American Journal of Nursing Science

2015; 4(3): 73-83

Published online April 24, 2015 (http://www.sciencepublishinggroup.com/j/ajns)
doi: 10.11648/j.ajns.20150403.15
ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online)

Assessment of Nurses’ Perceptions and Barriers on

Evidence Based Practice in Tikur Anbessa Specialized
Hospital Addis Ababa Ethiopia
G. Hadgu1, S. Almaz2, 3, S. Tsehay2
1
School of Nursing, Axum University, Axum, Ethiopia
2
School of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
3
Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Email address:
[email protected] (G. Hadgu)

To cite this article:

G. Hadgu, S. Almaz, S. Tsehay. Assessment of Nurses’ Perceptions and Barriers on Evidence Based Practice in Tikur Anbessa Specialized
Hospital Addis Ababa Ethiopia. American Journal of Nursing Science. Vol. 4, No. 3, 2015, pp. 73-83. doi: 10.11648/j.ajns.20150403.15

Abstract: Background: Historically, nurses have relied on expert’ opinions in clinical decision-making. However, these ways
of practicing may not only be outdated but unsafe. Experienced-based knowledge may be associated with biased thinking that
lead to errors. Objective: Assessment of nurses’ perceptions, level of use and barriers on Evidence Based Practice. Method: Two
hundred ten nurses were assessed through self-administer questionnaires for quantitative and fifteen nurses were also involved in
in-depth interview for qualitative. The quantitative data was analysis in SPSS version 21. The qualitative was analyzed through
open code. Results: 90% and 73.8% have good perception and positive attitude respectively. Of the total 210 121(57.6%) of
nurses were integrate EBP in their clinical practice. Only 19 (15.7%) use EBP in their clinical practice always. Knowledgeable
(AOR 3.2 95%CI 1.5-7.0); skill, (AOR 2.4, 95%CI 1.1-5.4); free time (AOR 7.9, 95%CI 3.5-17.6); supportive nursing managers
(AOR 5, 95%CI 1.7-14.5) have significant association with implementation of EBP. But, year of experience and perception have
no association. Conclusion: Both individual and organizational factors are the predominant factors that hinder implementation of
EBP. So, hospital managements and nursing leaders can easily overcome some of these barriers through arranging EBP training.

Keywords: Barriers, Evidence Based Practice, Nursing, Perception

research questions, while research serves as the foundation for

1. Introduction current practice. Practice and research therefore exist in a
Medical and health care is one of the most dynamic human circular continuum with one another (2)
disciplines, and large amounts of money are spent annually on Nursing staff are the largest health professional group in all
high-quality and sophisticated research, resulting in an sectors of healthcare (3) The majority of nurses work in direct
exponential growth in healthcare literature. Regularly, new care of patients; assessing patients’ needs and making
and more effective medicines, medical devices, and decisions on nursing interventions. Nurses’ practice of EBP
procedures are invented. One major objective behind all these can be assumed to have a major impact on patients’ outcomes
efforts is to help doctors, nurses, and medical technicians and patient safety. Hence, there is a potential to improve
provide the best possible care and treatment to patients. In quality of care and patient safety by enhancing Nurses’
addition to using traditional and well established procedures practice of EBP. Interventions aiming to enhance Nurses’
and practices, health care practitioners are adopting innovative practice of EBP need to target the factors that are important for
interventions that are based on best practices as well as solid EBP. (4)
research-based evidence.(1) Today, EBP, which is the use of theory-derived
Nursing is a science and therefore it is essential to derive its research-based findings along with reliable forms of evidence
knowledge from the findings of research. Scientific research is in clinical decision-making., is essential to the practice of
the standard by which sciences derive knowledge. Research nursing for purposes of promoting optimal patient outcomes
findings define, explain, and identify phenomena fundamental through incorporating research findings, the clinicians’
to nursing care. Nursing practice serves as the source for experience, and patient preferences. (5) Historically, nurses
74 G. Hadgu et al.: Assessment of Nurses’ Perceptions and Barriers on Evidence Based Practice in
Tikur Anbessa Specialized Hospital Addis Ababa Ethiopia

