Barriers to the adoption of evidence-based practice among nurses

Abstract

Aim: The purpose of this review was to investigate the barriers preventing nurses from evaluating and applying evidence from research findings in their nursing practice.
Background: Evidence-based practice, a recent addition to the nursing literature, has been reported to promote beneficial outcomes. The investigation of factors influencing its adoption and, in particular, the integration of empirical evidence with nursing practice is warranted.
Methods: A systematic review was performed using databases, such as PubMed, CINAHL, Health Source: Nursing/Academic Edition, and MEDLINE, to access articles published between 2008 and 2017. A total of 14 studies met the selection criteria and were included in the study. This review was undertaken in accordance with the PRISMA guidelines.
Results: The main barrier hindering the integration of research evidence into practice, and consequently, the application of evidence-based practice to nursing was nurses’ lack of time to conduct searches and read research articles. At the same time, many other factors, which are common among studies, appeared to influence differences in the nurses’ incorporation of research evidence into their practice.
Conclusions: There is a significant gap between research and nursing practice. Identifying the factors contributing to this gap might provide a foundation for developing strategies to reconcile it.
Keywords: Barriers; Evidence-based practice; Healthcare; Hospital; Nursing; Research utilization

Full text

journal homepage: http://kont.zsf.jcu.cz
DOI: 10.32725/kont.2020.017
Barriers to the adoption of evidence-based practice among
nurses
Maria Pitsillidou 1 *, Zoe Roupa 2, Antonis Farmakas 2, Maria Noula 2
1 Evangelistria Medical Center, Nicosia, Cyprus
2 University of Nicosia, Department of Life and Health Sciences, Nicosia, Cyprus
Abstract
Aim: e purpose of this review was to investigate the barriers preventing nurses from evaluating and applying evidence from research
ndings in their nursing practice.
Background: Evidence-based practice, a recent addition to the nursing literature, has been reported to promote benecial outcomes.
e investigation of factors inuencing its adoption and, in particular, the integration of empirical evidence with nursing practice is
warranted.
Methods: A systematic review was performed using databases, such as PubMed, CINAHL, Health Source: Nursing/Academic Edition, and
MEDLINE, to access articles published between 2008 and 2017. A total of 14 studies met the selection criteria and were included in the
study. is review was undertaken in accordance with the PRISMA guidelines.
Results: e main barrier hindering the integration of research evidence into practice, and consequently, the application of evidence-based
practice to nursing was nurses’ lack of time to conduct searches and read research articles. At the same time, many other factors, which are
common among studies, appeared to inuence dierences in the nurses’ incorporation of research evidence into their practice.
Conclusions: ere is a signicant gap between research and nursing practice. Identifying the factors contributing to this gap might provide
a foundation for developing strategies to reconcile it.
Keywords: Barriers; Evidence-based practice; Healthcare; Hospital; Nursing; Research utilization
* Author for correspondence: Maria Pitsillidou, Evangelistria Medical Center, Michael Giorgalla 1, Egkomi 1095, Nicosia, Cyprus;
e-mail: maria_pitsillidou@outlook.com
http://doi.org/10.32725/kont.2020.017
Submitted: 2020-01-20 • Accepted: 2020-04-06 • Prepublished online: 2020-04-30
KONTAKT 22/2: xxx–xxx • EISSN 1804-7122 • ISSN 1212-4117
© 2020 The Authors. Published by University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences.
This is an open access article under the CC BY-NC-ND license.
Review article
Introduction
Evidence-based practice (EBP) has been a priority in nurs-
ing practice over the last few years at the international level.
Aconsiderable number of studies conducted worldwide have
highlighted EBP’s importance (Saunders et al., 2019; Shayan
et al., 2019; orsteinsson and Sveinsdottir, 2014). It has been
dened as ‘a continuous interactive process involving the con-
scientious and wise examination of available research evidence
for better care’ (Canadian Nurses Association, 2010). e daily
accumulation of new knowledge and technologies, consumers’
changing needs, and nding, retrieving, and using existing
knowledge based on research evidence in practice are basic
concerns of nurses (Farokhzadian et al., 2015). Nursing servic-
es play a key role in the eectiveness of health systems (WHO,
2010), and nurses’ clinical decisions are essential for patients’
well-being and treatment outcomes (orsteinsson, 2013).
e application of evidenced-based practice benets both
patients and nurses. Healthcare systems, which in recent
years have been under pressure to save resources and improve
service performance, report positive outcomes (Leach et al.,
2016; Melnyk et al., 2010; Orta et al., 2016). Attempts to im-
prove the quality of healthcare services and to use available re-
sources rationally have led to repeated attempts to adopt EBP
(Lau et al., 2016; Orta et al., 2016).
