American Journal of Nursing Science

2020; 9(1): 35-42

http://www.sciencepublishinggroup.com/j/ajns
doi: 10.11648/j.ajns.20200901.16
ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online)

Barriers of Implementing Evidence-Based Practice in

Nursing Profession: A Literature Review
Munirah Alatawi*, Eman Aljuhani, Fatimah Alsufiany, Kawakeb Aleid, Rehab Rawah,
Sara Aljanabi, Maram Banakhar
Faculty of Nursing, King Abdulaziz University, Jeddah City, Saudi Arabia

Email address:
*
Corresponding author

To cite this article:

Munirah Alatawi, Eman Aljuhani, Fatimah Alsufiany, Kawakeb Aleid, Rehab Rawah, Sara Aljanabi, Maram Banakhar. Barriers of
Implementing Evidence-Based Practice in Nursing Profession: A Literature Review. American Journal of Nursing Science.
Vol. 9, No. 1, 2020, pp. 35-42. doi: 10.11648/j.ajns.20200901.16

Received: January 5, 2020; Accepted: January 18, 2020; Published: January 31, 2020

Abstract: Background: Evidence-based practice is important in improving the overall quality of patient care, enhance
nursing practice and increase the confidence in decision-making. Evidence-based practice is a technique used in solving
clinical issues regarding patient care by integrating well-designed evidence with patient preferences, patient assessments, and
health professionals. This review aims to explore barriers that confront nursing in the implementation of evidence-based
practice. Consequently, by determining some of the barriers to the implementation of EBP among nurses, health care systems
can form solutions that allow the health centers to avoid such issues and execute the approach among health care providers.
Methods: peer review was undertaken following a literature search in the databases involved CINAHL, MEDLINE and
EBSCO Web of Science databases. Included studies were from October 2018 to December 2018, English language and peer-
reviewed studies that aimed to explore the organizational and individual barriers within the healthcare setting. The quality
appraisal tool was used to appraise all the included studies. Results: A total of 12 studies were included. Six studies were
quantitative, five studies were qualitative, and one study used mixed methods. Four organizational barriers to implementing
Evidence-based practice among nurses were found by reviewing the literature which is ("lack of support and supervision",
"lack of training" and "education", "limited resources” and “time restriction”). While, four main themes were considering as an
individual barrier to implementing Evidence-based practice among nurses: ("lack of nurses' knowledge", "skills and awareness
regarding use the Evidence-based practice", "lack of professional characteristic", "nurses' attitude and experience in using" and
"language barrier in using or implementing Evidence-based practice"). Conclusions and implications for future practice:
Nursing administrators and educators have the main role to facilitate evidence-based practice implementation among nurses,
therefore; the findings of this review can help to overcome the identified barriers. Training and education are important to
enhance the knowledge and skills of nurses to use evidence-based practice. Time management, providing the required
resources and adequate supervision can facilitate the implementation of evidence-based practice which positively influences
the quality of care. For further research, it is very fruitful to investigate the common barriers of EBP in one specific culture
such as the middle eastern culture. Furthermore, future research may focus on barriers of implementing EBP related to the
patients and their families.
Keywords: Implementation, EBP, Barrier, Obstacle, and Challenge

assessments, and health professionals’ expertise leading to

1. Introduction lower health costs, better patient outcomes and safer care [1].
Evidence-based practice (EBP) is a technique used in Furthermore, this approach has been promoted as a method
solving problems regarding patient care by integrating well- for patients to receive the best services [2]. Nowadays, the
designed evidence with the patient preferences, patient health care system faces the challenge of providing consistent
and high-quality services. If it is well implemented and
36 Munirah Alatawi et al.: Barriers of Implementing Evidence-Based Practice in Nursing Profession: A Literature Review

