morning sessions and seminar presentations from experts’ experience (119) .”

Another focused group discussion participant expressed his perception as follows:

“ I understand that EBP is the use of scientifically proved evidence in the health service. It is a means of clinical practice based on rules and follows the scientific procedure (FGD5-02) .”

The nurses’ and midwives’ attributes

The nurses’ and midwives’ attributes are personal attributes that affect the ability to implement EBP. The nurses’ and midwives’ attributes include knowledge, skill, attitude and experience in IEBP. Knowledge, skill and attitude indicate the credibility of nurses’ and midwives’ expertise in implementing EBP. However, nurses and midwives felt that they did not have the knowledge, the skill and the attitude to implement EBP. Further, they could not differentiate quality research. This was described by one of the interviewees:

“ I am working in all wards and my colleagues too… . I do not expect knowledge and skill at the competency level to use evidence like standard guidelines , books and research findings . I do not think that we have the knowledge and the skill to perform every procedure using evidence particularly quality research . Some of the nurses and midwives may not be positive to read the evidence . They are negligent in using evidence (121) .”

The observation of BSc midwife using a checklist revealed that there were challenges to perform tasks without difficulty. Skilled delivery was attended without the steps of procedures. The skill and getting ready to perform the procedure were the practical challenges (H111).

Experience in IEBP

Experience in IEBP is the subcategory of nurses’ and midwives’ attributes. It is participants’ experience in using evidence such as standard guidelines, hospital protocols, experts’ opinions, books and research findings. Nurses and midwives use guidelines and hospital protocol for their day-to-day activities. Sometimes, they read books to increase their confidence in clinical decision-making practice. However, they use research findings to provide health services rarely. The experience of nurses and midwives in IEBP was stated by one of the FGD participants:

“ You see , implementation of evidence-based practice is beneficial . Medicine is updated every time . Evidence that we use today may not work for tomorrow . Most of the time , I use guidelines and hospital protocols . However , I didn’t use a research article . Even if , there is an off library in our hospital , we refer to some books . We know our job is teamwork and there is supporting and sharing ideas between team members (FGD4-03).”

The supporting of nurses and midwives for IEBP

The theme ‘the supporting of nurses and midwives for IEBP’ included the subthemes ‘the supportive organization to implement EBP’, ‘the support from Non-governmental Organizations (NGOs) and other stakeholders to implement EBP’ and ‘the supportive supervision, monitoring and evaluation of IEBP’. The support for nurses and midwives to implement evidence-based practice and managers’ role in supporting organizations affect the ability to implement EBP.

Supportive organization to implement EBP

Nurses and midwives’ managers and ward heads experienced that they did not support organizations to implement EBP. However, they understand that supportive organizational resources like electronic journals, work-based libraries, books and research findings had an impact upon IEBP. This was described by one of the interviewees:

“ I ask chief manager, “how to implement evidence- based practice through training and fulfill resources in the hospital?” I did nothing beyond this. I cannot communicate with higher officials and other stakeholders outside this hospital. The chief manager can do this. I understand using guidelines, books, hospital protocols, training manuals and experts’ opinions to improve quality health care. (124) .”

There should be a strong supportive organization for the existence of the IEBP. However, nurses and midwives felt no support and commitment in using updated guidelines, journals and protocols. This was described by one of the FGD participants:

“ Updated evidence like guidelines, hospital protocols, books and journals should be available to apply the evidence-based practice. I do not think that we are using updated guidelines and hospital protocols. As a nurse and midwife, commitment is essential. We have to support each other and get support. I do not remember this was done practically (FGD3-06) .”

NGOs’ and other stakeholders’ support for IEBP

One cannot expect the IEBP without the support of both local and international stakeholders. Non-governmental organizations like the world health organization, the health bureau and the Ethiopian ministry of health support hospitals by providing training for nurses and midwives, distribution of guidelines and training manuals. However, the NGOs’ and other stakeholders’ support for implementing EBP is still inadequate. There is no training considering research findings to use in clinical decision-making practice and healthcare. One of the labor and delivery ward head midwife describe the stakeholders’ support as follow:

“ There are NGOs like CDC , World Vision and Gender Health Ethiopia that provide short-term training and different guidelines . These organizations did well but it is not adequate support . We use these updated guidelines . Nevertheless , there is a big gap in using research articles and there are no supporters to use it (105) .”

The supportive supervision, monitoring and evaluation of IEBP

Mentoring and supportive supervision, control and evaluation were identified in all FGD and interview participants to change IEBP. One of the interviewees stated his experience:

” What do you mean ? How could we change without the mentoring and supervision of the IEBP ? I understand that it is important . However , there is no direct mentoring and supportive supervision , control and evaluation of nurses’ and midwives’ use of guidelines , books and manuals . We do it indirectly . I do not expect something good towards the use of research in our clinical settings (112) .”

The perceived barriers to IEBP

The theme ‘the perceived barriers to IEBP’ involved the subthemes ‘knowledge and skill’, ‘insufficient time’, ‘lack of resource and training’, and ‘lack of motivation’. The data analysis of interview, FGD, field note and observation identified the barriers of IEBP.

Insufficient time

All the study participants described that shortage of time was a barrier to implement EBP. One of the emergency ward head nurses described this barrier as follow:

“ We do not have any plan of implementation of evidence-based practice because of emergency activities . We work for 24 hours . We are too busy . We can get different pieces of evidence from the library . However , we cannot go to the library due to a lack of time in this emergency ward . Nurses are few compared to emergency activities . Nurses are working continuously . They are strong . Nurses do not use evidence because of the workload . As I told you , we have a shortage of time . I have no time to read books . There is tiredness . We sleep , when we get time . We cannot consider anything rather than this because of a shortage of time (111) .”

Lack of resources and training

The data from FGD, interview, field note and observation indicated that participants did not implement EBP because of a lack of guidelines, hospital protocols, books, research articles and training. One of the key informants described the condition:

“ Nurses and midwives use guidelines, books and hospital protocols. However, it is not easy to get books, guidelines and recent research. Nurses and midwives do not understand the best research findings. They do not have the skill to use it and we need training. We cannot get updated guidelines and manuals for most of the procedures (122) .”

During the hospital visit, the observation revealed that most of the procedures did not have guidelines and hospital protocols and there were no books and literature in the ward. Moreover, most of the hospitals had no library, computers and internet access in the wards. The nurse claimed the nonuse of these resources (H105).

Lack of motivation

The majority of interviewees and FGD participants believed that motivation is one of the driving forces of implementing EBP. They describe personal derive and motivation to change the IEBP. It is impossible to change the existing EBP of health care and clinical decision-making without personal drive and motivation. This was described by one of the key informants:

” Let me tell you the real history of an educated patient and doctor . The doctor has been a long time in the hospital . He was frustrated and he was as he had been graduated from college . There was no incentive for him to do his job and negligence is his habit which does not lead to a good attitude . The patient knows the doctor very well . The patient got this doctor during the examination , and the patient said that no…he did not read anything about his profession after he had been graduated . The patient went to another doctor who was working in the university thinking that he read many books and articles . Similarly , nurses and midwives were not motivated to update themselves through reading books , guidelines and research articles . They stick to traditional practice (108) .”

Nurses and midwives blamed that having unclear job descriptions decrease their interest and motivation in doing their job. One of the participants stated that an unclear job description decreases motivation to implement EBP.

“ There are no job descriptions of MSc, BSc and diploma nurses and midwives. There is no clear demarcation of job descriptions among nurses and midwives based on the level of education. You see here, this is a matter of morals. I feel less interested when I am always doing the same job of diploma (101) .”

This study presented that the participants’ perception towards IEBP, the nurses’ and midwives’ attributes, the supporting of nurses and midwives for IEBP, and the perceived barriers of IEBP were the main themes of analysis. The participants had an understanding of how to implement EBP. The supporting of nurses and midwives to implement EBP indicates quality healthcare and working for safe patient care [ 2 , 20 ]. Barriers to IEBP of nurses and midwives were the primary concern in the experience of IEBP [ 21 , 22 ].

In this study, participants were seen to perceive the concept of IEBP. They understood that IEBP was using different types of evidence as a source of knowledge and skill in clinical decision-making practice and healthcare service. They know which types of evidence they used frequently. Commonly, participants use guidelines, hospital protocols and training manuals for clinical decision-making practice in our study conducted among nurses and midwives working in Amhara Region public hospitals. The studies conducted in Ghana and England were in line with this finding which indicated participants’ understanding of IEBP [ 7 , 20 ]. However, our study findings showed that research was rarely used. This is because of a lack of understanding to use research and participants’ trust to use it for IEBP.