Although the application of EBP in nursing has been uni-
versally acknowledged as a way to improve healthcare services,
its complexity due to multiple factors has prevented its appli-
cation (Saunders et al., 2016). Barriers to research utilization
in nursing have been extensively reported in the literature
(Duncombe, 2018; Kiessling et al., 2011; Veeramah, 2016).
e results of studies on barriers to the use of EBP dier and
there is great ambiguity and confusion in dening the greatest
barriers. Studies show that nurses rarely incorporate research
ndings into their practice, as they tend to use practices de-
rived from pre-existing knowledge, experiences, and social
interactions (Friesen-Storms et al., 2015; Giord et al., 2018;
Stokke et al., 2014).
Aim
e purpose of this research was to investigate the factors that
impede the use of research evidence in the application of EBP
to the clinical practice of nurses.
KONTAKT / Journal of nursing and social sciences related to health and illness
NURSING

Pitsillidou et al. / KONTAKT
2
Materials and methods
A systematic review of the international literature was con-
ducted. In the creation of this paper, the content analysis
method was used. e relevant sources were searched using
the scientic databases PubMed, CINAHL, Health Source:
Nursing/Academic Edition, and MEDLINE. e survey was
conducted in August 2017. Gathering of data and results anal-
ysis were carried out from January 2008 to June 2017. e
search terms used were ‘evidence-based practice’, ‘research uti-
lization’, ‘nursing’, and ‘hospital’ in the titles of articles, and
the used Boolean operators were “AND” and “OR”. e results
are presented in a PRISMA – Suppl. le 1: PRISMA 2009 Flow
Diagram: selection strategy of studies for systematic review
(Moher et al., 2015).
During the rst phase of the search, 1,268 papers were
found. In the next phase of the analysis, all duplicates and
studies that did not deal with the topic in the required context
were removed. Also removed were studies older than 10 years
and studies for which I was unable to obtain their full text. e
resulting number of studies used for this review was 14pa-
pers. ese 14 papers were conducted in the US, Singapore,
England, Iran, Kenya, Norway, Turkey, Oman and China, with
samples ranging from 182 to 1,486 participants.
e key features of all the included studies (i.e. authors,
year of publication, country where the study was conducted,
number of participants, research objective, data collection
tools, and key research results) are summarized in Table 1.
An attempt was made to include only randomized studies,
but this was impossible because of the limited number of this
type of study. A quantitative synthesis of the results was not
performed; only a systematic review of the studies was con-
ducted. Specic tools were not used to assess the quality of
the studies because the purpose of this review was descriptive.
Inclusion and exclusion criteria
is systematic review focused on identifying studies pub-
lished in English or Greek. Studies (qualitative, quantitative,
or mixed-methods) consisting of nurses working in hospitals
or medical centres, aged 21–65 years, were selected for the
review. Surveys of primary care nurses, nursing students, or
other healthcare professionals were excluded. No secondary
analyses were included that did not fully investigate the sub-
ject under study.
Results
Fourteen international studies from the US (2), Singapore
(2), England (1), Iran (1), Kenya (1), Norway (1), Turkey (3),
and Oman (2) were reviewed. Although a considerable num-
ber of international studies have been conducted on research
utilization in the healthcare eld, few have examined barriers
aecting the application of research ndings to nursing prac-
tice; yet, nurses are one of the largest groups of health profes-
sionals and have key roles in the care of patients. e number
of studies on this topic using randomization was even fewer.
A large number of studies were excluded from this review be-
cause most of them included other health professionals (e.g.
midwives and doctors) or primary care nurses and nursing stu-
dents. e analysis of the 14 studies eligible for this systemat-
ic review revealed interesting results. Some of the studies had
common features, such as use of the same instrument, i.e. the
Barriers Scale (n = 8), although this feature was not a criterion
for the selection of studies.
is review found that the main barriers inuencing the
application of EBP were mostly organizational shortcomings
and malfunctions. e results of the 14 studies showed the
majority of nurses considered lack of time as one of the major
barriers to research utilization in their clinical practice, with
an agreement of 85.7% (n = 12) between the studies (Ammouri
et al., 2014; Brown et al., 2009; 2010; Dalheim et al., 2012;
Foo et al., 2011; Gerrish et al., 2008; Majid et al., 2011; Sari et
al., 2012; Tan et al., 2012; Wang et al., 2013; Yava et al., 2009;
Zhou et al., 2015). Lack of time was found to be the greatest
obstacle in six of the studies (Brown et al., 2009; 2010; Dal-
heim et al., 2012; Foo et al., 2011; Gerrish et al., 2008; Majid
et al., 2011) and one of the top ve barriers in the remaining
studies (n = 6) (Ammouri et al., 2014; Sari et al., 2012; Tan
et al., 2012; Wang et al., 2013; Yava et al., 2009; Zhou et al.,
2015). In the survey by Brown et al. (2009), respondents said
they had limited time to search for studies during scheduled
work hours and after work: ‘very little time to nd and read
research’ and ‘too many family responsibilities to read research
at home’.