utilized in health care facilities, EBP helps in improving the position to plan for better utilization of EBP among all health
overall care for patients [1]. care providers in health facilities.
Four major steps are followed in implementing EBP to
solve a clinical problem as well as to assist the healthcare 2. Methods of the Review
professionals in decision making. Firstly, healthcare
professionals need to cultivate a spirit of inquiry and develop 2.1. Search Strategy
a clear clinical question regarding the patient's issue [3].
After formulating the clinical questions, nurses need to Two steps of the search strategy were included in this
search in the literature for clinically relevant articles that review. The first step was an initial search of the database to
explain the problem the patient might be experienced [2]. If search keywords (implementation, adoption, compliance,
the nurses are successful in finding clinically relevant EBP, nurses, barrier, obstacle, and challenge). The second
articles, they need to evaluate the included studies to step, an extensive search in CINAHL, EBSCO, and
determine how useful and valid they are. It is important to MIDLAND database. The keyword used in the search was
evaluate the quality of the included articles because some of designed to reflect the subject heading (MeSH) terms,
the procedures or tests that may have been discussed keywords and phrases from the selected databases related to
regarding patient care may be outdated or irrelevant. Finally, the review question. The search for keywords connected by
after conducting an evaluation, the nurses can implement and using the boolean technique as AND, OR. For example;
disseminate the findings that they found useful in their (AND barriers OR obstacle OR challenge).
clinical practice [2]. 2.2. Inclusion and Exclusion Criteria
Nurses are often placed in a convenient position to
enhance the quality of health care services that are based on The inclusion criteria were all qualitative or quantitative
knowledge and research [4]. Several advantages were found studies that explore, describe, and measure barriers that affect
in applying EBP in the provision of health care services. EBP implementation of EBP among nurses, studies conducted
ensures that health professionals are delivering patient care among registered nurses, any study conducted in period
that is innovative and, thus, guaranteeing better outcomes for between 2013 to 2018 about search title ‘barrier of evidence-
patients [4]. Evidence-based practice also contributes to the based practice implementation in nursing', all peer-reviewed
science of nursing and increases the confidence in decision- studies published in English language. Exclusion criteria
making, resulting in ideal outcomes [4]. Finally, EBP incorporate any study conducted among other healthcare
maintains certain health practices relevant and current [4]. practitioners such as a physician or in non-healthcare
In the health care system, nurses make up the greatest contexts.
percentage of health care providers, meaning that their role in
the promotion of health care and delivery of quality services 2.3. Assessment of Methodological Quality
is massive. EBP has become an important subject in nursing After the search in the literature, all the included studies
and is being integrated into daily practices because it selected were examined regarding the quality of study
influences the capabilities, responsibility and professional design. Hawker, Payne, Kerr, Hardy, and Powell (2002)
development of nurses [5]. Nurses known for practicing critical appraisal tool was used to appraise all the included
based on scientific evidence make better decisions studies.
concerning the delivery of services and care. However, the The tool consists of nine items to evaluate the following
approach is not being consistently utilized despite the greater (Abstract and title, Introduction and aim, Method and data,
professional satisfaction it is known to cause [6]. The Sampling, Data analysis, Ethics and bias, Results,
development of research strategies has caused a change in the Transferability or generalizability, and Implications and
healthcare setting. Both experienced and new nurses usefulness) measured with four-point Likert scale, ranging
experience few difficulties to adjust to the new environment from (4 good, 3 fair, 2 poor and 1 very poor). An overall
of evidence-based practices from class practices [5]. studies quality score can be calculated by summing the nine
However, several changes, on how nurses provide quality items score. A score ranging from 9 – 18 is described as a
care to their patients, need to be made to ensure that EBP is poor-quality study, 18 – 27 as fair quality study and 28 – 36
correctly implemented into the healthcare system [5]. as good quality study.
Several barriers were found to hinder the implementation By critiquing the included studies, the results revealed that
of EBP among nurses. Evaluations conducted have revealed all the studies are considered as high-quality studies. Eleven
that both organizational and human factors are linked with of the included studies were rating as good quality studies
barriers affecting the implementation of EBP [7]. while only one study has fair scoring due to the limited
Consequently, by determining some of the barriers to the description of the ethical issues which have been encountered
implementation of EBP among nurses, health care systems by the researchers. The critique scores of all included studies
can form solutions that allow the health centers to avoid such are described in (table 1).
issues and execute the approach among health care providers.
By doing so, policymakers and managers will be in a better
 American Journal of Nursing Science 2020; 9(1): 35-42 37

Figure 1. PRISMA flow chart.