This study conducted in Amhara region public hospitals revealed that there was little support for nurses and midwives to implement EBP, and managers’ and ward heads’ commitment to support nurses’ and midwives’ IEBP was not successful. Moreover, nurses and midwives use guidelines and protocols without concern for the update. This finding let us understand the support for IEBP consisted of all the management team that provided mentorship, delivering resources and commitment to collaborative activities. This finding agrees with the studies that reported that barriers and facilitators to EBP occurred at the organization and individual level [ 21 – 24 ]. The reason could be less support of staff to decrease barriers of IEBP due to lack of managers’ commitment, poor access of resources and lack of expertise to share updated information in all studies with the same finding. Therefore, there should be support where there were barriers to the IEBP.

This study identified that the barriers to implementing EBP were time mismanagement, lack of knowledge, negative attitude, lack of motivation, lack of resources and training. These barriers could be categorized under individual and institution level barriers. Studies conducted in Canada, Ghana, Germany, Iran, China and Jordan presented these barriers to implementing EBP [ 20 , 22 , 23 , 25 – 27 ]. However, the perceived causes of these barriers to use guidelines, hospital protocols, books, experts’ opinions and research in our study were different from causes of barriers to IEBP in other studies. In our study, participants perceived that barriers to implementing EBP stem from the lack of incentive and unclear job descriptions between diploma and MSc nurses and midwives. Diploma and MSc nurses and midwives were seen to have the same clinical practice activities because of unclear job descriptions between diploma and MSc nurses and midwives. Participants had no interest in implementing EBP. Our study findings also indicated that nurses and midwives did not read books, guidelines and research in clinical decision-making practice due to negligence in doing the same thing. Otherwise, the USA’s study revealed that the lack of motivation was common among nurses working for long years in one health facility which resulted in the loss of interest due to the length of time between formal academic training and current employment [ 28 ].

Denmark’s study also revealed that lack of motivation of nurses presented and the perceived cause of lack of motivation was failed IEBP due to nobody taking action on the agreed plan [ 29 ]. Otherwise, our study also presented that the participants were inclined to traditional clinical practice. Our study participants think that the use of updated evidence added the burden or workload to their day-to-date activities. They were negligent and they were not interested. They were not motivated. They also wanted incentives and support to implement evidence-based practice.

Our study revealed a lack of supportive organizational resources to get electronic journals, a work-based library, and access to books and research. Otherwise, the lack of support presented in the study of Denmark was non-formalized at the organizational level. Denmark’s study had no problem of sharing new sources of evidence and consensus decision to use the new evidence [ 29 ]. The possible reason for this difference in this lack of support for both studies could be better promotion of implementing EBP in Denmark.

One of the outcomes identified as subthemes was “the lack of resources and training.” The participants had difficulty of getting updated guidelines, books and research findings. They had a knowledge gap even if they got journals and they wanted training to use research. As far as our search for other similar studies, no other studies reported this finding.

The strengths and limitations

The study’s major strength is the use of interviews, FGDs and observation data collection techniques that contributed to providing insight into the complexity of IEBP in the health care system. The risk of bias was restricted by ensuring privacy for the interviewee and a quiet room to conduct FGD. This study addresses that IEBP in this study is typically underpinned through addressing supporting factors for IEBP, perceived barriers of IEBP and the experience IEBP.

The first limitation of this study was the possibility for social desirability bias as the study was conducted using interview and FGD methods, while nurses and midwives were working in the hospitals. Moreover, the response of the participants might be inflated or underestimated due to individuals with some interests. Second, this study was conducted in hospitals where a more advanced human resource dynamic, quality medical service and well-organized structure were available. Hence, transferability is difficult for health centers and health posts.

The experience of IEBP indicated that there was limited support for IEBP. Nurses and midwives used guidelines, hospital protocol and training manuals in the clinical decision-making practice. However, the research was rarely used in clinical practice. The knowledge, attitude towards IEBP, lack of training, time mismanagement and lack of motivation were the barriers to implementing EBP. The study’s findings will serve as a baseline for measuring and monitoring change in IEBP readiness following a tailored educational and organizational intervention. To implement EBP and to provide high-quality healthcare, organizational and individual level support for the IEBP is crucial. Moreover, the promotion of adopting EBP and training on the identified barriers are mandatory. Future research should be conducted to see the impact of IEBP on the quality health care.

Supporting information

S1 file. availability of data and materials..

The data set necessary to replicate our study findings as supporting information files.

https://doi.org/10.1371/journal.pone.0256600.s001

S2 File. Tools.

The interview, FGD and observation guides used in the study were both Amharic and English language.

https://doi.org/10.1371/journal.pone.0256600.s002

Acknowledgments

We are thankful to data collectors and all nurses and midwives working in Amhara region public hospitals for their willingness to participate in the study. We would also like to thank Debre Tabor University College of health science department of midwifery for the facilitation of activities of the Center for International Reproductive Health Training and Amhara Region Health Bureau for giving information on the study population.

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What is Evidence-Based Practice in Nursing? (With Examples, Benefits, & Challenges)

Are you a nurse looking for ways to increase patient satisfaction, improve patient outcomes, and impact the profession? Have you found yourself caught between traditional nursing approaches and new patient care practices? Although evidence-based practices have been used for years, this concept is the focus of patient care today more than ever. Perhaps you are wondering, “What is evidence-based practice in nursing?” In this article, I will share information to help you begin understanding evidence-based practice in nursing + 10 examples about how to implement EBP.

What is Evidence-Based Practice in Nursing?

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possible for children with gastrointestinal symptoms, 10. implementing and educating patients about safety measures at home and in healthcare facilities, how to use evidence-based knowledge in nursing practice, step #1: assessing the patient and developing clinical questions:, step #2: finding relevant evidence to answer the clinical question:, step #3: acquire evidence and validate its relevance to the patient’s specific situation:, step #4: appraise the quality of evidence and decide whether to apply the evidence:, step #5: apply the evidence to patient care:, step #6: evaluating effectiveness of the plan:, 10 major challenges nurses face in the implementation of evidence-based practice, 1. not understanding the importance of the impact of evidence-based practice in nursing:, 2. fear of not being accepted:, 3. negative attitudes about research and evidence-based practice in nursing and its impact on patient outcomes:, 4. lack of knowledge on how to carry out research:, 5. resource constraints within a healthcare organization:, 6. work overload:, 7. inaccurate or incomplete research findings:, 8. patient demands do not align with evidence-based practices in nursing:, 9. lack of internet access while in the clinical setting:, 10. some nursing supervisors/managers may not support the concept of evidence-based nursing practices:, 12 ways nurse leaders can promote evidence-based practice in nursing, 1. be open-minded when nurses on your teams make suggestions., 2. mentor other nurses., 3. support and promote opportunities for educational growth., 4. ask for increased resources., 5. be research-oriented., 6. think of ways to make your work environment research-friendly., 7. promote ebp competency by offering strategy sessions with staff., 8. stay up-to-date about healthcare issues and research., 9. actively use information to demonstrate ebp within your team., 10. create opportunities to reinforce skills., 11. develop templates or other written tools that support evidence-based decision-making., 12. review evidence for its relevance to your organization., bonus 8 top suggestions from a nurse to improve your evidence-based practices in nursing, 1. subscribe to nursing journals., 2. offer to be involved with research studies., 3. be intentional about learning., 4. find a mentor., 5. ask questions, 6. attend nursing workshops and conferences., 7. join professional nursing organizations., 8. be honest with yourself about your ability to independently implement evidence-based practice in nursing., useful resources to stay up to date with evidence-based practices in nursing, professional organizations & associations, blogs/websites, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. what did nurses do before evidence-based practice, 2. how did florence nightingale use evidence-based practice, 3. what is the main limitation of evidence-based practice in nursing, 4. what are the common misconceptions about evidence-based practice in nursing, 5. are all types of nurses required to use evidence-based knowledge in their nursing practice, 6. will lack of evidence-based knowledge impact my nursing career, 7. i do not have access to research databases, how do i improve my evidence-based practice in nursing, 7. are there different levels of evidence-based practices in nursing.

• Level One: Meta-analysis of random clinical trials and experimental studies • Level Two: Quasi-experimental studies- These are focused studies used to evaluate interventions. • Level Three: Non-experimental or qualitative studies. • Level Four: Opinions of nationally recognized experts based on research. • Level Five: Opinions of individual experts based on non-research evidence such as literature reviews, case studies, organizational experiences, and personal experiences.

8. How Can I Assess My Evidence-Based Knowledge In Nursing Practice?

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Alba DiCenso , RN, PhD 1 ,
Nicky Cullum , RN, PhD 2 ,
Donna Ciliska , RN, PhD 3
1 School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
2 Centre for Evidence Based Nursing, Department of Health Studies, University of York, UK
3 School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

https://doi.org/10.1136/ebn.1.2.38

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During the brief time that we have been engaged in developing Evidence-Based Nursing we have been fascinated by the reactions of friends, professional colleagues, and the media. The overwhelming majority of responses to the concepts of evidence-based nursing and the creation of this journal have been positive. But there have also been misgivings, sometimes generated by misunderstandings. This editorial addresses the following criticisms which we have encountered in person and in print: (1) evidence-based practice isn't new: it's what we have been doing for years, (2) evidence-based nursing leads to “cookbook” nursing and a disregard for individualised patient care and, (3) there is an over-emphasis on randomised controlled trials and systematic reviews in evidence-based health care. We intend the paper to generate, rather than close the debate!