Lack of time was considered by many investigations (Brown
et al., 2009; 2010; Dalheim et al., 2012; Foo et al., 2011; Ger-
rish et al., 2008; Majid et al., 2011) as the main factor inter-
fering with the adoption of EBP; in other studies, nurses had
dierent perceptions (Ammouri et al., 2014; Sari et al., 2012;
Tan et al., 2012; Wang et al., 2013; Yava et al., 2009; Zhou et
al., 2015). Barriers were considered to reect a lack of power to
make changes in practice (Brown et al., 2009; 2010; Tan et al.,
2012; Wang et al., 2013; Yava et al., 2009), lack of time to make
changes in practice (Brown et al., 2010; Foo, et al. 2011; Tan et
al., 2012; Zhou et al., 2015), and inadequate workplace facilities
for the use of research ndings (Mutisya et al., 2015; Sari et al.,
2012; Yava et al., 2009). ese factors were among the most
frequently encountered barriers.
Almost all the studies showed similar ndings with respect
to EBP barriers, with dierences in their rank order by impor-
tance of the barriers. Lack of skills for nding and managing
research evidence, the inability to understand statistical terms
used in research articles, lack of relevant references or refer-
ences obtained from only one source, and poor knowledge of
research were reported as barriers, although to dierent de-
grees (Ammouri et al., 2014; Brown et al., 2009; 2010; Dal-
heim et al., 2012; Farokhzadian et al., 2015; Foo et al., 2011;
Gerrish et al., 2008; Majid et al., 2011; Tan et al., 2012; Sari et
al., 2012; Wang et al., 2013; Zhou et al., 2015).
Several studies reported dierent outcomes, such as those
by Mutisya et al. (2015) and Ammouri, et al., (2014) conduct-
ed in Kenya and Oman, respectively, which identied diculty
nding research reports or the unavailability of research stud-
ies as a major barrier to the implementation of EBP. is bar-
rier was not identied in any of the other studies as the most
important barrier inuencing the adoption of EBP. Dierent
results were also reported by Farokhzadian et al. (2015). In
that study, the greatest barrier for the implementation of EBP
was diculty assessing the quality of research articles, a bar-
rier that nurses from the other studies classied as important
but not as the greatest barrier. Two other studies (Dalheim et
al., 2012; Wang et al., 2013) conducted in countries that do
not have English as their rst language reported that the pub-
lication of research articles in English was a major barrier to
research utilization in practice.

Pitsillidou et al. / KONTAKT
4
Table 1. Studies included
Research Aim Country Research population Measurement tool Environment Results/Outcome
Gerrish et al.,
2008
Comparison of factors inuencing
the development of evidence-based
practice
England 598 nurses Developing Evidence-
Based Practice
Questionnaire
2 hospitals 1. Nurses reported lack of time and lack of resources as major
barriers
2. Major barriers are also considered to be the diculty in
understanding and evaluating the quality of research
Brown et al., 2009
Quantitative
research
(Descriptive,
Synchronous
Study)
A description of the practice,
knowledge, and attitudes of nurses
associated with EBP and the
relationship between perceived barriers
and factors facilitating EBP
USA 458 nurses Evidence-Based Practice
Questionnaire (Upton and
Upton, 2006)
Barriers to Research
Utilization (Funk et al.,
1991)
Academic
Medical
Center in
California
e organizational barriers (lack of time for reading surveys,
insucient time in practice, lack of power for change, and
lack of knowledge concerning research) were the top barriers
Yava et al., 2009
(Quantitative
research)
Identifying nurses' perceptions of
barriers and facilitating the use of
research
Turkey 631 nurses Barriers Scale 9 Hospitals in
Ankara
e most important barriers were inadequate power
(63.6%), lack of time (54.0%), inadequate facilities
(52.8%), the perception of nurses that the results are not
universally applicable (48.7%), and the lack of support for
implementation by the rest of sta (46.0%)
Brown et al., 2010 Investigation of the relationship
between barriers using research and
application of EBP by nurses, and the
identication of barriers as predictive
factors in the implementation of EBP
USA 1,301 nurses Evidence-Based Practice
Questionnaire (by Upton
and Upton, 2006),
Barriers Scale (Funk et al.,
1991)
4 hospitals in
California
e top barriers mentioned are lack of time, insucient
time to change practice, lack of power for change, and lack of
knowledge for the research
Majid et al., 2011
Quantitative
Research
(Descriptive
Research)
Investigation of nurses' knowledge and
attitude towards EBP as well as factors
that may discourage or encourage the
adoption of EBP
Singapore 1,486 registered
nurses
Questionnaire
Development
2 public
hospitals
1. e main barrier to the adoption of EBP was the lack of
time to search for and read research articles in the workplace
2. e three following barriers, identied by 47% of the
nurses, were inability to understand the statistical terms,
inadequate understanding of the technical terminology used
in the research articles, and diculty in assessing the quality
of research articles and reports
3. 46% of participants said they did not have enough time to
change current patient care practices
Foo et al., 2011
Quantitative
Research
Investigation of attitudes, knowledge,
barriers, and factors facilitating the
implementation of EBP as well as the
education and training of nurses
Singapore 1,141 nurses Questionnaire
Development
National
University
Hospital
1. e biggest barrier mentioned was the diculty of nding
time at work for searching and reading articles and reports
(53.84%)
2. e second biggest barrier was insucient working time
for changes in current practice (46.73%)
3. Diculty in judging the quality of research and the
inability to understand the statistical terms used in research
articles
