Newman, M., Papadopoulos, I., & Sigsworth, J. (1998). Barriers to Evidence-based Practice. Clinical Effectiveness in Nursing, 2(1), 11-18.

Format: Peer-reviewed article

Type: Research — Non-experimental

Experience level of reader: Fundamental

Annotation: Study explored barriers to implementing evidence-based practices and found that: 1) evidence-based practice was a low management priority; 2) There were problems with dissemination; 3) Inadequate systems for personal and professional development; 4) Difficulties in the management of innovation; 5) Resource constraints on accessing evidence and resources.

Setting(s) to which the reported activities/findings are relevant: Community

Knowledge user(s) to whom the piece of literature may be relevant: Clinicians, Researchers

Knowledge user level addressed by the literature: Organization

This article uses the Commercial Devices and Services version of the NtK Model

• Existing hierarchical structures within organizations and between professional groups, emphasize the routine or status quo in clinical decision-making. The cultural and practice norms mean that one cannot assume a motivation to change practice; there are ill-defined and competing interpretations of clinician roles and practices; and there exists a culture focused on doing while inhibiting questioning of current practices.
  Individual interviews with key members of a clinical organization (n=24) and informal focus groups with clinical nurse and medical managers and staff (n=56).
  Occurrence of finding within the model: KTA Step 1.D, KTA Step 2.D

• Structures and cultures within organizations can be substantial barriers to the identification, acceptance and use of evidence-based practices. Organizational barriers include being a low management priority; difficulties establishing teamwork or management innovations; inadequate systems for professional development or knowledge dissemination; constraints on resources and on accessing new evidence.
  Individual interviews with key members of a clinical organization (n=24) and informal focus groups with clinical nurse and medical managers and staff (n=56).
  Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C

• Actions taken in one organization to promote evidence-based practice: Clinical effectiveness strategy drafted; new clinical board proposed; ward manager training to be reviewed; established ward action research project; course on multi-disciplinary skills for EBP; initiated strategy for communication, dissemination and management of evidence; EBP to be included in staff and management performance reviews; focus on creating culture of a learning organization.
  Individual interviews with key members of a clinical organization (n=24) and informal focus groups with clinical nurse and medical managers and staff (n=56).
  Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C

• Given the reality of organizational and professional barriers, and the reliance on routine practices, overcoming barriers to evidence-based practice requires adopting multiple strategies to facilitate and promote the use of evidence in clinical decision-making.
  Individual interviews with key members of a clinical organization (n=24) and informal focus groups with clinical nurse and medical managers and staff (n=56).
  Occurrence of finding within the model: KTA Step 1.C, KTA Step 1.D, KTA Step 2.C

• Clinical effectiveness is not a frequent consideration for managerial boards; Two-thirds of boards had no written clinical effectiveness strategy; few innovative approaches have been widely take up; few health authorities generate clinical effectiveness bulletins. (Walshe & Ham [1997])
  Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C

• There are important differences between the cultures of academics and practitioners. Theories, models, research and evidence are useful parts of the researcher's conceptual and practical tool kit, but to the practitioner they often appear irrelevant to their task. (Mulhall [1996])
  Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C

• Barriers to evidence practice include: Access to libraries; lack of knowledge about databases and related initiatives; lack of critical appraisal, change management or IT and implementation skills; research and researchers are inaccessible and intimidating; insufficient time and resources; lack of autonomy; dissemination limitations; inter-professional problems. (Mulhall [1996])
  Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C

Carrier: Two attributes are required for the pursuit and implementation of evidence-based practice within the culture of a clinical organization: 1) Motivation and 2) Competence. (Muir Gray [1997b])
Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C