Evidence-based practice isn't new; it's what we have been doing for years

The plea that “each nurse must care enough about her own practice to want to make sure it is based on the best possible information” is not new. It was written more than 15 years ago. In the same article, Hunt noted that the phrase “nursing should become a research-based profession” had already become a cliché! 1 Over 20 years ago, Gortner et al lamented the lack of research evidence in many areas of nursing practice, 2 and the year after, Roper spoke of nursing performing “far too many of its tasks on a traditional base and not within a framework of scientific verifications” . 3

Read the full text or download the PDF:

Implementing Evidence-Based Care in Nursing Practice

Two nurses walking down a hospital hallway. One has a stethoscope around their neck, the other is holding a patient chart.

Providing high-quality care is the primary goal of a nurse. Evidence-based care is a way of ensuring that the care for patients is up-to-date, effective, and reliable. This article explores the meaning of evidence-based care, its importance, benefits, and challenges in nursing practice. Further, the article discusses steps to implement evidence-based nursing practice, strategies for continuous improvement and education, and answers frequently asked questions about evidence-based care in nursing.

Understanding Evidence-Based Care in Nursing

Definition of evidence-based care.

Evidence-based care is a systematic approach to healthcare decision-making that integrates the best available evidence from well-conducted research studies with clinical expertise and patient values. In nursing, evidence-based care involves using research findings and other relevant sources of evidence to inform clinical practice, ensuring that patients receive the most effective treatments and interventions.

The Importance of Evidence-Based Care in Nursing

The implementation of evidence-based care in nursing is essential for several reasons. First, it ensures that patients receive the most effective care based on the latest research, which can reduce complications, shorten hospital stays, and improve quality of life. Second, it promotes the efficient use of resources since evidence-based interventions have proven more cost-effective than those based on tradition or opinion.

Moreover, evidence-based care helps nursing professionals continually update their knowledge and skills, foster a culture of continuous learning, and minimize the use of outdated or ineffective practices. By making decisions based on the best available evidence, nurses can provide safer, higher-quality care and contribute to better patient outcomes.

Goals and Benefits of Evidence-Based Care

The primary goal of evidence-based care in nursing is to ensure that patients receive the most effective, safe, and appropriate interventions based on current evidence. Some benefits of incorporating evidence-based care into nursing practice include the following:

Improved patient outcomes: Evidence-based care can lead to better clinical outcomes, higher patient satisfaction scores, decreased complications, and lower readmission rates.
Reduced healthcare costs: By providing more effective care, evidence-based care can lower the cost of healthcare for both patients and healthcare organizations.
Informed decision-making: Evidence-based care empowers nurses to make clinical decisions based on solid evidence, reducing the reliance on tradition and personal opinion and enhancing the quality and consistency of care.
Professional development: Incorporating evidence-based care into practice can improve nursing professionals’ knowledge and skills, foster continuous learning, and enhance the overall quality of the nursing profession.

Steps to Implement Evidence-Based Nursing Practice

Asking the right clinical questions.

The first step in evidence-based nursing practice is formulating a well-defined clinical question. This question should be relevant and specific to the patient’s needs and must address the elements of population or patient group, intervention, comparison or alternative, and outcomes (PICO). For instance, a PICO question might be: “In patients with type 2 diabetes, is aerobic exercise more effective than resistance exercise in improving glycemic control?”

Acquiring and Evaluating Relevant Literature

Once you have formulated a clear clinical question, the next step is to search for relevant research studies and literature. This may involve using electronic databases, such as PubMed, Cochrane Library, or CINAHL, and employing appropriate search strategies and keywords. It’s important to consider the quality and reliability of the sources when selecting studies for review. Systematic reviews, meta-analyses, and randomized controlled trials (RCTs) are considered high levels of evidence, while expert opinion and case studies represent lower levels of evidence.

Assessing and Synthesizing Evidence

After collecting and evaluating the relevant studies, you must now appraise the quality and strength of the evidence. This process might involve assessing the study design, sample size, methodology, statistical analysis, and conclusions. You must also synthesize the findings from different studies to draw meaningful conclusions and identify any gaps or inconsistencies in the evidence.

Integrating Evidence into Practice and Evaluating Outcomes

The final step is to integrate the evidence into nursing practice by developing and implementing clinical guidelines, procedures, or protocols based on the synthesized evidence. This process often requires collaboration with other healthcare professionals, such as physicians and specialists. After implementing the evidence-based intervention, it’s crucial to monitor and evaluate its efficacy, patient satisfaction, and any potential side effects in order to refine the intervention and ensure continuous improvement in patient care.

Overcoming Barriers and Challenges

In many organizations, leaders face various barriers and challenges that hinder their ability to maintain continuous improvement and education within their teams. Nursing practice is no exception. Here are some of the biggest challenges facing organizations in the nursing field.

Lack of Time and Resources

One of the most common challenges organizations face is a lack of time and resources to support continuous improvement and education initiatives. Employees’ workload can make it challenging to allocate time for learning, and budget constraints may limit the resources available for providing training and development opportunities.

To address this challenge, organizations can prioritize learning and resource allocation appropriately. Time-management strategies, such as designating specific hours for learning or setting up a regular schedule for training, can help make learning a consistent part of employees’ work routines. Moreover, leveraging low-cost or free resources, such as online courses, webinars, or industry-related blogs, can offer valuable learning opportunities without straining the budget.

Resistance to Change

Many organizations experience resistance to change from employees who may hesitate to adopt new processes, technologies, or ways of thinking. This resistance can impede the implementation of continuous improvement and education initiatives.

To overcome resistance, leaders can communicate the benefits of continuous education to employees by illustrating how it aligns with the organization’s goals and values. Providing ongoing support and encouragement, addressing concerns, and celebrating successes can help build trust and buy-in from employees-essential elements for successful change management.

Developing Effective Leadership and Collaboration

Effective leadership and collaboration are necessary for overcoming barriers and fostering an environment that supports continuous improvement and education. Leaders must set a positive example by engaging in continuous learning themselves and encouraging their teams to do the same.

Furthermore, leaders can facilitate collaboration within their teams by creating spaces for open communication, providing opportunities for cross-functional collaboration, and leveraging the unique skills and expertise of team members. Collaboration helps build relationships within the team and fosters an environment where learning and the exchange of ideas thrive.

Strategies for Continuous Improvement and Education

Having explored various challenges and potential solutions, we’ll now delve into specific strategies that organizations can use to promote a culture of continuous improvement and education within their teams.

Creating a Culture of Continuous Learning

Building a culture of continuous learning starts with leadership. Leaders who prioritize learning create an environment where employees feel encouraged and supported in their professional growth. Here are some ways to establish a culture of learning within your organization:

Encourage a growth mindset: Promote the idea that skills and abilities can be developed over time with effort and practice, emphasizing that learning is a key aspect of personal and professional growth.
Recognize achievements: Regularly acknowledge and celebrate employees’ learning accomplishments, such as completing a course or earning a certification, to create a positive learning culture.
Promote knowledge sharing: Provide opportunities for employees to share their knowledge and expertise with one another, such as through presentations, workshops, or mentoring programs.

By implementing these strategies, organizations can set the foundation for a culture where continuous learning and improvement are valued and embraced.

Supporting Ongoing Professional Development

Providing ongoing professional development opportunities for employees is another critical aspect of continuous improvement and education. Some ways to support professional development include:

Establishing training and development programs: Offer a range of in-house and external training courses, workshops, and seminars tailored to employees’ needs and interests.
Providing career development resources: Offer resources, such as career coaching or access to networking events, that help employees grow in their careers.
Supporting continued education: Offer financial assistance or flexibility in work schedules for employees pursuing formal education or certifications.

Using Technology to Enhance Evidence-Based Practice

Embracing technology is a powerful way to enhance evidence-based practice and promote continuous improvement and education. Technologies such as analytics, artificial intelligence, and machine learning can provide valuable insights for organizations to make well-informed decisions, streamline processes, and optimize performance. Some ways to leverage technology include:

Adopting learning management systems (LMS): LMS platforms can help organizations manage, track, and evaluate employees’ learning progress, facilitating their professional growth.
Utilizing data analytics: Data analysis can reveal trends and patterns in employee performance, helping organizations tailor their learning and development programs to address specific needs.
Exploring virtual and augmented reality: VR and AR technologies can offer innovative, immersive learning experiences that enhance skill development and retention.

By strategically adopting technology to support evidence-based practice, organizations can drive continuous improvement and education efforts, unlocking their teams’ full potential.