have relied on expert’ opinions of seasoned nurses in clinical the use of EBP for nursing.
decision-making. (6)However, these traditional ways of Although Evidence-Based Clinical Practice (EBCP) is
practicing may not only be outdated but unsafe (5). Also, known to improve the quality of health care, making it
experienced-based knowledge may be associated with biased cost-efficient while improving clinical results, barriers for
thinking that lead to errors(2, 7-8) transferring research into clinical practice challenge this
EBP is not clinical problem solving. While evidence-based process, which, in their final state, would culminate in what
practice is a mechanism for solving clinical problems and Davis called ‘the adoption process.(14)Dijkstra, synthesized
making decisions about interventions, it is distinct from some barriers and facilitators, as well as interventions, to
traditional problem-solving approaches in health care. improve the implementation of new knowledge, identifying
Conventional decision making about clinical practices relied that they depend, basically, on factors associated to the
on expert opinion sometimes achieved by consensus, but professionals, the organization they work for and their
rarely through experimentation combined with “standard management policies.(15)
practice.” EBP is a systematic process of reviewing the best Currently more and more developments are being
available research evidence and then incorporating clinical advocated and more international organizations are fostering
experience and patient preferences into the mix.(9) the need of incorporating EBP. EBP is the theme in most
The EBP process need not be onerous and basically nursing conferences both nationally and internationally and
includes five elements: (1) formulating an appropriate more continuing professional development programs targeting
question, (2) performing an efficient literature search, (3) EBP are being developed. (16)
critically appraising the best available evidence, (4) applying Across Africa (for example South Africa, Botswana, Kenya,
the best evidence to clinical practice, and (5) assessing Malawi, Nigeria), EBP is being advocated for nurses. EBP is
outcomes of care.(10) also being emphasized in Africa but, Africa lags behind in
In fact, evidence alone is never sufficient to make a specific research as fewer nurses are available who are sufficiently
clinical decision about a specific patient. The clinician needs prepared at higher level to enable them to conduct research
evidence plus good judgment, clinical skill, and knowledge of because of few higher institutions and exodus of nurses to
the patient’s unique needs to apply evidence to a specific developed countries for greener pastures. Lack of funding is
patient care situation. The definition of evidence-based also another obstacle for the nurses to conduct research
practice, in fact, holds evidence as only one element of the regardless of having research knowledge. (17)
triad of decision making. Clinical judgment and patient values Especially the newly graduated and less experienced nurses
must be considered when applying the evidence to a single may perceive EBP to be useful, as they have recently learned
situation. Patient care, on the other hand, requires a holistic in nursing curriculum's (2). However, ‘expert’ nurses may
approach to the care of individuals with physical, have difficulty translating evidence to practice because of
psychosocial, and/or spiritual needs. This care is founded on their traditional way of thinking about practice and their use of
the provider–patient relationship and an appreciation of the methods that were successful in the past.(18) Moreover,
patient’s unique needs.(9) nurses may not have the skill or expertise how to obtain the
Finally, studies continue to prove that nursing practice is research evidence from the literature or how to apply the
still not based on best available evidence. This call for a need evidence. Ultimately, nurses’ beliefs regarding attitudes
to specifically research further hence in trying to address the toward EBP was influence their use of EBP. Despite the
problems raised, the researcher was used a qualitative and benefits, barriers do exist which impede adopting EBP and its
quantitative approach with the hope of providing better use.
understanding of the research problems. In recent years, there has been increased attention to
Healthcare organizations face considerable challenges in evidence-based nursing practice. The number of systematic
ensuring patient care is based on the best available evidence. reviews and resources for evidence-based practice has also
Studies consistently demonstrate a failure to implement risen. Despite these factors, application of evidence to practice
interventions that have been shown to be both effective and remains challenging for nurses as well as for other
cost-effective.(11) Although this gap between evidence and clinicians.(19)
practice is common to all healthcare settings, failure to bridge The five greatest barriers to evidence-based practice were 1)
this gap in developing countries can have serious insufficient time to find research reports, 2) insufficient time
consequences and hinder progress towards better health.(12) to find organizational information (such as guidelines and
Valuable resources continue to be used for practices that are protocols), 3) lack of confidence in assessing the quality of
out of date, have no demonstrable benefit or are even harmful, research, 4) difficulty in understanding English-language
while interventions that have been shown to be both publications and insufficient time at work to implement
inexpensive and effective have not been widely changes in practice.(20-21) Several studies have attempted to
implemented.(13)Many published articles and advances on analyze this phenomenon from different perspectives, such as
EBP; nursing practice is still not based on evidence. The the influence of knowledge management(22-23), attitudes,
provision of care in the Hospital is widely demanding and values or training in the process of knowledge transferrable
requires high level critical thinking and decision making into clinical practice.(24-25) Barriers perceived by
skills inherent in the nursing profession there by demanding professionals concerning the use of research into clinical
 American Journal of Nursing Science 2015; 4(3): 73-83 75

