Factors influencing the development of evidence-based practice among nurses: a self-report survey

BMC Health Services Research Factors influencing the development of evidence-based practice among nurses: a self-report survey Anne Dalheim 0 1 Stig Harthug 0 Roy M Nilsen 0 Monica W Nortvedt 1 0 Department of Research and Development, Patient Safety Unit, Haukeland University Hospital , Jonas Liesvei 65, Bergen N-5021 , Norway 1 Centre for Evidence-Based Practice, Bergen University College , Postbox 7030, Bergen N-5020 , Norway Background: Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. Aims: The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. Methods: Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP). The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. Results: Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse's age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. Conclusion: Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice. Evidence-based practice; Nurses; Sources of knowledge; Barriers - Background Evidence-based practice requires making professional decisions based on systematically gathered evidence drawn from research and from experience and on the patients desires and needs in a specific situation [1]. Public authorities and professional organizations, international and national organizations [2-6] have promoted making evidence-based practice the standard for health services. The benefit is that evidence-based health services will be better able to meet the challenges of improving patient safety and the quality of services. The need for systematic information literacy is necessary because of an increasing amount of formal and informal health information, expectations related to new treatments and patient extended role related to clinical decisions [7]. Complex and often unpredictable conditions within the organization determine whether an implementation process for evidence-based nursing practice is successful [8,9]. Flodgren et al. [10] conducted a systematic review where the purpose was to identify which organizational infrastructures promote evidence-based practice in nursing services. Only one study met the inclusion criteria. The absence of relevant literature may be due to the fact that it is difficult to carry out intervention studies in organizations such as hospitals, because ongoing changes makes it difficult to decide which interventions have led to change. It is unclear which individual factors must be present for practice to be evidence-based. Individual factors are influenced by the fact that the individual nurse is working in a context with others, so that colleagues, organizational and cultural factors influence the practice [11]. Implementation must not only consider what knowledge to be implemented, but also how knowledge is facilitated in the context where it will be used [12]. Successful implementation is the function of knowledge, context and facilitation according to the frame work Promoting action on Research Implementation in Health Care (PARiHS) [13]. Research shows that measures for implementing evidence-based practice are more likely to succeed if they overcome identified barriers [14]. The BARRIERS to Research Utilization Scale [15] is the most frequently used instrument for mapping the barriers to evidencebased practice among nurses. Reviews of research show that the predominant barriers are related to organizational factors such as lack of time to find research and to implement this and lack of authority to implement the findings. The barriers are consistently independent of time, geographical location, sample size, response rate and organization [16]. In Norway, Hommelstad & Ruland [17] conducted a survey study using BARRIERS to Research Utilization Scale in a sample consisting of perioperative nurses. The main identified barriers in this study was that the research literature is not compiled in one place, lack of time, uncooperative physicians, insufficient resources and lack of access to information. The BARRIERS to Research Utilization Scale has been criticized because it solely identifies the barriers to the use of research and does not identify the degree to which nurses use other sources of information to support practice in relation to the definition of evidencebased practice [18]. Clinical experience is a prerequisite for determining whether research findings are relevant for use in practice, whether as general measures for a specific patient group or as measures for individual patients [19]. Since the BARRIERS to Research Utilization Scale was developed, the Internet has become an important tool for gathering information. Medical databases, journals that disseminate research and large international guideline databases are now available free of charge for health care personnel in Norway through the Norwegian Electronic Health Library [20]. How this influences the use of various sources of knowledge needs to be examined. Gathering evidence to be used in practice requires systematic methods and not arbitrary Internet searches. How nurses rate their own skills in finding, assessing and using evidence seems to be an important factor to consider in implementing evidence-based practice. In Norway, health authorities have decided that the health care services should be evidence-based. The present study aimed to identify the sources of knowledge on which nurses base their practice, barriers they consider hinder evidence-based practice and the skills they identify in finding, reviewing and using researchbased evidence. Further, we wanted to determine whether the self-reported skills in finding, reviewing and using research in practice we (...truncated)