4. e least eecting factor in the application of EBP was
inability to apply the recommendations of research studies to
the clinical practice
Dalheim et
al., 2012
(Synchronous/
Sectional
Research)
Determining the factors aecting
nurses in the application of Evidence-
Based practice
Norway 407 nurses Developing Evidence-
based Practice
questionnaire (DEBP)
Norwegian
University
Hospital
e ve major barriers to evidence-based practice were
1. Insucient time to nd research reports
2. Insucient time to nd organizational information (such
as guidelines and protocols)
3. Diculty in assessing the quality of research
4. Diculty understanding the English language versions
5. Insucient working time to implement changes in practice

4
Table 1. (Continued)
Research Aim Country Research population Measurement tool Environment Results/Outcome
Sari et al., 2012
Descriptive and
Synchronous
Study
Evaluation of barriers in the use of
research in nursing practice
Turkey 718 nurses Barriers to Research
Utilization Scale
3 hospitals 1. e participants stated that the top ve barriers
were inadequate facilities, lack of relevant bibliography
concentrated in one place, insucient knowledge of research,
lack of collaboration by doctors in the implementation of
research ndings, and lack of time for reading the surveys
Tan et al., 2012
Synchronous
Research
Identifying barriers in the
implementation of research ndings in
clinical practice
Turkey 1,094 nurses Barriers Scale 13 hospitals 1. e reported top ve barriers in the use of the research are:
a) Nurses’ inability to apply new ideas (45.4%)
b) Nurses’ lack of power to change practice (32.4%)
c) Nurses’ lack of time to retrieve and read surveys (30.3%)
d) Lack of cooperation on behalf of the doctors (29.4%)
e) Lack of support for the implementation by the rest of sta
(28.7%)
Wang et al., 2013
Synchronous
Research
Investigating the factors that aect
nurses in exploiting research in
practice
China 590 nurses e Barriers Scale,
Facilitators Scale
3 tertiary care
hospitals
1. e three more signicant barriers were identied as
lack of power (15.7%), lack of time (13.4%), and inability to
understand English-language research (15.0%)
2. e participants identied additional barriers, such as
patient reluctance to exploit research (3.64%), lack of funding
(2.88%), and lack of legal protection from clinical risk of
using research in practice (1.0 %)
Ammouri
et al., 2014
Quantitative
Research
(Descriptive,
Synchronous,
Correlation
Research)
Description of attitude, knowledge,
nursing practice, and perceived barriers
to EBP
Oman 414 nurses Evidence-Based Practice
Questionnaire and
Developing Evidence-
based Practice
Questionnaire (DEBPQ).
4
governmental
hospitals in
Muscat region
1. e major obstacles the participants have reported in the
implementation of the TEN were diculty of nding research
reports, inadequate time to nd research reports, diculty
in assessing the quality of research articles and reports,
diculty in determining the impact of research on practice,
and diculty in understanding research
Farokhzadian
et al., 2015
Quantitative
Research
(Prevalence
Study)
Investigation of nurses' attitudes
towards EBP and factors inuencing
the application of EBP
Iran 182 nurses Questionnaire (Majid et
al., 2011)
Four Medical
Hospital
Universities
in Kerman
e major barriers to the application of EBP were diculty in
assessing the quality of research work and reports, diculty
in identifying the applicability of research evidence, inability
to implement research recommendations in clinical practice,
and inability to correctly interpret the results of research
studies
Mutisya et al.,
2015
Assessment of the use of research by
nurses and factors aecting it
Kenya 534 nurses Barriers to Research
Utilization Scale
National
Hospital of
Kenya
1. Nurses stated that the biggest barriers to the use of
research were that surveys were not readily available (68.7%),
that there are unclear eects on practice (66.5%), inadequate
facilities for implementation (66.4%), inadequate power
(65%), and delayed publication of surveys (63.7%)
Zhou et al., 2015
Quantitative
Research
Investigating the use of research
among nurses
China 648 registered nurses Barriers Scale 4 educational
hospitals
1. e most signicant reported barriers were nurses’ lack
of time to apply new ideas and to change their practice,
and nurses’ isolation from colleagues who know about the
research
2. From there on, the following were also declared as barriers:
the great amount of information that is available, lack of time
to nd and read research at work, and the conviction of the
non-relevance of research in the nursing practice
Pitsillidou et al. / KONTAKT

5
Discussion
is review’s results showed that the implementation of EBP
is not easy, and that a multitude of factors, such as organiza-
tional barriers aect the application of research ndings. is
review revealed lack of time as one of the greatest barriers to
the application of research ndings in clinical practice. Stud-
ies that were excluded from this review because their samples
consisted of populations other than those required for this
study (e.g. primary care nurses, nursing students, or other
health professionals) also found the same results. Studies have
reported that these professionals do not have enough time to
search for and read research papers and reports (Atkinson et
al., 2008; Breimaier et al., 2011; Chau et al., 2008; Koehn and
Lehman, 2008; Mehrdad et al., 2008; O’Connor and Pettigrew,
2009). e review by Sadoughi et al. (2017) of studies of nurses
also found that lack of sucient time was the most frequently
mentioned barrier in 86% of the studies. Although a barrier,
lack of time might also reect lack of interest, lack of need for
new knowledge, or lack of knowledge. Nurses might wish to
avoid additional responsibilities or tasks, such as the process
of exploiting research ndings (Ozdemir and Akdemir, 2009).