practice have been studied(26-27), as well as the lack of Improved patient outcomes, decrease health care costs, which
support of health organizations towards EBCP (28)Most of the is a priority of governmental and funding agencies.
studies were conducted on developed country which the
factors may rise in developing country like Ethiopia.(28-35) 2. Objectives
Similarly, Research suggests that the implementation of
EBP by staff nurses is problematic and influenced by attitude, 2.1. General Objective
barriers and knowledge. Some studies have already proposed
the complexity of the variables involved in the transferrable of To assess nurses’ perceptions and barriers on evidence
knowledge into clinical practice. It is worrying to observe how, based practice implementation in clinical practice in Tikur
along the route that lies between the production of knowledge Anbessa Specialized Hospital
and the clinical decision of professionals, there is a 2.2. Specific Objectives
progressive decrease in knowledge, in favor of beliefs,
opinions, etc(11, 35-36). To assess nurses’ perception about evidence based practice
Evidence-based practice requires making professional in Tikur Anbessa Specialized Hospital.
decisions based on systematically gathered evidence drawn To determine the level of use evidence based practice in
from research and from experience and on the patients’ desires Tikur Anbessa Specialized Hospital.
and needs in a specific situation (37) Public authorities and To assess barriers to implement evidence based practice in
professional organizations, international and national Tikur Anbessa Specialized Hospital.
organizations (12, 37-39) have promoted making
evidence-based practice the standard for health services. Even 3. Methodology
though Several studies have attempted to analyze this
phenomenon from different perspectives, such as the 3.1. Study Area
influence of knowledge management, attitudes, values or
training in the process of knowledge transfer into clinical The study was carried out in Tikur Anbessa Specialized
practice, and barriers perceived by professionals concerning Hospital which is found in Addis Ababa (capital city of
the use of research into clinical practice have been studied, as Ethiopia) in lideta sub-city. According to Central Statistical
well as the lack of support of health organizations towards Agency of Ethiopia (CSA), as of2007 the town of Addis
EBCP, the detail factors are not analyzed, especially in Ababa has a total population of 2,739,551, of whom 1,305,387
developing country like Ethiopia. are men and 1,434,164 women. In the town, most people are
Although the benefit is that evidence-based health services engaged in commercial activities, include shops, food and
was be better able to meet the challenges of improving patient drink establishment, workshops, flour mills and transport
safety and the quality of services the implementation was seen sector (though inadequate) predominate. Originally TASH
as difficult due to different factors. Literatures on EBP in was built to accommodate 500 beds and currently has more
developing country especially Ethiopia is scarce. Since the than 600 beds. Of note, the hospital was having a compiled
factors are many and different in developing country than Drug and equipment list during its establishment which was
developed, the literatures were not representative. published in 1967 GC.
Tikur Anbessa specialized hospital was affiliated with the It serves about 250,000 patients per year in its outpatient
Addis Ababa University’s providing tertiary care in a country, department and about 24,000 in the inpatient and same
Training center for undergraduate and postgraduate medical number in the emergency departments. It is also the largest
students. Similarly a reputation for excellence in research, teaching hospital of the country; it trains large number of
staffed with the most senior specialists, managing patients undergraduate medical students as well as several residents
with complex illness and exposed to highly specialized care and fellows. It is a center to produce instructors for the various
also serving as a practical educational site for students and medical schools in the country as well. The hospital has more
health care providers in addition to the daily patient care. This than 1700 medical and non-medical staff. Of these 433(396
hospital was one of the hospitals expected to implement EBP. BSc, 10 MSc and 27 diploma) are nurses who offers inpatient,
So, this cross-sectional design was assess the perception of outpatient and emergency services in about 20 special clinics
nurses and barriers on implementation of EBP. and units. The ratio of nurse to population in TASH is 1:3000.
Health care consumers, society, government, and 3.2. Study Design
third-party payers expect care based on the latest evidence. (40)
Evidence based practice assists bedside nurses in decision Institution based Cross sectional study design using
making and accountability for their own practice and (41) quantitative and qualitative methods was employed for this
Care of the individual, policies and procedures, patient care study. For quantitative, self-administered questionnaires’ was
management tools through improving Health care decisions used to assess perception and barriers on EBP implementation.
and interventions. (42) For qualitative study, In-depth interview was used to assess
Generally this study is significant for nurses and healthcare nurses’ perceptions on EBP implementation in clinical
professionals to provide the highest quality of care in meeting practice in Tikur Anbessa Specialized Hospital.
the needs of patients and families as a whole Specifically it
76 G. Hadgu et al.: Assessment of Nurses’ Perceptions and Barriers on Evidence Based Practice in
Tikur Anbessa Specialized Hospital Addis Ababa Ethiopia

