Title : Implementation of Evidence-Based Nursing: Challenges and Barriers

Implementation of Evidence-Based Nursing:

Challenges and Barriers



Nursing research provides the foundation for evidence-based nursing (EBN) practice. Evidence-based practice (EBP) has gained mo-mentum in nursing although definitions vary widely. Research findings, knowledge from basic science, clinical knowledge and expert opinion are all considered “evidence”. However, practices based on re-search findings are more likely to result in the desired patient outcomes across various settings and geographic locations. The staff nurse is a critical link in bridging research-based changes into clinical practice. Depending on the environment, a health care organisation may or may not have the resources to ensure critical, succinct, reasonable evaluation and application of research findings as they relate to the point-of-care delivery. Both EBM and EBN fall under the umbrella of evidence-based practice. Nurses are committed to providing holistic care; treating and working with patients rather than working on them. Effectiveness of treatment is only one part of the clini-cal decision-making process. In deciding on therapeutic interventions, acceptability to the patient and cost-effectiveness are considered. Several barriers in implementing evidence-based practice have been identified. Nurse administrators are key leaders in facilitating an EBP culture within a healthcare facility. They are in the best position to support new nurses in their transition and in evidence-based practice.

The past century has witnessed spectacular changes in the way we live and think. Human brilliance and technology have come together to propose solutions we dared not imagine 50 years ago. Many diseases have been conquered, millions of people have been saved from premature death and disability and the search for better solutions to health care is on.


In EBP approach, health care professionals use the best evidence possible, i.e. the most appropriate information available, to make clinical decisions for individual patients. It involves complex and conscientious decision-making based not only on the avail-able evidence but also on patient characteristics and preferences.

Theory-guided practice must be paced at the core of nursing and must integrate relevant outcome-driven practice with the art & science of caring & healing (Walker & Redmon, 1999). EBP requires nurses to base treatment on scientific research. However, the ideas behind the practice were introduced long before by the nursing pioneer Florence Nightingale.

It was during late 1980’s that EBP originated in medicine. It was built on the promise that health professionals should not centre practice on traditions & beliefs but on sound information grounded in research findings and scientific developments. There is an ongoing emphasis on development of nursing knowledge through research and theory building to improve their practice basis. Nursing relies on multiple ways of knowledge because it has characteristics of social, behavioural, and biological sciences.

Implementing treatment after analysing the re-views is an important step in evidence-based nursing practice. Everyone involved in treating the pa-tient will use the research information to create a treatment plan. EBP represents a shift toward more scientific inquiry in patient care. However, personal experience, wisdom and patient relationships are still very much a part of successful nursing care.


Some examples are given below which bridge the gap from research to clinical practice. These examples show that research evidence plays a significant role in health care practices. Different persons and populations need not respond similarly to interventions.


Challenges & Barriers

Nurses face real challenge when translating best evidence into clinical practice. For example, the relevant research-based databases are not comprehensive in many areas. Also, there is ongoing explosion in the amount and type of information available. Some of the barriers are as follows: 


  1. Lack of administrative support.
  2. Lack of time to critically appraise literature for relevant and best evidence.



3.    Lack of knowledge regarding evidence-based practice strategies.

4.  Uncertainty that evidence based practice will re-sult in better patient outcome than traditional care.

5.    Lack of interest.

6.    Lack of confidence in critical appraisal skills.

7.    Nurses feel overwhelmed by the volume of evi-dence.

8.    Lack of authority and co-operation to change pa-tient care procedures.

9.    Negative beliefs, attitudes and values.


10.  Educational preparations.

11.  Heavy patient workloads.

12.  Lack of support from nurse managers.

13.  Different goals for practice between administra-tors and staff nurses.

14.  Lack of evidence-based practice mentors in health care systems.

15.  Lack of resources, inadequate staffing

16.  Difficulty in understanding statistical analysis.


17.  Limited IT Skills / Lack of Searching Skills.




From the beginning of the nursing research endeavour, nurses have been interested in using nursing  research to effectively impart the care of individuals. It is important for nurses to advance EBP by assessing the barriers to EBP, correcting the misperceptions about EBP goals and question the current clinical practices. Health care administrators must facilitate an environment that fosters in-tellectual curiosity & support research efforts.


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Author : Padma B1, Madhavi Latha K2


The authors are: 1. Principal, and 2. Asst. Professor (Medical Surgical Nursing), both at Chalmeda Anand Rao Institute of Medical Sciences, College of Nursing, Bommakal, Karimnagar (AP).

Source: TNAI Journal