Table 1. The critique scores of included studies.

Method Introduction Data

Authors Abstract Sampling
and data and aims analysis
Elham Azmoude 4 4 4 4 4
Mohammad Khammarnia 3 4 4 4 4
Bridget Johnston, Carol Coole, Melanie Narayansamy, Ruth Feakes, Gillian Whitworth, Tracy
3 3 4 3 4
Tyrrell, and Beth Hardy
Wendy Gifford, Qing Zhang, Shaolin Chen, Barbara Davies, Rihua Xie, Shi-Wu Wen, and
4 4 4 3 4
Gillian Harvey
Rebecca R. DeBruyn, Sandra Catalina Ochoa-Marín, and Sonia Semenic 4 4 4 3 3
Srijana KC, Prithwi Raj Subramaniam, and Sarita Paudel. 4 4 4 4 3
Mahmoud ALKalaldeh, Roger Watson and Mark Hayter 3 4 4 4 4
Aste Renolen and Esther hjalmhult 4 4 4 4 4
Souraya Sidani, Milisa Manojlovich, Diane Doran, Mary Fox, Christine L. Covell, Helen 3
4 4 4 4
Kelly, Lianne Jeffs, and Mary McAllister
Bowers, Candice Andrea 3 4 4 4 4
Jamileh Farokhzadian, Reza Khajouei, and Leila Ahmadian. 3 4 4 4 4
P Jordan, C Bowers, M Cur; D Morton. 4 4 2 4 4
38 Munirah Alatawi et al.: Barriers of Implementing Evidence-Based Practice in Nursing Profession: A Literature Review

Table 1. Continued.

Ethics Findings Transferability / Implications

Authors Total
and bias / results generalisability and usefulness
Elham Azmoude 4 4 4 4 36 good
Mohammad Khammarnia 1 4 4 4 32 fair
Bridget Johnston, Carol Coole, Melanie Narayansamy, Ruth Feakes, Gillian
2 4 3 4 26 Fair
Whitworth, Tracy Tyrrell, and Beth Hardy
Wendy Gifford, Qing Zhang, Shaolin Chen, Barbara Davies, Rihua Xie, Shi-Wu
4 4 3 4 34 Good
Wen, and Gillian Harvey
Rebecca R. DeBruyn, Sandra Catalina Ochoa-Marín, and Sonia Semenic 2 4 3 3 30 Good
Srijana KC, Prithwi Raj Subramaniam, and Sarita Paudel. 1 4 3 3 30 Good
Mahmoud ALKalaldeh, Roger Watson and Mark Hayter 3 4 3 3 32 good
Aste Renolen and Esther hjalmhult 4 4 4 3 35 good
Souraya Sidani, Milisa Manojlovich, Diane Doran, Mary Fox, Christine L. Covell,
4 4 3 3 33 good
Helen Kelly, Lianne Jeffs, and Mary McAllister
Bowers, Candice Andrea 4 4 3 4 34 good
Jamileh Farokhzadian, Reza Khajouei, and Leila Ahmadian. 2 4 3 3 31 good
P Jordan, C Bowers, M Cur; D Morton. 4 4 3 3 32 good

