Evidence-Based Practice: Too Little, Too Late?

Abstract

Recently an article appeared in the American Journal of Nursing (AJN) titled, "Readiness of U.S. Nurses for Evidence-Based Practice" (Pravikoff, Tanner, & Pierce, 2005). It felt like we never left the 198Os! The authors might easily have substituted the term research utilization for evidence-based practice in the article's title because it appears that little has changed in over 20 years. The article by Pravikoff, Tanner, and Pierce (2005) shares the results of a survey the authors conducted to examine "nurses' perceptions of their skills in obtaining evidence and their access to tools with which to do so" (p. 41). The survey assumed that lack of time was the primary barrier to nurses' use of an evidence-based practice (EBP) approach to practice and listed the following as the next five top-ranked barriers: * Lack of value for research in practice * Lack of understanding of organization or structure of electronic databases * Difficulty accessing research materials * Lack of computer skills * Difficulty understanding research articles. How different are these from the barriers described in earlier decades in relation to research utilization? In 1990, Levin discussed the primary factors cited in the literature as contributing to the gap between research and practice. These were: (a) the nurses' educational preparation, which could provide the skills for understanding how to access research or evidence and understanding how to read and critique research; (b) communication of research findings by researchers-that is, disseminating research findings in a way that all nursing clinicians could understand; and (c) organizational resources, which include the climate for using research (or evidence) in practice, the availability of consultation, and financial support (which includes providing nurses with time away from the bedside to engage in scholarly practice). In 1993, Feldman et al. published their article, "Bridging the Nursing Research-Practice Gap through Research Utilization," to highlight the need to overcome many of these same barriers. A year later, in 1994, Pettengill, Gillies, and Clark cited lack of time as the factor that most discouraged research utilization, no different from the recent AJN finding cited above. Also, lack of nursing staff support was cited as a discouraging factor for service nurses. This is akin to having the support staff available to cover patient assignments, giving nurses time to access and review research (evidence) related to a clinical problem. Most interesting was the perception by educators that they lacked administrative support for research utilization activities. In studies conducted over the past 2 years by Fineout-Overholt, Levin, and Melnyk (2004/2005) similar barriers to EBP as described above over three decades are still evident: lack of knowledge of how to implement the EBP process (previously the research or research utilization process); deficiency of critical appraisal skills to evaluate research (or other types of evidence); and lack of administrative or organizational support for the scholarly aspect of practice. Over the past 2 years, however, we have learned that the introduction of an EBP model for practice and the implementation of this model can be a reality. What is needed are the following facilitators: * Organizational commitment of financial resources, whether in the form of released time for nurses via coverage of direct care responsibilities or financial reimbursement for continuing education * The implementation of a mentorship model (e. …