Lack of power to change nursing practice, which emerged
as a barrier in this review, has been identied as a major bar-
rier in other reviews (Al Ghabeesh, 2015; Heydari and Zeydi,
2014). Lack of power might be related to the prevailing hier-
archical structure of modern hospitals, as directors and phy-
sicians have power roles, whereas nurses appear to be execu-
tive bodies, thus, undermining their role (Yava et al., 2009).
Similarly, inadequate facilities for the application of EBP has
also been reported as a barrier, not only by nurses but also
by other health professionals in studies conducted in many
countries (China, Nepal, Ireland, Bahrain, Turkey and Spain)
(Buhaid et al., 2014; Chien et al., 2013; Mehrdad et al., 2008;
Moreno-Casbas et al., 2011; Srijana et al., 2016; Uysal et al.,
2010). A lack of essential equipment and facilities leads to
limited use of research ndings. Moreover, the economy of a
country plays a major role in this barrier, as nurses from more
developed countries, such as Norway and the US did not share
the same opinions (Brown et al., 2009; 2010; Dalheim et al.,
2012). Many nurses also reported an inability to assess the
quality of research reports, which is probably due to their low
levels of research knowledge (Linton and Prasun, 2013).
Agreement with regard to nurses’ lack of time to imple-
ment new ideas and changes in practice was found in this re-
view. In another review study (Athanasakis, 2013), 23 of the
37 investigations classied insucient time to implement new
ideas as one of the top ve barriers. Finally, a signicant obsta-
cle was that published research was available only in English.
Diculty reading English journals can cause many misunder-
standings in the application of EBP in nursing (Wang et al.,
2013).
Conclusions
In summary, the ndings of this review showed that the same
top barriers were classied similarly by nurses in dierent
countries despite their cultural dierences. Furthermore, the
ndings suggest that lack of time to access and read research
is the most important factor in the inability to use research
ndings in practice, and consequently, in the adoption of EBP
by nurses. e reasons for the lack of time to engage in these
activities are not clear and warrant further investigation. e
reasons may concern issues, such as time management, role
overload, or priorities.
According to the international literature and contrary to
expectations, research utilization in nursing practice remains
limited, despite the positive attitudes which nurses present.
Recent literature has reported signicant gaps between re-
search and nursing practice. e adoption of EBP is a relatively
new approach, which has benecial eects on health and on
the healthcare system (Leach et al., 2016; Orta et al., 2016;
Saunders and Vehviläinen-Julkunen, 2015; Saunders et al.,
2016), but it requires proper guidance and education. e
knowledge of the barriers will help the health system and poli-
cy makers to address these and to provide a positive culture to
the EBP. In any case, organizational strategies must be in place
to encourage and support nurses at all stages of the nursing
process to base their practice on research evidence.
Acknowledgements
is study is part of the researcher’s thesis at the Nursing De-
partment of Nicosia University, Cyprus. e author is grateful
to the research team for its help in writing this systematic re-
view.
Funding
is systematic review was not funded.
Ethical approval
is study does not require approval from the National Bioeth-
ics Committee of Cyprus.
Conflict of interests
e authors have no conict of interests to report.
Pitsillidou et al. / KONTAKT

6
Bariéry implementace ošetřovatelství založeného na důkazech zdravotními sestrami do praxe
Souhrn
Cíl: Cílem této přehledové studie bylo prozkoumat bariéry, které brání zdravotním sestrám ve vyhodnocení a aplikování poznatků
získaných vědeckým výzkumem do jejich ošetřovatelské praxe.
Úvod: Ošetřovatelství založené na důkazech je v odborné literatuře relativně novým jevem a přináší zajímavé výsledky. Je žádoucí
provést výzkum faktorů, které ovlivňují přijetí těchto postupů do praxe, a zejména zjistit, jak jsou empirické poznatky do ošetřo-
vatelské praxe implementovány.
Metodika: Systematická přehledová studie, při které byly s pomocí databází jako PubMed, CINAHL, Health Source: Nursing/
Academic Edition a MEDLINE prohledány vědecké články publikované v letech 2008 až 2017. Celkem vyhovělo daným kritériím
14publikací, které byly následně zařazeny do této studie, jež byla provedena v souladu s pokyny PRISMA.