the lack of knowledge as a common barrier to implementing

3. Results EBP [17]. Recently, Gifford et al (2018) conducted a
qualitative study using semi-structured interviews to explore
The total number of included studies is 12 according to the barriers and facilitators to evidence-based practice in Hunan
PRISMA flow chart. (figure 1) province in a less developed region in China. Less than half
Themes are identified by using the data extraction table. of the nurses 46% were aware of the concept of EBP, and
The main themes founded are individual barriers and only two of the six participants from the community had
organizational barriers. heard of it [15]. Similar results were demonstrated by Kc et
al (2016) who conducted a descriptive, cross-sectional study
3.1. Individual barriers aimed to determine the perceived barriers and facilitators of
In the literature, four main themes were categorized as Nepalese nurses in utilizing research in the workplace.
individual barriers in implementing EBP among nurses: lack Results showed that nurses’ isolation from knowledgeable
of nurses’ knowledge, skills and awareness regarding the use colleagues to discuss research (47.6%), minimal benefits of
of EBP, lack of professional characteristics, nurses' attitude changing nursing practice (40.2%), and nurses being
and experience in using EBP and language barriers in using incapable of evaluating research quality (37.6%) were rated
EBP. These themes will be explained in detail in the as barriers to research utilization [14].
following subsections. Bowers (2014) carried out a quantitative, explorative,
descriptive and contextual research design aimed to identify
3.1.1. Lack of Professional Characteristics barriers to the implementation of evidence-based practices in
Lack of professional characteristics was demonstrated as a critical care unit. Results reflected that nurses were not
an individual barrier to implement EBP in nursing within two completely familiar with evidence-based practices and nurses
studies in the literature [8, 9]. In the UK, Johnston et al had difficulty to locate by using search engines with a lack of
(2016) conducted a qualitative study to identify barriers and quality control such as Google and Wikipedia, which contain
facilitators to community nurses implementing research into information that lacks validity or reliability [10]. Similarly,
practice. The findings showed that nurses had little choice Jordan et al (2016) conducted a quantitative, exploratory
regarding the used EBP tools and only expected to use those study aimed to determine the individual and organizational
available on the computer system [8]. Similarly, in Colombia, implementation barriers of EBP among nurses in a private
DeBruyn et al (2014) carried out a qualitative descriptive intensive care unit (ICU). Results showed that the degree of
study by using the semi-structured interview to identify and familiarity with EBP among nurses is 46% with incorrectly
describe the perceptions of nurses regarding the barriers of defined and understood of the EBP concept [16]. However, in
implementing EBP. The study revealed that nurses’ lack of a further qualitative study which aimed to gain more
professional autonomy was linked to evidence-based nursing knowledge about what nurses perceive as the most important
(EBN) implementation [9]. challenge in implementing evidence-based practice and to
explain how they act to face and overcome this challenge
3.1.2. Lack of Awareness, Knowledge, and Skills [12]. The authors found that the nurses had difficulty finding
A total of nine studies revealed that lack of knowledge was scientific knowledge they were willing to trust because some
found as a barrier in EBP implementation [10-18] evidence may harm the patient [12].
In Iran Khammarnia et al (2015) conducted a quantitative Likewise, Farokhzadian et al (2015), conducted a
analytical cross-sectional study aimed to determine the quantitative, cross-sectional study aimed to examine nurses'
barriers to implement EBP among nurses. The results attitudes towards EBP, their self-efficacy and training needs,
demonstrated that 54.4% of the participant nurses agreed on
 American Journal of Nursing Science 2020; 9(1): 35-42 39