Implementing evidence-based care in nursing is crucial for improving patient outcomes and promoting high-quality, safe, and effective care. It involves a collaborative effort between nurses, healthcare professionals, and researchers to continually evaluate and update best practices based on the latest evidence. By incorporating evidence-based care into their practice, nurses can ensure that they are providing the best possible care for their patients while advancing the nursing field. While implementing evidence-based care may require a shift in practice, it is worth the effort to improve patient care and ultimately benefit the health of individuals and communities.

Frequently Asked Questions: Evidence-Based Care in Nursing

What is the importance of evidence-based care in nursing.

Evidence-based care is critical in nursing because it ensures that nursing practice is informed by the latest research findings, clinical expertise, and patient preferences. This comprehensive approach improves patient outcomes, promotes cost-effective practices, and enhances professional development among nurses. It also leads to a more patient-centered healthcare system, where individual patient characteristics, preferences, and values are incorporated into the decision-making process.

What are the steps involved in applying evidence-based care?

The process of applying evidence-based care in nursing generally follows these five steps:

Ask a clear and focused clinical question: Formulate a specific question relevant to the patient’s problem by considering the patient’s condition, intervention, comparison, and outcome (known as PICO).
Search for the best available evidence: Search for relevant research studies and meta-analyses that can inform the clinical question.
Critically appraise the evidence: Evaluate the validity, reliability, and applicability of the research findings to the specific patient situation.
Apply the evidence to clinical decision-making: Integrate the evidence with clinical expertise and patient preferences to inform nursing care.
Evaluate the outcomes: Assess the results of implementing evidence-based care, and adjust the nursing practice accordingly if needed.

Remember to involve the patient in the decision-making process to ensure their preferences, values, and beliefs are taken into account.

What are the potential challenges in implementing evidence-based care?

Some challenges faced by nursing professionals in implementing evidence-based care include:

Lack of time: Nurses often have tight schedules and heavy workloads, making it challenging to research and incorporate the latest evidence in their practice.
Access to research: Nursing professionals may not have access to the latest research articles or databases, hindering their ability to find relevant evidence.
Resistance to change: Some nurses may be reluctant to change their established practices, even when presented with new evidence.
Limited knowledge and skills: Nurses may need additional training in searching for, appraising, and applying research evidence to their clinical practice.

By addressing these challenges, organizations can help promote a culture of evidence-based care and facilitate its implementation within their nursing teams.

Can evidence-based care conflict with a nurse’s personal beliefs and preferences?

There may be situations where evidence-based care conflicts with a nurse’s personal beliefs or preferences. In these cases, it is crucial for the nurse to consider the patient’s best interest and make decisions that align with current research evidence, clinical expertise, and patient preferences. Nurses should be aware of any biases they may have and ensure that they do not interfere with providing optimal patient care.

What are some mistakes to avoid when applying evidence-based care?

Nurses should avoid the following mistakes when applying evidence-based care:

Over-reliance on a single research study: It is essential to consider multiple sources of evidence to make well-informed clinical decisions.
Ignoring patient preferences and values: The patient’s voice is a critical component of evidence-based care, and their preferences should always be taken into consideration.
Not seeking updated research: Evidence-based care requires staying informed about the latest research and being open to modifying practices based on new evidence.
Failing to evaluate nursing interventions: Regularly evaluating the outcomes of evidence-based interventions allows for continuous improvement and ensures that nursing practice remains current and effective.

By avoiding these mistakes, nurses can enhance the quality and effectiveness of their evidence-based practice.

What resources can help nurses implement evidence-based care?

Many resources can help nurses implement evidence-based care in their practice, including:

Online databases: Subscription-based or open-access databases, such as the Cochrane Library, PubMed, and CINAHL, offer access to a wealth of research studies and reviews in nursing and related fields.
Professional organizations: Nursing associations and societies often provide guidelines, resources, and training on evidence-based care.
Journals: Nursing journals, both print and online, regularly publish articles discussing evidence-based practice and the latest research findings.
Continuing education and training programs: Many institutions offer courses or workshops on evidence-based care and related skills.
Mentors and colleagues: Experienced nursing professionals who have successfully implemented evidence-based care can provide valuable insights and guidance.

Taking advantage of these resources can help nursing professionals incorporate evidence-based care more effectively into their practice.

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Challenges and Opportunities for Evidence Based Practice

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Evaluation of Facilitators and Barriers to Implementing Evidence-Based Practice in the Health Services: A Systematic Review

Ali ayoubian.

1 Department of Health Services Management, Faculty of Medical Sciences and Technologies, Science and Research Branch, Islamic Azad University, Tehran, Iran

Amir Ashkan Nasiripour

Seyed jamaledin tabibi, mohammadkarim bahadori.

2 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Background:

Evidence-based practice (EBP) is an ambition for health service administrators. We aimed to systematically review the major relevant articles in case of barriers and facilitators to implementing evidence-based practice in health services.

Materials and Methods:

The type of study was a systematic review. We searched the libraries and online sources such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, Scopus, Science Direct, Cochrane Library, and Google scholar. We used keywords included "Evidence-Based Practice", "Evidence-Based Management", "Healthcare", "Care Management, Evidence-Based Healthcare Management", "Health Care", Health", "Barrier", "Facilitator", policy and "Evidence-Based Healthcare".

In total, 12 studies were included. Several barriers and facilitators were recognized through the included papers, the factors such as organization support and a helpful education system improved skills, knowledge, and confidence to EBP. The outcomes of studies were identified as the employ of the internet as a highest-rated skill for increasing EBP quality.

Conclusion:

Generally, the results showed health service administrators should first identify barriers of EBP then transferred them to facilitators to the implementation of proper and efficient EBP.

Introduction

Evidence-based practice (EBP) is an ambition for health service administrators. EBP has been the combination of best study evidence with clinical expertise and patient uses in the decision-making method for patient administration [ 1 - 4 ]. EBP is an essential function in upholding the national health system; it supports efficient interventions and therefore presents the ground for evidence-based administration of supplies and workforce. Recently there has raised interest, comprehensive, in evidence-based health policy and interpretation of study to work [ 5 , 6 ].

Many eastern Mediterranean countries are lagging behind in biomedical study publications and interpretation of study evidence into health policy and programs, the applications have been restricted in developing such capability [ 6 - 8 ]. One of the principal barriers to the implementation of EBP is the shortage of science and abilities required for the interpretation of evidence into applications and policy [ 8 - 10 ]. EBP has been slowly utilized by healthcare workers in the globe [ 7 , 8 ]. So, there is a noticeable gap between this perfect situation and the status quo [ 6 - 10 ]. The major factors were identified from the different studies. EBP has been influenced by various factors such as the organizational, strategies, individual and social circumstances. But, dependent on participants’ field and different studies, various facilitators and barriers to implementing EBP in the health services have been reported [ 1 , 2 , 10 , 12 ]. In this study, we proposed to systematically review of the major relevant articles in case of facilitators and barriers to implementing EBP in the health services in order to help clinical managers and administrations to have a better knowledge of these technologies and deciding the better therapeutic decision.

Search Strategies

We searched the libraries and online sources such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, Scopus, Science Direct, Cochrane Library, and Google scholar. We used keywords included “Evidence-Based Practice”, “Evidence-Based Management”, “Healthcare”, “Care Management”, “Evidence-Based Healthcare Management”, “Health Care”, “Health”, “Barrier”, “Facilitator”, “Policy and Evidence-Based Healthcare.” Two reviewers AA and AAN were independently evaluated the titles and abstracts of all studies. The conflicts were solved by the third reviewer (LN). The two reviewers AA and AAN who conducted the literature search also individually made decisions and selected studies. The differences were solved by either discussing a third reviewer (LN) or argument. For methodological quality before inclusion papers in the review, the CASP checklist for qualitative research was used. The CASP checklist was used from 10 questions with 3 potential responses: “yes”, “no” and “can’t tell” to evaluate qualitative research. If greater than eight of the questions on the questionnaire were fitted, the research was assessed as good quality; if five to seven were fitted, it was assessed as fair quality; and if less than five were fitted, it was marked as poor quality. Figure-1 showed a Prisma flow chart for this study.

An external file that holds a picture, illustration, etc.
Object name is gmj-9-e1645-g001.jpg

The PRISMA flow chart depicts the database explorations, abstracts selected and the papers included

Our search initially retrieved 168 studies published up to January 2019. However, 150 articles were removed for the reason duplication between databases. Then, 18 papers were involved for initial selection. Upon screening abstracts and titles, 12 papers were recognized for full-text review ( Figure-1 ). Table-1 showed studies’ characteristics regarding the author’s name (data), sample, design, purpose, barriers, and facilitators. The quality of the studies varied between five to eight out of 10 questions (fair-to-good quality).