Výsledky: Hlavní překážkou v implementaci ošetřovatelství založeného na důkazech do praxe byl nedostatek času, který zdravotní
sestry mají na vyhledávání a čtení odborných článků. Kromě nedostatku času se v publikacích opakovaly i mnohé další faktory, jež
ovlivňovaly rozdíly mezi zdravotními sestrami v přejímání vědeckých poznatků do jejich ošetřovatelské praxe.
Závěr: Existuje významný rozdíl mezi vědeckými poznatky a ošetřovatelskou praxí. Identikace faktorů by mohla být základem ke
stanovení strategií při využívání principů ošetřovatelství založeného na důkazech.
Klíčová slova: aplikace výzkumu; bariéry; nemocnice; ošetřovatelství založené na důkazech; zdravotnictví
References
1. Al Ghabeesh SH (2015). Barriers and suggested facilitators
to the implementation of best practice: an integrative
review. Open Journal of Nursing 5(1): 77–87. DOI: 10.4236/
ojn.2015.51009.
2. Ammouri AA, Raddaha AA, Dsouza P, Geethakrishnan R,
Noronha JA, Obeidat AA, Shakman L (2014). Evidence-based
practice: knowledge, attitudes, practice and perceived barriers
among nurses in Oman. Sultan Qaboos Univ Med J 14(4):
e537–545. PMID: 25364558.
3. Athanasakis E (2013). Nurses’ research behavior and barriers to
research utilization into clinical nursing practice: a closer look.
International Journal of Caring Sciences 6(1): 16–28.
4. Atkinson M, Turkel M, Cashy J (2008). Overcoming barriers
to research in a Magnet community hospital. J Nurs Care Qual
23(4): 362–368. DOI: 10.1097/01.NCQ.0000336675.48466.37.
5. Breimaier HE, Halfens RJ, Lohrmann C (2011). Nurses’
wishes, knowledge, attitudes and perceived barriers on
implementing research findings into practice among graduate
nurses in Austria. J Clinic Nurs 20(11–12): 1744–1756.
DOI:10.1111/j.1365-2702.2010.03491.x.
6. Brown CE, Eco L, Kim SC, Wickline MA, Rose B, KlimpelK,
Glaser D (2010). Multi-institutional study of barriers to
research utilisation and evidence-based practice among
hospital nurses. J Clinic Nurs 19(13–14): 1944–1951.
DOI:10.1111/j.1365-2702.2009.03184.x.
7. Brown CE, Wickline MA, Eco L, Glaser D (2009). Nursing
practice, knowledge, attitudes and perceived barriers to
evidence-based practice at an academic medical center.
J Advanced Nurs 65(2): 371–381. DOI: 10.1111/j.1365-
2648.2008.04878.x.
8. Buhaid N, Lau R, O’Connor M (2014). A survey of nurses’
perceived barriers to research utilization in Bahrain in
comparison to other countries. Middle East J Nurs 8(2): 3–9.
DOI: 10.5742/MEN.2014.92475.
9. Canadian Nurses Association (2010). Position Statement:
Evidence Informed Decision-making and Nursing Practice.
Ottawa: Author.
10. Chau JP, Lopez V, ompson DR (2008). A survey of Hong Kong
nurses’ perceptions of barriers to and facilitators of research
utilization. Res Nurs Health 31(6): 640–649. DOI: 10.1002/
nur.20289.
11. Chien WT, Bai Q, Wong WK, Wang H, Lu X (2013). Nurses’
perceived barriers to and facilitators of research utilization
in mainland china: a cross-sectional survey. Open Nurs J 7:
96–106. DOI: 10.2174/1874434601307010096.
12. Dalheim A, Harthug S, Nilsen RM, Nortvedt MW (2012).
Factors inuencing the development of evidence-based practice
among nurses: a self-report survey. BMC Health Serv Res
24(12): 367. DOI: 10.1186/1472-6963-12-367.
13. Duncombe DC (2018). A multi-institutional study of the
perceived barriers and facilitators to implementing evidence-
based practice. J Clin Nurs 27(5–6): 1216–1226. DOI: 10.1111/
jocn.14168.
14. Farokhzadian J, Khajouei R, Ahmadian L (2015). Evaluating
factors associated with implementing evidence-based practice
in nursing. J Eval Clin Pract 21: 1107–1113. DOI: 10.1111/
jep.12480.
15. Foo S, Majid S, Mokhtar IA, Zhang X, Luyt B, Chang YK,
engYL (2011). Nurses’ perception of evidence-based practice
at the National University Hospital of Singapore. J Contin
Educ Nurs 42(11): 522–528. DOI: 10.3928/00220124-
20110516-04.