as well as supporting factors and barriers for implementing language, while some nurses have a lack of readable and
EBP. The study demonstrated that the most important barrier understandable of research evidence in Chinese [15].
was difficulty in judging the quality of research papers and
reports (2.46 ± 0.92) [18]. In a further study, semi-structured 3.2. Organizational Barriers
interviews were carried out to examine Jordanian nurses’ A total of four organizational barriers were found by
perspectives on the implementation of EBP related to enteral reviewing the literature including lack of support and
nutrition, using the appropriate clinical guidelines and supervision, lack of training and education, limited resources
protocols, and on what constituted successful teamwork and time restriction.
while providing nutritional care in the ICU [11]. The findings
revealed that clinical experience is the first source of 3.2.1. Limited Organization Resources
knowledge considered for obtaining evidence [11]. However, Seven studies demonstrated that lack of resources within
university education is the second source of knowledge the healthcare organizations are barriers to implement the
despite the lack of holistic information [11]. While in a EBP [9, 10, 13, 14, 16, 17, 19]
mixed-method study that aimed to explore nurses’ perception Midwives reported inadequate facilities as an
of evidence-based interventions targeting patient-oriented organizational barrier for implementation of EBP with (mean
outcomes [13]. Results illustrated that nurses’ perceptions of = 2.64) [19]. As well as, a total of 75.3% of nurses in
evidence-based interventions have been overlooked as factors Nepalese reported that inadequate facilities for implementing
that influence uptake and implementation of these research findings are an organizational barrier to research
interventions in practice [13]. utilization [14]. The same finding was found in which
indicated that the material resources required to provide some
3.1.3. Nurses Personal Attitude and Experience interventions were not readily available [13].
A total of eight studies found that nurses' attitudes and Lack of adequate access to computers was considered by
experience as barriers to implementing EBP [10-16, 19]. 66% of nurses as an organizational barrier in implementing
A study carried out by Kc et al (2016) demonstrated that EBP [16]. In addition, a total of 49% of the nurses mentioned
the nurse is unwilling to change or try new ideas 30.5%. the availability of computers and slow or poor access to the
Additionally, nurses did not perceive research as being an research evidence in the critical care unit is a barrier to
important element of their practice [14]. Similarly, Kalaldeh implement EBP [10]. Likewise, Khammarnia et al., (2015)
et al (2014) found that nurses are poorly adhering to EBP and study results showed that 56% and 57% of nurses agreed that
their current practice was based on practice transmitted from lack of internet access at work (72.2%), workload (70.0%)
one person to another. This result is supported by Gifford et and shortage of nurse (lack of human resources) (78.3%)
al (2018) study in which most nurses had negative attitudes were the most organizational barriers to implement EBP.
and beliefs towards research. Additionally, nurses did not Furthermore, the lack of rewards in conducting nursing
have enough details about how to apply the research into research, and institutional incentives for developing research
practice [15]. Moreover, nurses reported that evidence-based skills were considered as barriers to implementing EBP [9].
practice considered a challenge, information is missing here
and difficult to be carried out and were unconfident in 3.2.2. Lack of Support and Supervision
applying it into practice [13]. Similarly, another study A total of nine studies stated that insufficient support from
showed that nurses did not rely on research and they are not managers would be a barrier to implement EBP [8-16].
comfortable with the research assessments; however, nurses Lack of knowledge, direction, support, and leadership
used their own experiences and knowledge as they believe in skills from hospital administrators in implementing EBP
the knowledge they were going to use [12]. [15]. Similarly, around 27% of nurses mentioned that nurse
Resistant to change from traditional practice to EBP managers do not support the implementation of EBP [16].
considers by 49% of professional nurses as a barrier to Additionally, a total of 91% of nurses indicated that there is
implementing EBP [10]. Similarly, 59% of nurses showed needed for an EBP mentor or champion in the ICU to
resistance to change from traditional and ritualistic practices enhance the effective implementation of EBP [16].
to EBP [16]. While in a quantitative cross-sectional study The lack of institutional administrators, head nurses, and
aimed to describe the attitude toward the application of EBP colleagues support could reduce the implementation of EBP
among midwives in maternity care, the results showed the [11]. Lack of authority to change practice was a barrier to
highest mean scores (4.18 ± 0.53) it improves patient health facilitate the implementation of EBP as reported by around
care outcomes [19]. 58% of nurses (Jordan et al., 2016). Additionally, 34% of
nurses agreed and 23% strongly agreed that the lack of
3.1.4. Language Barriers authority to change practice in the critical care unit is a
Only two studies showed that language is considered a barrier in implementing EBP [10]. Similarly, 54.2% of nurses
barrier to implement EBP [13, 15]. For example, the reported that lack of support from health team members
language barrier among patients with cognitive impairment which make Nepalese nurses restricted with insufficient
and older first-generation immigrants were highlighted by authority to change the practice of patient care [14]. Also,
nurses [13]. Moreover, the majority of nursing research there are other barriers mentioned by 71.6% nurses such as
evidence and guidelines were published in the English
40 Munirah Alatawi et al.: Barriers of Implementing Evidence-Based Practice in Nursing Profession: A Literature Review