Gifford . (2018) [ ]	Staff nurses, head nurses and directors (n=13)	Descriptive qualitative	Evaluated facilitators and barriers of EBP in the Hunan, a low grown province in China	A shortage of accessible evidence in Chinese, nurses’ absence of knowledge of what EBP indicates, and worry that patients will be offended of obtaining overhaul that is regarded as modern.	Administration support and the fast grown of social network services	Fair
Duncombe (2018) [ ]	100 nurses	Descriptive, comparative study, they obtained data by self-administered questionnaires.	Explored barriers and facilitators of evidence-based practice in the Bahamas, in the hospital and community setting related to geriatric, psychiatric	“Inadequate resources for implementing research findings and “Inadequate training in research methods”	“Training in research methods” and “Organizational policies and protocols that are evidence-based”	-
Sullivan . (2017) [ ]	14 pediatric surgeons	Qualitative -semi-structured interviews	Assessed facilitators and barriers to the perforation of EBP among pediatric surgeons	Resource limitations and time constraints, a lack of required skills, the commonly poor quality of data in pediatric surgery, and a belief that remains to trust on a training style of education.	Having a native peer/champion that supports EBP employment, and working in a research hospital	good
Oh . (2016) [ ]	73 academic faculty nurses from 54 universities	Mixed method	Investigated self-efficacy, course needs, barriers, and facilitators related to the nurses	Absence of initial investment, skill, and knowledge for teaching EBP; rules-oriented nursing culture, hierarchical; limited research application and dissemination, latent student overloads in treating EBP	The collaboration in hospitals and schools; the importance of EBP to the work of nursing; and ongoing teaching in teaching/utilizing EBP	Fair
Majdzadeh . (2012) [ ]	Policy-makers and managers of the Ministry of Health and Medical Education (thirteen in-depth interviews and six focus group discussions)	Qualitative in-depth interview	Evaluation of the obstructions to EBDM in Iran’s health system	They reported that important barriers to EBDM including standards for choosing decision-makers, organizational values, and the approach to near EBDM.	-	Fair
Jacobs . (2010) [ ]	447 of chronic disease practitioners at the regional and state levels, the involvement of the NACDD	Descriptive qualitative	Evaluation of chronic disease practitioners’ self-reported barriers to EBDM	They reported that organizational barriers have higher scores than personal barriers. The main informed obstructions to EBDM were inadequate funding, absence of rewards/incentives, an acuity of state legislators not supportive evidence-based policies and interventions, and sense the require to be a professional on various subjects	-	Fair
Pagoto . (2007) [ ]	37 behavioral professionals	Qualitative study	Evaluation and describe the main barriers and facilitators to evidence-based practice (EBP).	The professionals reported that lack of training and negative attitudes about EBP are most frequently barriers.	They showed that a growing evidence-base is a major facilitator.	Fair
Chang . (2010) [ ]	89 Taiwanese nursing homes	Quantitative, descriptive study	Investigation of perceived facilitators and barriers, and also attitudes toward to research utilization between 89 Taiwanese RNs	The most common barriers were including difficulty understanding statistical analyses, inadequate authority to change practice, and supposed isolation from informed coworkers with whom to discuss the investigation	The facilitators were efficient research training, accessibility to Internet facilities and improved computers, and collaboration with academic nurses	-
Yadav . (2012) [ ]	Sample size was 370 of psychiatric nurses	A descriptive cross-sectional study	Evaluation of the facilitators, barriers, and skills in developing EBP between psychiatric nurses in Ireland	The greatest barriers were insufficient resources to modify practice and insufficient time to find and read research reports.	The most supportive resource for altering was reported as practice development coordinators. They reported that the highest-rated skill was using the Internet to search, and the lowest-rated skill was using research to modify practice for developing evidence-based practice.	-
Boerner . (2015) [ ]	124 Canadian health professionals	Descriptive qualitative	Evaluation of evaluated facilitators and barriers of the evidence-based behavioral sleep-related car by 124 Canadian health professionals	The main barrier and facilitator associated with training, knowledge, and education.	The facilitators included beliefs and supportive sleep attitudes, and the barriers included require to institutional support and time.	Fair
Kaper . (2015) [ ]	537 international expert clinicians.	Descriptive qualitative	Evaluation of facilitators and barriers for EBP in patient care	They reported the EBP inventory consists of 26 items in 5 scopes: subjective norm, decision making, perceived behavior control, attitude, and behavior and intention	-	Fair
Malik et al. (2016) [ ]	135 nurses employed in a tertiary health care network in Victoria, Australia.	Descriptive qualitative	Evaluation of the factors related to EBP	They showed that the absence of skills and knowledge, restricted support, poor time allowance, and inadequate resources are as barriers to acceptance of EBP in health care.	The adequate resources, governmental support, and admittance to long-term education are as factors supporting of acceptance of EBP	Fair

Barriers and Facilitators

In the nurses, barriers constituted a shortage of accessible data in Chinese, nurses’ absence of knowledge of what EBP indicates, and worry that patients will be offended of obtaining overhaul that is regarded as modern. Facilitators involved administration support and the fast grown of social network services [ 1 ]. The most common barriers in the nursing homes were including difficulty understanding statistical analyses, the inadequate authority to change practice and perceived isolation from knowledgeable colleagues with whom to discuss the research. Also, the facilitators were efficient research training, accessibility to Internet facilities and improved computers, and collaboration with academic nurses [ 8 ]. The greatest barriers in psychiatric nurses were insufficient resources to modify practice and insufficient time to find and read research reports. The most supportive resource for altering was reported as practice development coordinators. The highest-rated skill was using the Internet to search, and the lowest-rated skill was using research to modify practice for developing evidence-based practice [ 9 ]. The absence of skills and knowledge, restricted support, poor time allowance, and inadequate resources are as barriers to acceptance of EBP in health care for nurses employed in a tertiary health care network [ 13 ]. Also, another study related to the nurses discovered that the blocks to education EBP were the absence of initial investment, skill, and knowledge for teaching EBP; rules-oriented nursing culture, hierarchical; limited research application and dissemination, latent student overloads in treating EBP. Facilitators were recognized as the collaboration in hospitals and schools; the importance of EBP to the work of nursing; and ongoing teaching in teaching/utilizing EBP [ 4 ]. The majority of barriers related to geriatric, psychiatric were including “Insufficient resources for applying investigation results and “Inadequate training in research methods”. The greatest facilitators reported were as follows: “Training in research methods” and “Organizational policies and protocols that are evidence-based” [ 2 ]. Six fields among pediatric surgeons were recognized as significant to altering pediatric surgeons’ usage of evidence in practice; goals, skills, knowledge, environmental resources and context, social/professional role and identity, and social influence. The main barriers to evidence-based practice employment included resource limitations and time constraints, a lack of required skills, the commonly poor quality of data in pediatric surgery, and a belief that remains to trust on a training style of education. Facilitators were as follows having a native peer/champion that supports EBP employment, and working in a research hospital [ 11 ]. The obstructions to evidence-based decision making (EBDM) in Iran’s health system classify into the research system, decision-makers’ characteristics, and the decision-making atmosphere, with each type including further related themes and subthemes. Also, there are multi-dimensional solutions that can strange the impact of scientific evidence on decision-making. Numerous documented obstructions to EBDM are fixed in health system stewardship, such as the ill-defined priorities and weakness of inter-sectoral collaborations [ 5 ]. In territorial chronic disease practitioners, organizational barriers have higher scores than personal barriers. The largest reported barriers to EBDM were inadequate funding, lack of incentives/rewards, a perception of state legislators not supporting evidence-based policies and interventions, and feeling the require to be a professional on many issues. In adjusted models, the women were more prone to the description of a lack of skills in communicating with policymakers and in developing evidence-based programs. Participants with a bachelor’s degree were more prone than those with public health master’s degrees to description deficient of skills in developing evidence-based programs. In contrast, the specialists, Men, and participants with doctoral degrees were all more prone to feel require to be a professional on many issues to efficiently make evidence-based decisions [ 6 ]. The analysis of data on behavioral professionals showed seven themes to explain both facilitators and barriers: (1) attitudes, (2) training, (3) logistical considerations, (4) consumer demand, (5) policy, (6) institutional support, and (7) evidence. The lacks of training and negative attitudes about EBP were most frequently barriers. Also, the growing evidence base is a major facilitator [ 7 ]. The main barrier and facilitator evidence-based behavioral sleep-related car associated with training, knowledge, and education. The facilitators included beliefs and supportive sleep attitudes, and the barriers included require institutional support and time [ 10 ]. Facilitators and barriers for EBP inpatient care consist of five scopes: subjective norm, decision making, perceived behavior control, attitude, and behavior and intention [ 12 ].