16. Friesen-Storms JH, Moser A, Van der Loo S, Beurskens AJ,
Bours GJ (2015). Systematic implementation of evidence-based
practice in a clinical nursing setting: a participatory action
research project. J Clin Nurs 24(1–2): 57–68. DOI: 10.1111/
jocn.12697.
17. Funk SG, Champagne MT, Wiese RA, Tornquist EM (1991).
Barriers: the barriers to research utilization scale. Appl Nurs Res
4(1): 39–45. DOI: 10.1016/s0897-1897(05)80052-7.
18. Gerrish K, Ashworth P, Lacey A, Bailey J (2008). Developing
evidence-based practice: experiences of senior and junior
clinical nurses. J Adv Nurs 62(1): 62–73. DOI: 10.1111/j.1365-
2648.2007.04579.x.
19. Giord W, Zhang Q, Chen S, Davies B, Xie R, Wen S, Harvey G
(2018). When east meets west: a qualitative study of barriers
and facilitators to evidence-based practice in Hunan China.
BMC Nursing 17: 26. DOI: 10.1186/s12912-018-0295-x.
20. Heydari A, Zeydi AE (2014). Barriers to and facilitators of
research utilization among Iranian nurses: a literature review.
JCaring Sci 3(4): 265–275. DOI: 10.5681/jcs.2014.029.
21. Kiessling A, Lewitt M, Henriksson P (2011). Case-based training
of evidence-based clinical practice in primary care and decreased
mortality in patients with coronary heart disease. Ann Fam Med
9(3): 211–218. DOI: 10.1370/afm.1248.
Pitsillidou et al. / KONTAKT

7
22. Koehn ML, Lehman K (2008). Nurses perceptions of
evidence based nursing practice. J Adv Nurs 62: 209–215.
DOI:10.1111/j.1365-2648.2007.04589.x.
23. Lau R, Stevenson F, Ong BN, Dziedzic KT, Treweek S, EldridgeS,
et al. (2016). Achieving change in primary care – causes of
the evidence to practice gap: systematic reviews of reviews.
Implement Sci 11: 40. DOI: 10.1186/s13012-016-0396-4.
24. Leach MJ, Hofmeyer A, Bobridge A (2016). e impact of
research education on student nurse attitude, skill and uptake
of evidence-based practice: a descriptive longitudinal survey.
JClin Nurs 25(1–2): 194–203. DOI: 10.1111/jocn.13103.
25. Linton MJ, Prasun MA (2013). Evidence-based practice:
collaboration between education and nursing management.
J Nurs Manag 21(1): 5–16. DOI: 10.1111/j.1365-
2834.2012.01440.x.
26. Majid S, Foo S, Luyt B, Zhang X, eng Y, Chang Y, Mokhtar AI
(2011). Adopting evidence-based practice in clinical decision
making: nurses’ perceptions, knowledge, and barriers. J Med
Libr Assoc 99(3): 229–236. DOI: 10.3163/1536-5050.99.3.010.
27. Mehrdad N, Salsali M, Kazemnejad A (2008). e spectrum
of barriers to and facilitators of research utilization in Iranian
nursing. J Clin Nurs 17(16): 2194–2202. DOI: 10.1111/j.1365-
2702.2007.02040.x.
28. Melnyk BM, Fineout-Overholt E, Giggleman M, Cruz R (2010).
Correlates among cognitive beliefs, EBP implementation,
organizational culture, cohesion and job satisfaction in
evidence-based practice mentors from a community hospital
system. Nurs Outlook 58(6): 301–308. DOI: 10.1016/j.
outlook.2010.06.002.
29. Moher D, Shamseer L, Clarke M, Ghersi DL, Liberati A,
Petticrew M, et al. (2015). Preferred reporting items for
systematic review and meta-analysis protocols (PRISMA-P)
2015 statement. Syst Rev 4(1). DOI: 10.1186/2046-4053-4-1.
30. Moreno-Casbas T, Fuentelsaz-Gallego C, Gil de Miguel A,
Gonzalez-Maria E, Clarke SP (2011). Spanish nurses’ attitudes
towards research and perceived barriers and facilitators
of research utilisation: a comparative survey of nurses
with and without experience as principal investigators.
JClin Nurs 20(13–14): 1936–1947. DOI: 10.1111/j.1365-
2702.2010.03656.x.
31. Mutisya AK, Karani AK, Kigondu C (2015). Research utilization
among nurses at a teaching hospital in Kenya. J Caring Sci 4(2):
95–104. DOI: 10.15171/jcs.2015.010.
32. O’Connor S, Pettigrew CM (2009). e barriers perceived to
prevent the successful implementation of evidence-based
practice by speech and language therapists. Int J Lang Commun
Disord 44(6): 1018–1035. DOI: 10.1080/13682820802585967.
33. Orta R, Messmer PR, Valdes GR, Turkel M, Fields SD, WeiCC
(2016). Knowledge and Competency of Nursing Faculty
Regarding Evidence-Based Practice. J Contin Educ Nurs 47(9):
409–419. DOI: 10.3928/00220124-20160817-08.