research articles were not published fast enough, and 48.8% research skills were all organizational barriers in
of nurses mentioned that research has not been replicated implementing EBP in nursing practice. In addition, the major
[14]. perceived barrier to research utilization for nurses is lack of
Lack of support to implement EBP from the hospital time on the job to implement new ideas (60.3%)[14].
administrator and lack of visible nursing profession leaders Moreover, according to Bowers (2014) 34% of nurses agreed
were perceived as contributing factors to the low recognition that there was insufficient time to find or read research
of nursing, another barrier was a lack of institutional reports. While Farokhzadian et al (2015) study results
incentives for developing research skills, conducting nursing indicated that the least important organizational barrier in
research or implementing evidence-based practices [9]. implementing EBP was difficulty in finding time at the
Moreover, the nurses’ contracts lack protected time for nurses workplace to search for these resources.
to acquire education or research skills, or engage in research
activities [9]. 3.2.4. Lack of Training and Education
In a further study, Johnston et al (2016) illustrated that Three studies mentioned that inadequate training and
structured supervision was lacking and the main barrier was education is considered as a barrier to implementing EBP [8,
perceived to be the lengthy approvals procedure within the 10, 12].
organization, this meant that services often struggled to Johnston et al (2016) reported that lack of training could
respond to the research agenda. Nurses perceived that they be used as a barrier to implement research into practice.
had little power to introduce tools without management Although the training itself might be of an acceptable
support [8]. This result is supported by Renolen and standard, nurses did not necessarily feel confident in
Hjälmhult (2015) study which revealed that it was difficult to applying EBP [8]. While in Renolen & Hjälmhult (2015)
implement new knowledge when the particular practice was study, nurses experienced that educational opportunities to
not required or controlled by anyone and the managers at learn more about the evidence-based practice was not given
various levels largely did not check adherence to using new sufficient priority by the managers. In addition, Bowers
knowledge. Nurses felt that resources and priority of this (2014) demonstrated that around 50% of nurses agreed that
were lacking [12]. Furthermore, nurses indicate that their in-service education on EBP would promote evidence uptake.
situations with patients and their relationships with Whereas around 47% agreed that an EBP mentor was
colleagues were crucial in implementing EBP [12]. necessary in the critical care unit to perform searches and
Moreover, in Sidani et al (2016) study, nurses mentioned the disseminate that information to the rest of the staff. However,
need to collaborate with other health professionals to a total of 50% of the participants agreed that in-service
implement some of the evidence-based interventions in training would promote the understanding of, and adherence
which it considered a barrier for implementation of EBP. to, evidence-based practices [10]. While 50% of the
participants strongly agreed that best-practice guidelines
3.2.3. Lack of Time could promote evidence-based practices [10].
Lack of time considered the main barrier in the
implementation of evidence-based practice in nursing [8-19]. 4. Discussion
In Azmoude et al (2018) study, the results showed that the
nurse does not have time to read research (mean = 2.70). This review has thematically synthesized the evidence
Furthermore, in Khammarnia et al (2015) study, the results regarding the important barriers in implementing EBP among
highlighted that (83.7%) of the participant mentioned the nurses in clinical practice. In this review, a total of six
most important barrier to implement EBP is lack of time to included studies identified the barriers of implementing EBP
read the literature. While Jordan et al (2016) study results among nurses by using a quantitative cross-sectional study
indicated that nurses had insufficient time to implement the design [10, 14, 16-19]. The cross-sectional study design is
change that is required for EBP. Also, Johnston et al (2016) appropriate for describing phenomena at a fixed point [20].
stated that nurses had a lack of time to keep up to date with Although five included studies were conducted by using
research evidence and the uptake of educational qualitative research design, two studies were grounded theory
opportunities. As in another study, nurses felt they had and three studies were phenomenology designed to provide
limited time during their scheduled working hours to provide maximal explanation and additional understanding from
patient care and EBP was seen as an extra work [15]. different dimensions [8, 9, 11, 12, 15]. While only one
According to Sidani et al (2016), nurses mentioned that included study was conducted by using a mixed-method
implementing evidence-based interventions was time- research design because the researcher in quantitative design
consuming. Similarly, the study results of Kalaldeh et al come up with a nurse’s perception and their attitude toward
(2014) showed that restricted time can affect nurses' applying EBP regarding certain procedures such as
empowerment to develop and establish evidence-based acupressure, guided imagery, massage, and relaxation [13].
guidelines. Likewise, Renolen and Hjälmhult (2015) found However, the researcher used a qualitative design to clarify
that lack of time was a challenge in implementing EBP. Also, the reasons underlying nurses' responses [13].
DeBruyn et al (2014) highlighted that lack of time to read the This review revealed eight barriers that were categorized
research, to dedicate to research, and to acquire education or into individual and organizational barriers. Individual barriers
 American Journal of Nursing Science 2020; 9(1): 35-42 41

