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• Cindy Lewis, MSN, RN

Evidence-based practice is an important approach to providing the best quality care and improves patient outcomes. Research has shown that patients who receive care based on evidence from well-designed studies experience approximately 30% better outcomes.¹ However, the barriers to implementing valid research results into nursing practice are well known. Despite an accumulating body of knowledge about the effectiveness of some nursing interventions, a gap often exists between what is known and what is practiced.

The literature cites several barriers to implementing evidence-based practice, for example, demanding patient workloads, lack of knowledge regarding evidence-based practice strategies, uncertainty or skepticism that evidence-based practice will result in better patient outcomes than traditional care, lack of time and resources to search for and appraise evidence, organizational constraints such as lack of administrative support, and peer pressure to continue practices “because they have always been done this way.”² In one study in which the researchers addressed the need for evidence-based practice and the barriers, of the 752 nurses who responded, 17% indicated they never personally seek information from journal articles and 58% said they never seek information from a research report.³

Getting research into practice is not as simple as choosing an intervention and hoping for the best. Aside from determining the intervention itself, other factors include considering the characteristics of the patient, the practitioner, and the desired behavior change. Getting practitioners to start doing something new, such as routinely asking patients if they smoke, may require a different strategy than in the past. In addition, administrative, financial, and system barriers may exist and challenge the ease of adopting a new behavior. Interventions should be tailored to an individual’s stage of change. Nurses are well aware of the risks of smoking and may not require additional educational intervention, but they can be helped by a prompt or trigger within the patient’s medical history assessment. If the practitioners lack information, awareness, or skills, then strategies such as educational packets and interactive in-services might be effective.

The literature identifies that educational materials, including distributing recommendations for clinical care, clinical practice guidelines, publications, audiovisual materials, and didactic presentations, have limited effect on promoting behavior change. However, incorporating multifaceted interventions and interactive educational strategies, such as reminders (manual or computerized), implementing audits, providing ongoing feedback, discussions, and workshops, can be more consistently effective to promote behavioral change.⁴

The gap between research and practice is not merely the consequence of nurses failing to keep up to date. Changing behavior is complex, involves many systems, and is unlikely to be solved solely by educational strategies. Organizational supports and resources that encourage nurses to participate in research projects and initiatives, connect with larger networks such as through national conferences and specialty groups, gain experience with clinical appraisal and research use tools, and become involved in professional committee meetings, journal clubs, developing posters, oral presentations, and publishing can facilitate this process.

Evidence-based practice, a problem-solving approach to using best practice in making decisions about patient care, is no longer an option for staff nurses. Patient care must be based on evidence for effect optimal outcomes. Equally important as using evidence as the foundation of quality patient care is the conduct of research to fill the gaps in existing nursing literature.

Little attention has been paid to ensuring that the findings of research are implemented into routine clinical practice. It is imperative we identify and share successful strategies for implementing evidence-based practice. Sources such as nursing journals and our Journal can be ideal avenues to share research. Share with us your evidence-based practice changes. Share with us your stories on how you implemented best practice changes. We look forward to hearing from you!

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References 

1. Melnyk B, Fineout-Overholt E. Evidence-based practice in nursing and healthcare. Philadelphia: Lippincott, Williams, and Wilkins; 2005;
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2. LoBiondo-Wood G, Haber J. Nursing research: methods and critical appraisal for evidence-based practice. St. Louis: Mosby Elsevier; 2006;
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3. Pravikoff DS, Tanner AB, Pierce ST. Readiness of U.S. nurses for evidence-based practice. Am J Nurs. 2005;105:40–51
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   • MEDLINE
4. Betz C. Evidence-based practice in nursing and healthcare. Philadelphia: Lippincott, Williams and Wilkins; 2005;
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