In general, different groups of health care providers have less knowledge about proprietary evidence-based terminology, and reference books are the most important source of information for EBP. The key concepts in EBP include scientific and professional care, patient-centeredness, and attention to the quality of service. The factors such as organization support and a helpful education system improved skills, knowledge, and confidence to EBP [ 14 - 17 ]. The studies demonstrate that the organization as a sustaining body for research-correlated actions but not for skilling the body to approve EBP. The enormous majority of participants in the previous studies robustly experienced that they required educational alteration to improve their examination and assessment skills [ 15 - 17 ]. Lack of adequate facilities, time, knowledge with the research method, and lack of discretion to make changes are the most important barriers to EBP; also providing adequate opportunity, training in research methodology, and holding evidence-based training courses as important facilitators have been suggested. The teaching of the principles of the research methodology and how to apply their results, conducting evidence-based performance training courses, regular, transparent and understandable information gathering in the organization are as the most important facilitators of EBP. These results are also consistent with the results of most studies [ 37 - 39 ]. Education can be used as a procedure to overcome EBP barriers and to produce positive approaches. Several studies reported that sufficient resources, organizational support, and use of verified educational policies are the main apparatus for the success of EBP [ 4 - 8 , 18 - 22 ]. The results of interventions in the field of EBP indicate a significant impact of these interventions. By examining and considering the most important barriers to EBP mentioned in the studies, we will find that these results are consistent with the results of many studies. Pagoto et al .reported that negative attitudes and lack of training were as the most important barriers [ 35 ] also, Bayley et al showed that time shortage was the main barrier to EBP [ 36 ]. The level of supposed barriers and the commonly cited barriers to using research has been consistent in current studies. However, the most repeatedly cited barriers differ among countries such as Africa, Iran, Australia, the USA, Sweden, and the UK [ 10 , 13 , 22 - 24 ]. The barriers of EBDM classified into three groups including research system, decision-maker characteristics, and decision-making environment. The key point is that the logical and proper connection must to be upholding between these three components to ensure a perfect EBDM process. If there is no effective and correct connection between these three domains. Innvaer et al . and Mitton et al . evaluated the obstructions to EBDM in health management and policymaking. They divided the obstructions of EBDM as follows: organizational level (incentives stronger than EBDM, non-supportive culture, unsuitable reward systems for researchers, rapid replacement of staff and absence of political stability), personal level (poor ability for studying and operating evidence and lack of experienced personnel, negative feelings toward change and absence of mutual trust), time-related factors (limited time for decision making and diverse time-frame), communication factors (high volume of data, poor selection of messenger, absence of an actionable message, inappropriate scientific language for policy-makers, and lack of direct communication), low-quality research, and disputes over power and financial resources. Another study recognized like factors as obstructions, plus the organizational system of government and its rigidity toward alteration, and the lake of a ‘functioning policy network’ including the policy-maker, researcher, and official [ 25 - 28 ].

Certainly, the most frequently presented associated with the absence of particular techniques or skills, knowledge, and education or training. This is confirmed by several studies, interestingly, these barriers were parallel to the facilitators. The health professionals showed that certified education is as the facilitator for barriers including the absence of particular techniques or skills, knowledge, and education or training. Most of research reported that knowledge achieves during education and autonomous learning. This is coordinated with previous studies that representative formal education is deficient in health professional training programs [ 25 - 29 ]. For example, a study of training in sleep recommended several negative results related to the absence of training in sleep, counting unsuitable interferences being delivered, unsuitable or referrals to specialists, non-evidence-based practice, or the absence of consideration to sleep symptoms [ 30 - 32 ]. The lack of skills, knowledge, education, techniques, and training presented to be mainly salient for nurses, and one barrier at least associated with this issue. There is obviously a requirement to improved knowledge of how to make possible education between health professionals to make certain that high-quality patient care [ 24 - 29 ]. Time is one of the most frequently presented barriers to EBP. In particular, the lack of time repotted as the barriers by more one-half of general practitioners who responded to questions. Interestingly, although the absence of time is one of the most frequently reported barriers to EBP, time was identified in a few studies as facilitators. Whereas, it is surely the case that health professionals have a lot of demands on their time in both practice and training [ 10 , 13 , 33 , 34 ]. The outcomes of studies were identified as the employ of the internet as the highest-rated skill for increasing EBP quality. The local internet access is restricting in the workplace; therefore, internet access may not give access to the types of databases that include the vast body of investigation. Therefore, considering the results of the present study and the similar other studies, providing appropriate facilities for implementing EBP, providing sufficient time for study and evidence-based action through volume reduction work, increasing human resources, training in time management, providing training principles of research methodology, applying research results, training principles and standards of EBP and establishing legal, political and administrative infrastructures, implementation of research results by service providers with monitoring of professional, ethical and some legal aspects, providing strategies for enhancing physician collaboration, and conducting language courses seem inevitable for the development and success of EBP. In reviewing the scientific sources on EBP, it was found that reference books and the internet have the most use, which is in agreement with the results of Oliveri et al . [ 40 ] in Denmark. Among the four most widely used sources, articles and journals were the least used, while in the study of Krahn et al . [ 41 ] in Germany, articles and journals were the most frequently used sources of information. Due to the limited information provided in the reference books and the lack of up-to-date information [ 42 ], the use of articles and journals is recommended. Consideration the low rate of use of articles that may be due to a lack of reading proficiency due to lack of English proficiency, removing these and other potential barriers is essential for evidence-based practice. The results of the studies show the low level of knowledge, practice and using of evidence among health care providers [ 43 - 45 ], while in some studies, the level of knowledge, knowledge, practice and using EBP rate is greater [ 46 - 48 ]; increasing knowledge, attitude, and use of evidence in care by providing appropriate training, providing financial and non-financial incentives, appropriate culture building, and other measures are necessary in this regard and the authorities and policymakers in this field should pay more attention. Scientific and professional care, patient-centered care, and attention to the quality of service are key concepts in evidence-based practice [ 49 - 51 ]. The results of interventional studies in EBP have shown that they have been effective in promoting EBP, and the results of recent studies and interventions have also improved EBP [ 52 - 56 ]; therefore, consideration to the small number of interventional studies, and the positive effects of interventions; the designing and implementing efficient interventions to improve EBP can be an effective solution. Weaknesses of the present study include failure to review abstracts of papers published in congresses, and organizational reports, as well as failure to perform statistical analyzes such as meta-analysis of studies. Other weaknesses of this study are the limitations of access to some databases; however, the results of this study can be of the great application by examining the relatively different aspects of evidence-based performance that have been studied separately and in one-dimensional previous studies.

Generally, the results showed health service administrators should first identify barriers of EBP then transferred them to facilitators to the implementation of proper and efficient EBP.

Acknowledgment

The authors would like to express their appreciation to the reviewers to evaluated articles.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Key EBP Nursing Topics: Enhancing Patient Results through Evidence-Based Practice

This article was written in collaboration with Christine T. and ChatGPT, our little helper developed by OpenAI.

Key EBP Nursing Topics Enhancing Patient Results through Evidence-Based Practice

Evidence-based practice (EBP) is the use of the best available evidence to inform clinical decision-making in nursing. EBP has become increasingly popular in nursing practice because it ensures that patient care is based on the most current and relevant research. In this article, we will discuss the latest evidence-based practice nursing research topics, how to choose them, and where to find EBP project ideas.

What is Evidence-Based Practice Nursing?

EBP nursing involves a cyclical process of asking clinical questions, seeking the best available evidence, critically evaluating that evidence, and then integrating it with the patient’s clinical experience and values to make informed decisions. By following this process, nurses can provide the best care for their patients and ensure that their practice is informed by the latest research.

One of the key components of EBP nursing is the critical appraisal of research evidence. Nurses must be able to evaluate the quality of studies, including study design, sample size, and statistical analysis. This requires an understanding of research methodology and the ability to apply critical thinking skills to evaluate research evidence.

EBP nursing also involves the use of clinical practice guidelines and protocols, which are evidence-based guidelines for clinical practice. These guidelines have been developed by expert groups and are based on the best available evidence. By following these guidelines, nurses can ensure that their practice is in line with the latest research and can provide the best possible care for their patients.

Finally, EBP nursing involves continuous professional development and a commitment to lifelong learning. Nurses must keep abreast of the latest research and clinical practice guidelines to ensure that their practice is informed by the latest research. This requires a commitment to ongoing learning and professional development, including attending conferences, reading scholarly articles, and participating in continuing education programs.

You can also learn more about evidence-based practice in nursing to gain a deeper understanding of the definition, stages, benefits, and challenges of implementing it.

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How to Choose Evidence-Based Practice Nursing Research Topics

Choosing a science-based topic for nursing practice can be a daunting task, especially if you are new to the field. Here are some tips to help you choose a relevant and interesting EBP topic:

Look for controversial or debated issues

Look for areas of nursing practice that are controversial or have conflicting evidence. These topics often have the potential to generate innovative and effective research.

Consider ethical issues

Consider topics related to ethical issues in nursing practice. For example, bereavement care, informed consent , and patient privacy are all ethical issues that can be explored in an EBP project.

Explore interdisciplinary topics

Nursing practice often involves collaboration with other health professionals such as physicians, social workers, and occupational therapists. Consider interdisciplinary topics that may be useful from a nursing perspective.

Consider local or regional issues

Consider topics that are relevant to your local or regional healthcare facility. These topics may be relevant to your practice and have a greater impact on patient outcomes in your community.