in implementing EBP among nurses incorporate lack of [4] A. Sharma et al., "Using digital health technology to better
professionalism, lack of awareness, knowledge, and skills, generate evidence and deliver evidence-based care," Journal
of the American College of Cardiology, vol. 71, no. 23, pp.
nurses’ attitude and experience and language barriers. 2680-2690, 2018.
Although the organizational barriers to implement EBP
include limitation of resources, lack of support and supervision, [5] C. Boswell and S. Cannon, Introduction to nursing research.
lack of time, lack of training and education. This finding Jones & Bartlett Learning, 2018.
highlighted the ubiquity of barriers to implement EBP among [6] B. M. Melnyk et al., "The First US Study on Nurses’
nurses and the necessity to study it to overcome them. Evidence-Based Practice Competencies Indicates Major
In this review, the time was the most common barrier Deficits That Threaten Healthcare Quality, Safety, and Patient
found in all included studies among nurses such as nurses Outcomes," Worldviews on Evidence-Based Nursing, vol. 15,
no. 1, pp. 16-25, 2018.
have no time for reading research [17, 19] or implement the
changes required by EBP [16] which is caused by having [7] L. Wallis, "Barriers to implementing evidence-based practice
staff shortage within the healthcare organizations leading to remain high for US nurses," AJN The American Journal of
an increase in the workload [11, 15-17]. Nursing, vol. 112, no. 12, p. 15, 2012.
The nurses play a pivotal role in generating clinical [8] B. Johnston et al., "Exploring the barriers to and facilitators of
questions about patient care and safety. However, nine implementing research into practice," British Journal of
studies recognized that lack of nurse’s knowledge as a barrier Community Nursing, vol. 21, no. 8, pp. 392-398, 2016, doi:
in EBP implementation, [14-16]. Consequently, nurses need 10.12968/bjcn.2016.21.8.392.
to develop essential knowledge and skills about research and [9] R. R. DeBruyn, S. C. Ochoa-Marín, and S. Semenic, "Barriers
evidence-based practice to use the best evidence to provide and facilitators to Evidence-Based Nursing in Colombia:
the healthcare required to improve healthcare and cost-saving Perspectives of nurse educators, nurse researchers and
[21]. graduate students/Barreras y facilitadores en la práctica de la
Enfermería Basada en la Evidencia en Medellín, Colombia,"
Investigación y Educación en Enfermería, vol. 32, no. 1, p. 9,
5. Conclusion 2014.