34. Ozdemir L, Akdemir N (2009). Turkish nurses’ utilization
of research evidence in clinical practice and inuencing
factors. Int Nurs Rev 56: 319–325. DOI: 10.1111/j.1466-
7657.2009.00707.x.
35. Sadoughi F, Azadi T, Azadi T (2017). Barriers to using electronic
evidence based literature in nursing practice: a systematised
review. Health Info Libr J 34: 187–199. DOI: 10.1111/
hir.12186.
36. Sari D, Turgay AS, Genc RE, Bozkurt OD (2012). Research
activities and perceptions of barriers to research utilization
among Turkish Nurses. J Contin Educ Nurs 43(6): 251–258.
DOI: 10.3928/00220124-20111115-05.
37. Saunders H, Vehviläinen-Julkunen K (2015). e state
of readiness for evidence-based practice among nurses:
an integrative review. Int J Nurs Stud 56: 128–140.
DOI:10.1016/j.ijnurstu.2015.10.018.
38. Saunders H, Gallagher-Ford L, Kvist T, Vehviläinen-JulkunenK
(2019). Practicing Healthcare Professionals’ Evidence-Based
Practice Competencies: An Overview of Systematic Reviews.
Worldviews Evid Based Nurs 16(3): 176–185. DOI: 10.1111/
wvn.12363.
39. Saunders H, Stevens KR, Vehviläinen-Julkunen K. (2016).
Nurses’ readiness for evidence-based practice at Finnish
university hospitals: a national survey. J Adv Nurs 72(8):
1863–1874. DOI: 10.1111/jan.12963.
40. Shayan SJ, Kiwanuka F, Nakaye Z (2019). Barriers Associated
With Evidence-Based Practice Among Nurses in Low- and
Middle-Income Countries: A Systematic Review. Worldviews
Evid Based Nurs 16(1): 12–20. DOI: 10.1111/wvn.12337.
41. Srijana KC, Subramaniam PR, Paudel S (2016). Barriers and
facilitators of utilizing research among nurses in Nepal.
JContin Educ Nurs 47(4): 171–179. DOI: 10.3928/00220124-
20160322-07.
42. Stokke K, Olsen NR, Espehaug B, Nortvedt MW (2014).
Evidence based practice beliefs and implementation
among nurses: a cross-sectional study. BMC Nurs 13(1): 8.
DOI:10.1186/1472-6955-13-8.
43. Tan M, Sahin ZA, Özdemir FK (2012). Barriers of research
utilization from the perspective of nurses in Eastern
Turkey. Nurs Outlook 60(1): 44–50. DOI: 10.1016/j.
outlook.2011.07.002.
44. orsteinsson HS (2013). Icelandic nurses’ beliefs, skills, and
resources associated with evidence-based practice and related
factors: a national survey. Worldviews Evid Based Nurs 10(2):
116–126. DOI: 10.1111/j.1741-6787.2012.00260.x.
45. orsteinsson HS, Sveinsdóttir H (2014). Readiness for and
predictors of evidence-based practice of acute-care nurses:
across-sectional postal survey. Scand J Caring Sci 28(3): 572
–581. DOI: 10.1111/scs.12083.
46. Upton D, Upton P (2006). Development of an evidence-based
practice questionnaire for nurses. J Adv Nurs 54(4): 454–458.
DOI: 10.1111/j.1365-2648.2006.03739.x.
47. Uysal A, Temel AB, Ardahan M, Ozkahraman S (2010).
Barriers to research utilisation among nurses in Turkey.
JClin Nurs 19(23–24): 3443–3452. DOI: 10.1111/j.1365-
2702.2010.03318.x.
48. Veeramah V (2016). e use of evidenced-based information
by nurses and midwives to inform practice. J Clin Nurs 25:
340–350. DOI: 10.1111/jocn.13054.
49. Wang LP, Jiang XL, Wang L, Wang GR, Bai YJ (2013). Barriers
to and facilitators of research utilization: a survey of registered
nurses in China. PLOS One 8(11): e81908. DOI: 10.1371/
journal.pone.0081908.
50. World Health Organization (2010). A Global Survey Monitoring
Progress in Nursing and Midwifery. Geneva: Health Professions
Networks Nursing & Midwifery Human Resources for Health.
51. Yava A, Tosun N, Cicek H, Yavan T, Terakye G, HatipogluS
(2009). Nurses’ perceptions of the barriers to and the
facilitators of research utilization in Turkey. Appl Nurs Res
22(3): 166–175. DOI: 10.1016/j.apnr.2007.11.003.
52. Zhou F, Maier M, Hao Y, Tang L, Guo H, Liu H, Liu Y (2015).
Barriers to research utilization among registered nurses in
traditional Chinese medicine hospitals: a cross-sectional survey
in China. Evidence Based Complementary and Alternative
Medicine, 2015: 1–8. DOI: 10.1155/2015/475340.
Pitsillidou et al. / KONTAKT