Using research evidence in healthcare facilities improves treatment outcomes, but most nurses make decisions based on their previous experience in the field, patient records, senior colleagues’ recommendations, and their intuition. They rarely make decisions based on research findings or journal articles. Research by Brown et al. (2010) explored the barriers to introducing evidence-based practice (EBP) in clinical settings.
A literature review revealed that lack of resources, lack of administrative support, and burnout were the most common barriers to EBP introduction. However, Brown et al. (2010) aimed to explore two issues. The first aim was to correlate EBP with perceived barriers, and the second aim was to examine the correlation between perceived barriers in EBP and their role as predictors of EBP implementation.
Four hospital systems participated in the study, and each system issued an Institutional Review Board (IRB) approval to the researcher. With consent from the institutions, the researchers recruited nurses through flyers, newsletters, staff meetings, and leadership meetings. Participating in the study was optional and anonymous.
The nurses eligible for participating in the study needed to be over 21 years of age, registered nurses with full-time or part-time contracts, and capable of reading and comprehending English. A total of 974 respondents submitted the survey for evaluation. There were no benefits or risks associated with participation because the cross-sectional self-reported study design was anonymous and required little time to complete. The survey was in electronic format and submitted through an encrypted website to improve the protection of nurses participating. On the first page of the survey, the IRB approval and terms of consent were presented to the nurses who had the option of agreeing or declining the terms.
The researchers used the BARRIERS Scale, which is a five-point Likert scale with 29 items. It was used to collect data about the nurses’ perceptions of barriers in EBP implementation. In addition to BARRIERS, the researchers used the Evidence-Based Practice Questionnaire (EBPQ) to collect information about the attitudes towards EBP and its implementation in healthcare.
According to Brown et al. (2010), the four subscales in the BARRIERS Scale scored .80, .80, .72, and .65 when the Cronbach’s alpha was tested while the entire EBPQ showed the Cronbach’s alpha of .87. Based on those results, it is possible to suggest high consistency and reliability for both questionnaires, so the data collected through those methods can be considered valid for making a strong conclusion. Both questionnaires were taken at the same time without time limits, and the nurses were required to leave their demographic information once they were done with the questionnaires.
Demographic variables were clearly identified, and they included gender, age, and ethnicity, years of experience in the field of nursing, educational level, and position within the hospital system. Along with the four subscales of the BARRIERS Scale, the demographic variables were used as predictors while the practice of EBP, attitude towards, EBP, and knowledge/skills associated with EBP were the dependent variables.
Correlational analysis was used to explore the correlation between EBP and perceived barriers for implementation, which was the first aim of the study. The correlation between perceived barriers in research use as predictors of EBP implementation was the second aim of the study, and hierarchical multiple regression analyses were used to investigate that aim. SPSS version 15.0 was used to ensure the quality of the data analysis, and the statistical significance was set at p < .05. All p-values were reported, and the authors analyzed results thoroughly. Only statistically significant correlations were reported in the text.
However, because the study was cross-sectional, it is not possible to include the possibility of bias in interpreting the information as those types of studies cannot be used to define cause-and-effect relationship. Furthermore, self-selection and self-reporting from the participants’ side could have contributed to some biased results, especially because the nurses frequently omitted data by selecting the “no opinion” option when completing the BARRIERS Scale. These two limitations were reported by the authors before concluding their discussion.
Based on the results of the study, Brown et al. (2010) concluded their study was the first that found minimal impact of barriers on EBP implementation or their influence as predictors of EBP implementation. Therefore, it is possible to suggest that reducing the barriers identified with EBP will not significantly facilitate its implementation. However, the study is mainly inconclusive because of the flaws in design and possibility of bias in both data collection and interpretation.
Although the findings are inconclusive and do not show practical implication, it is possible that Brown et al. (2010) redefined the course of future research. Before their research, it was considered that removing barriers would inevitably result in EBP implementation in nursing. While other studies looked for barriers in the educational system (Halcomb & Peters, 2009) or at the organizational level (Retsas, 2008) in the effort to identify barriers that need to be removed for implementing EBP (Dalheim, Harthug, Nilsen, & Nortvedt, 2012), research by Brown et al. (2010) suggests that identifying nurse subsets that would be able to adopt EBP and finding relevant predictors for EBP implementation is more relevant than focusing on barriers, so future research should take that in account.
References
Brown, C. E., Ecoff, L., Kim, S. C., Wickline, M. A., Rose, B., Klimpel, K., & Glaser, D. (2010). Multi‐institutional study of barriers to research utilisation and evidence‐based practice among hospital nurses. Journal of Clinical Nursing, 19(13‐14), 1944-1951.
Dalheim, A., Harthug, S., Nilsen, R. M., & Nortvedt, M. W. (2012). Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC health services research, 12(1), 367.
Halcomb, E. J., & Peters, K. (2009). Nursing student feedback on undergraduate research education: Implications for teaching and learning. Contemporary Nurse, 33(1), 59-68.
Retsas, A. (2008). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31(3), 599-606.
Rolfe, G., Segrott, J., & Jordan, S. (2008). Tensions and contradictions in nurses’ perspectives of evidence‐based practice. Journal of Nursing Management, 16(4), 440-451.