Nursing administrators and educators are responsible for [10] C. A. Bowers, "Barriers to Implementation of Evidence-based
Practices in a Critical Care Unit," Nelson Mandela
facilitating evidence-based practice implementation. Metropolitan University, 2014.
Therefore, the findings of this review assist the nursing
administrators to overcome the identified barriers. [11] M. A. Kalaldeh, R. Watson, and M. Hayter, "Jordanian
Training and education to increase the level of nursing intensive care nurses' perspectives on evidence-based practice
in nutritional care," British Journal of Nursing, vol. 23, no. 19,
knowledge and skills to use evidence-based practice, pp. 1023-1029, 2014, doi: 10.12968/bjon.2014.23.19.1023.
organizing the nursing time, support nurses with the
resources required and provide adequate supervision can [12] Å. Renolen and E. Hjälmhult, "Nurses experience of using
facilitate the implementation of evidence-based practice scientific knowledge in clinical practice: a grounded theory
study," Scandinavian Journal of Caring Sciences, vol. 29, no.
which positively influences the quality of care. For further 4, pp. 633-641, 2015, doi: 10.1111/scs.12191.
research, it is very fruitful to investigate the common barriers
of EBP in one specific culture such as the middle eastern [13] S. Sidani et al., "Nurses’ Perceptions of Interventions for the
culture. Furthermore, future research may focus on barriers Management of Patient-Oriented Outcomes: A Key Factor for
Evidence-Based Practice: Perceptions of Interventions,"
of implementing EBP related to the patients and their Worldviews on Evidence-Based Nursing, vol. 13, no. 1, pp.
families. 66-74, 2016, doi: 10.1111/wvn.12129.
[14] S. Kc, P. R. Subramaniam, and S. Paudel, "Barriers and
Facilitators of Utilizing Research Among Nurses in Nepal,"
References Journal of continuing education in nursing, vol. 47, no. 4, pp.
171-179, 2016, doi: 10.3928/00220124-20160322-07.
[1] B. M. Melnyk, L. Gallagher-Ford, L. E. Long, and E. Fineout-
Overholt, "The establishment of evidence-based practice [15] W. Gifford et al., "When east meets west: a qualitative study
competencies for practicing registered nurses and advanced of barriers and facilitators to evidence-based practice in
practice nurses in real-world clinical settings: Proficiencies to Hunan China," BMC nursing, vol. 17, no. 1, pp. 26-11, 2018,
improve healthcare quality, reliability, patient outcomes, and doi: 10.1186/s12912-018-0295-x.
costs," Worldviews on Evidence-Based Nursing, vol. 11, no. 1,
pp. 5-15, 2014. [16] P. Jordan, C. Bowers, and D. Morton, "Barriers to
implementing evidence-based practice in a private intensive
[2] S. Majid et al., "Adopting evidence-based practice in clinical care unit in the Eastern Cape," Southern African Journal of
decision making: nurses' perceptions, knowledge, and Critical Care, vol. 32, no. 2, pp. 50-54, 2016.
barriers," Journal of the Medical Library Association: JMLA,
vol. 99, no. 3, p. 229, 2011. [17] M. Khammarnia, M. Haj Mohammadi, Z. Amani, S. Rezaeian,
and F. Setoodehzadeh, "Barriers to implementation of
[3] T. W. Reader, A. Gillespie, and J. Roberts, "Patient complaints evidence based practice in zahedan teaching hospitals, iran,
in healthcare systems: a systematic review and coding 2014," Nursing research and practice, vol. 2015, pp. 357140-
taxonomy," BMJ Qual Saf, vol. 23, no. 8, pp. 678-689, 2014. 5, 2015, doi: 10.1155/2015/357140.
42 Munirah Alatawi et al.: Barriers of Implementing Evidence-Based Practice in Nursing Profession: A Literature Review

[18] J. Farokhzadian, R. Khajouei, and L. Ahmadian, "Evaluating [20] D. Polit and C. Beck, "Essentials of nursing research:
factors associated with implementing evidence-based practice Appraising evidence fornursing practice," ed: Wolters
in nursing," Journal of Evaluation in Clinical Practice, vol. Kluwer/Lippincott/Williams Wilkins Health, Philadelphia, PA,
21, no. 6, pp. 1107-1113, 2015, doi: 10.1111/jep.12480. USA, 2014.
[19] E. Azmoude et al., "Midwives’ Attitude and Barriers of [21] D. Dang and S. L. Dearholt, Johns Hopkins nursing evidence-
Evidence Based Practice in Maternity Care," Malaysian based practice: Model and guidelines. Sigma Theta Tau, 2017.
Journal of Medical Sciences, vol. 25, no. 3, pp. 120-128,
2018, doi: 10.21315/mjms2018.25.3.12.