Check out the latest research

Review recent research in your area of interest to identify gaps in the literature or areas where further research is needed. This can help you develop a research question that is relevant and innovative.

With these tips in mind, you can expand your options for EBP nursing research topics and find a topic that fits your interests and goals. Remember that patient outcomes should be at the forefront of your research and choose a topic that has the potential to improve treatment and patient outcomes.

Where to Get EBP Project Ideas

There are several sources that nurses can use to get EBP project ideas. These sources are diverse and can provide valuable inspiration for research topics. By exploring these sources, nurses can find research questions that align with their interests and that address gaps in the literature. These include:

Clinical Practice Guidelines

Look for clinical practice guidelines developed by professional organizations or healthcare institutions. These guidelines provide evidence-based guidelines for clinical practice and can help identify areas where further research is needed.

Research databases

Explore research databases such as PubMed, CINAHL, and the Cochrane Library to find the latest studies and systematic reviews. These databases can help you identify gaps in the literature and areas where further research is needed.

Clinical Experts

Consult with clinical experts in your practice area. These experts may have insights into areas where further research is needed or may provide guidance on areas of practice that may benefit from an EBP project.

Quality Improvement Projects

Review quality improvement projects that have been implemented in your healthcare facility. These projects may identify areas where further research is needed or identify gaps in the literature that could be addressed in an EBP project.

Patient and family feedback

Consider patient and family feedback to identify areas where further research is needed. Patients and families can provide valuable information about areas of nursing practice that can be improved or that could benefit from further research.

Remember, when searching for ideas for EBP nursing research projects, it is important to consider the potential impact on patient care and outcomes. Select a topic that has the potential to improve patient outcomes and consider the feasibility of the project in terms of time, resources, and access to data. By choosing a topic that matches your interests and goals and is feasible at your institution, you can conduct a meaningful and productive EBP research project in nursing.

Nursing EBP Topics You Can Use in Your Essay

Here are some of the latest evidence-based practice nursing research topics that you can use in your essay or explore further in your own research:

The impact of telehealth on patient outcomes in primary care
The use of music therapy to manage pain in post-operative patients
The effectiveness of mindfulness-based stress reduction in reducing stress and anxiety in healthcare workers
Combating health care-associated infections: a community-based approach
The impact of nurse-led discharge education on readmission rates for heart failure patients
The use of simulation in nursing education to improve patient safety
The effectiveness of early mobilization in preventing post-operative complications
The use of aromatherapy to manage agitation in patients with dementia
The impact of nurse-patient communication on patient satisfaction and outcomes
The effectiveness of peer support in improving diabetes self-management
The impact of cultural competence training on patient outcomes in diverse healthcare settings
The use of animal-assisted therapy in managing anxiety and depression in patients with chronic illnesses
The effectiveness of nurse-led smoking cessation interventions in promoting smoking cessation among hospitalized patients
Importance of literature review in evidence-based research
The impact of nurse-led care transitions on hospital readmission rates for older adults
The effectiveness of nurse-led weight management interventions in reducing obesity rates among children and adolescents
The impact of medication reconciliation on medication errors and adverse drug events
The use of mindfulness-based interventions to manage chronic pain in older adults
The effectiveness of nurse-led interventions in reducing hospital-acquired infections
The impact of patient-centered care on patient satisfaction and outcomes
The use of art therapy to manage anxiety in pediatric patients undergoing medical procedures
Pediatric oncology: working towards better treatment through evidence-based research
The effectiveness of nurse-led interventions in improving medication adherence among patients with chronic illnesses
The impact of team-based care on patient outcomes in primary care settings
The use of music therapy to improve sleep quality in hospitalized patients
The effectiveness of nurse-led interventions in reducing falls in older adults
The impact of nurse-led care on maternal and infant outcomes in low-resource settings
The use of acupressure to manage chemotherapy-induced nausea and vomiting
The effectiveness of nurse-led interventions in promoting breastfeeding initiation and duration
The impact of nurse-led palliative care interventions on end-of-life care in hospice settings
The use of hypnotherapy to manage pain in labor and delivery
The effectiveness of nurse-led interventions in reducing hospital length of stay for surgical patients
The impact of nurse-led transitional care interventions on readmission rates for heart failure patients
The use of massage therapy to manage pain in hospitalized patients
The effectiveness of nurse-led interventions in promoting physical activity among adults with chronic illnesses
The impact of technology-based interventions on patient outcomes in mental health settings
The use of mind-body interventions to manage chronic pain in patients with fibromyalgia
Optimizing the clarifying diagnosis of stomach cancer
The effectiveness of nurse-led interventions in reducing medication errors in pediatric patients
The impact of nurse-led interventions on patient outcomes in long-term care settings
The use of aromatherapy to manage anxiety in patients undergoing cardiac catheterization
The effectiveness of nurse-led interventions in improving glycemic control in patients with diabetes
The impact of nurse-led interventions on patient outcomes in emergency department settings
The use of relaxation techniques to manage anxiety in patients with cancer
The effectiveness of nurse-led interventions in improving self-management skills among patients with heart failure
The impact of nurse-led interventions on patient outcomes in critical care settings
The use of yoga to manage symptoms in patients with multiple sclerosis
The effectiveness of nurse-led interventions in promoting medication safety in community settings
The impact of nurse-led interventions on patient outcomes in home healthcare settings
The role of family involvement in the rehabilitation of stroke patients
Assessing the effectiveness of virtual reality in pain management
The impact of pet therapy on mental well-being in elderly patients
Exploring the benefits of intermittent fasting on diabetic patients
The efficacy of acupuncture in managing chronic pain in cancer patients
Effect of laughter therapy on stress levels among healthcare professionals
The influence of a plant-based diet on cardiovascular health
Analyzing the outcomes of nurse-led cognitive behavioral therapy sessions for insomnia patients
The role of yoga and meditation in managing hypertension
Exploring the benefits of hydrotherapy in post-operative orthopedic patients
The impact of digital health applications on patient adherence to medications
Assessing the outcomes of art therapy in pediatric patients with chronic illnesses
The role of nutrition education in managing obesity in pediatric patients
Exploring the effects of nature walks on mental well-being in patients with depression
The impact of continuous glucose monitoring systems on glycemic control in diabetic patients

The Importance of Incorporating EBP in Nursing Education

Evidence-based practice is not just a tool for seasoned nurses; it’s a foundational skill that should be integrated early into nursing education. By doing so, students learn the mechanics of nursing and the rationale behind various interventions grounded in scientific research.

Bridging Theory and Practice:

Introducing EBP in the curriculum helps students bridge the gap between theoretical knowledge and clinical practice. They learn how to perform a task and why it’s done a particular way.

Critical Thinking:

EBP promotes critical thinking. By regularly reviewing and appraising research, students develop the ability to discern the quality and applicability of studies. This skill is invaluable in a rapidly evolving field like healthcare.

Lifelong Learning:

EBP instills a culture of continuous learning. It encourages nurses to regularly seek out the most recent research findings and adapt their practices accordingly.

Improved Patient Outcomes:

At the heart of EBP is the goal of enhanced patient care. We ensure patients receive the most effective, up-to-date care by teaching students to base their practices on evidence.

Professional Development:

Familiarity with EBP makes it easier for nurses to contribute to professional discussions, attend conferences, and conduct research. It elevates their professional stature and opens doors to new opportunities.

To truly prepare nursing students for the challenges of modern healthcare, it’s essential to make EBP a core part of their education.

In summary, evidence-based practice nursing is an essential component of providing quality patient care. As a nurse, it is important to stay up to date on the latest research in the field and incorporate evidence-based practices into your daily work. Choosing a research topic that aligns with your interests and addresses a gap in the literature can lead to valuable contributions to the field of nursing.

When it comes to finding EBP project ideas, there are many sources available, including professional organizations, academic journals, and healthcare conferences. By collaborating with colleagues and seeking feedback from mentors, you can refine your research question and design a study that is rigorous and relevant.

The nursing evidence-based practice topics listed above provide a starting point for further exploration and investigation. By studying the effectiveness of various nursing interventions and techniques, we can continue to improve patient outcomes and deliver better care. Ultimately, evidence-based practice nursing is about using the best available research to inform our decisions and provide the highest quality care possible to our patients.

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Nursing Research and Evidence-Based Practice Free Essay Example
(PDF) Nursing Informatics Application as A Tool for Evidence Based
Essay The Role of Evidence-Based Practice in Nursing
The Impact of Evidence-Based Practice in Nursing
(PDF) Evidence-Based Practice and Research Methodologies: Challenges
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Addressing the current challenges of adopting evidence-based practice
It has been suggested that the idea of delivering care based on evidence had its early foundations in the 1800s with Florence Nightingale, who aimed to provide better outcomes for patients who experienced unsanitary conditions (Mackey and Bassendowski, 2017).However, it is generally agreed that Professor Archie Cochrane, whose work inspired the Cochrane Collaboration (Smith and Rennie, 2014 ...
Challenges Of Implementing Evidence Based Practice Nursing Essay
One of the greatest challenges facing implementation of EBP is lack of knowledge on use of evidence based practices. It has been shown that most nurses do not have enough knowledge to integrate research findings in their practices. Research findings shows that there is little evidence that shows that most nurses, especially novice nurses have ...
Implementation of evidence-based practice: The experience of nurses and
Results. Nurses and midwives perceived that implementation of evidence-based practice is the use of research findings, guidelines, hospital protocols, books, and expert experience in clinical decision-making practice. However, there was limited support for the implementation of evidence-based practice by nurses and midwives.
Factors Affecting the Application and Implementation of Evidence-based
6. CONCLUSION. This study identified several factors that influence the application of EBP in the nursing environment of Cyprus. The findings indicate that nurses' lack of authority is the most important factor in their inability to use the results of research in practice and, consequently, in adopting EBP.
Addressing the current challenges of adopting evidence-based practice
Abstract. This aim of this article is to explore the current position of evidence-based practice (EBP) in nursing. The article provides an overview of the historical context and emergence of EBP with an outline of the EBP process. There is an exploration of the current challenges facing the nursing profession as it endeavours to adopt EBP into ...
Evidence-Based Practice in the United States: Challenges, Progress, and
Despite the barriers and concerns mentioned above, the nursing field in the United States has responded successfully and in many different ways to the call for evidence-based practice to support quality improvement and health care transformation (Stevens, 2013).Increasing demands for accountability in safety and in health care quality improvement has driven such responses, but much is still to ...
British Journal of Nursing
The problems with the uptake and effective implementation of EBP led to the emergence of the EIP concept. This concept is based on the premise that healthcare practice should, as a matter of principle, be informed by, rather than based on, evidence (Nevo and Slonim-Nevo, 2011). This implies that other forms of evidence (for example, patient experiences, the nurse's expertise and experiences ...
Advanced practice nurses' experiences of evidence-based practice: A
The aim of evidence-based practice (EBP) is to harmonize, justify and ensure high-quality nursing practices regardless of the care unit, nursing employee, and client/patient. 1 EBP has been shown to significantly reduce healthcare costs 2,3 and improve patient safety as well as the quality of care. 1 EBP refers to the judicious use of the best available evidence in decision-making related to ...
PDF Challenges of Implementing Evidence Based Practice
The recent transition from authority-based Nursing Practice has driven fundamental changes in clinical practice, Nursing research and Nursing education. Key words: Evidence Based Practice, Challenges 1 Evidence Based Practice Evidence-based practice refers to making right decisions about patient care based on the best evidence obtained by
Evidence-based practice beliefs and implementations: a ...
A cross-sectional survey design was used with a convenience sample of 241 nursing students from two public universities. Students were asked to answer the questions in the Evidence-Based Practice Belief and Implementation scales. This study revealed that the students reported a mean total belief score of 54.32 out of 80 (SD = 13.63).
PDF Overcoming Barriers to Implementing Evidence-Based Practice
nursing practice (Gennaro, Hodnett, & Kearney, 2001). The literature also shows that implementation of EBP is hard work and requires more than desire and excite-ment. Successful implementation of EBP requires commitment by practitioners and support from adminis-trators and nurse educators. Evidence-based practice has been described as ''the in-
Implementation of evidence-based practice: The experience of ...
Background. Implementation of evidence-based practice in clinical practice is crucial. Nurses and midwives play a vital role in using updated evidence. However, limited support and barriers to implementing evidence-based practice hamper the use of up-to-date evidence in clinical decision-making practice. Therefore, this study aimed to explore ...
What is Evidence-Based Practice in Nursing? (With Examples, Benefits
The following are five main skills required to implement evidence-based practice in nursing. 1. Critical Thinking: ... However, one of the most significant challenges nurses face in the implementation of evidence-based practice in nursing is the lack of resources from which they can gather data. Overcoming this challenge will require employer ...
Implementing evidence-based nursing: some misconceptions
The overwhelming majority of responses to the concepts of evidence-based nursing and the creation of this journal have been positive. But there have also been misgivings, sometimes generated by misunderstandings. This editorial addresses the following criticisms which we have encountered in person and in print: (1) evidence-based practice isn't ...
Addressing the current challenges of adopting evidence-based practice
This aim of this article is to explore the current position of evidence-based practice (EBP) in nursing. The article provides an overview of the historical context and emergence of EBP with an outline of the EBP process. There is an exploration of the current challenges facing the nursing profession as it endeavours to adopt EBP into care delivery, along with actions to address these ...
Implementing Evidence Based Practice nursing using the PDSA model
Project Phases Activities; Phase 1: Pre Implementation Audit A baseline audit of care was conducted to identify key areas of concern with regard to nursing and to determine where adherence to the evidence base could contribute to improved nursing care.Both pre and post Implementation findings are provided in Table 2.: Phase 2: Stakeholder Consensus workshop using modified experience based co ...
Nurses' roles in changing practice through implementing best practices
Introduction. Globally, in the last decades, there have been rapid changes in healthcare and nursing practice, based on the best available evidence, to improve patient, nursing and organisational outcomes whilst, at the same time, using resources efficiently (Cullen & Donahue 2016; Salmond & Echevarria 2017).A sustained change in practice through the implementation of best practices is ...
Understanding Evidence-Based Practice in Nursing
Challenges of Implementing Evidence-Based Practice in Nursing. Implementing evidence-based practice in nursing can be challenging, despite its many benefits. Some of the main challenges include: Limited access to evidence; Nurses may face difficulties in accessing up-to-date and relevant research evidence due to limited time, resources, and skills.
Implementing Evidence-Based Care in Nursing Practice
Implementing Evidence-Based Care in Nursing Practice. This article explores the meaning of evidence-based care, its importance, benefits, and challenges in nursing practice. Providing high-quality care is the primary goal of a nurse. Evidence-based care is a way of ensuring that the care for patients is up-to-date, effective, and reliable.
Challenges and Opportunities for Evidence Based Practice
Challenges can be defined as barriers, difficulty during apply the evidence-based practice in nursing. Actually, there are many challenges of EBP development, in the article will try to divide into four types to discuss: Challenge of the nurse, Challenge of the clinical environment, Challenge of the research and Challenge of the organization.
Evaluation of Facilitators and Barriers to Implementing Evidence-Based
Introduction. Evidence-based practice (EBP) is an ambition for health service administrators. EBP has been the combination of best study evidence with clinical expertise and patient uses in the decision-making method for patient administration [1-4].EBP is an essential function in upholding the national health system; it supports efficient interventions and therefore presents the ground for ...
Top EBP Topics in Nursing: Improving Patient Outcomes
The impact of team-based care on patient outcomes in primary care settings. The use of music therapy to improve sleep quality in hospitalized patients. The effectiveness of nurse-led interventions in reducing falls in older adults. The impact of nurse-led care on maternal and infant outcomes in low-resource settings.
Challenges Of Implementing Evidence Based Practice Nursing Essay
With growth in research, there has been great changed experienced in the healthcare setting. The new environment in provision of healthcare has been modeled to cope with the ever changing nature of di

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Evidence-informed practice: simplifying and applying the concept for nursing students and academics

Background:

Journey towards evidence-informed practice

Systems thinking

The evidence-informed practice model

The revised model

Drivers for EIP

In-service training or pre-service

Coaching, supervision and mentoring

Systems-level partnership

Internal management support

Staff performance and programme evaluation

Elements of the EIP model

Throughput: the evidence-informed practice cycle

Element 2. Informed decision-making

Element 3. Research awareness

Element 4. Application of knowledge

Element 5. Evaluation

Element 6. Conditions affecting research utilisation

Factor 2 (Output). Critical thinker and doer, the professional nurse

CPD reflective questions

Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students

Design and setting

Population and sample

Measurement

Ethical considerations

Data collection procedure

Data analysis

Study limitations and recommendations

Availability of data and materials

Abbreviations

Acknowledgments

Author information

Contributions

Corresponding author

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BMC Nursing

Implementation of evidence-based practice: The experience of nurses and midwives

Conclusions

Study design and setting

Participants, sampling and recruitment

Data collection

Data analysis

Trustworthiness

Ethics approval and consent to participate

The perceptions towards the IEBP

The nurses’ and midwives’ attributes

Experience in IEBP

The supporting of nurses and midwives for IEBP

Supportive organization to implement EBP

NGOs’ and other stakeholders’ support for IEBP

The supportive supervision, monitoring and evaluation of IEBP

The perceived barriers to IEBP

Insufficient time

Lack of resources and training

Lack of motivation

The strengths and limitations

Supporting information

S2 File. Tools.

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What is Evidence-Based Practice in Nursing? (With Examples, Benefits, & Challenges)

What is Evidence-Based Practice in Nursing?

8. How Can I Assess My Evidence-Based Knowledge In Nursing Practice?

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