3.3. Source and Study Population n= (1.96)2*α/2*0.5(1-0.5)/ (0.05)2n = 384

The source and study population was all nurses of Tikur Since the study population were 406 which is below 10,000
Anbessa Specialized Hospital. the study use correction formula as follow:

3.4. Inclusion and Exclusion Criteria Nc =197

3.4.1. Inclusion Criteria 10% of the sample size was added for non-response rate so
All BSc and above nurses were included in the study. Since that a total of 217 study subjects were needed. Where:
BSc and above nurses were expected to implement new Nc= corrected sample size, n= sample size, N= study
research findings in clinical setting (EBP) using supportive population,
evidence. P= since no previous study was found o.5 prevalence is
used,
3.4.2. Exclusion Criteria d= the margin of sampling error tolerated (0.05),
Nurses who were on post graduate program and diplomas Z1 = the standard normal variables at (1-x) % confidence
were exclude both in quantitative (self-administered level and α/2 is mostly 5% that was 95 % confidence interval.
questionnaire) and qualitative (in-depth interview) study
since: 3.6. Sampling Procedures
Post-graduate Nurses- were not available during the time of
data collection and may not have knowledge about the current A total of 210 BSc and above nurses were taken from 406
practice in the hospital setting. BSc and above nurses using random sampling. Using
Diploma Nurses- in nursing curriculum research was not proportional 44 were nurses’ case team co-coordinator from
incorporated extensively for diploma nurses and have no 83 whereas 166 were staff nurses from 323 staff nurses
research experience so, EBP was not expected from them. purposively. For in-depth interview 15 BSc and above nurses
were selected randomly from 189 BSc and above nurses who
3.5. Sample Size Determination were not selected for quantitative. 12 BSc and above staff
nurses from 150 BSc and above staff nurses were selected
15 BSc and above nurses were taken for qualitative whereas randomly by lottery method. Similarly 3 BSc and above case
217 BSc and above nurses were taken for the quantitative team coordinators were selected randomly by lottery method
using correction formula as follows: from 39 BSc and above case team coordinators who were not
involved in quantitative. From the 15 BSc and above nurses,
Ζ 
2

n =  α / 2  P (1 − P ) the 3 case team coordinators were selected proportionally for

 d  in-depth interview.

Fig. 3.1. Sampling procedure.

3.7. Data Collection Procedures (Instrument, Personnel, quantitative study tools were divided into three sections. The
Data Quality Control) first section collects demographic information. The second
include nurses’ beliefs and attitudes toward implementing EBP.
The study was continuously collect primary data through The third questionnaire focuses on barriers of implementing
data collection tools which were adopted from Majid et.al EBP. All sections were constructed on a 5-point Likert scale,
(2011) and modified after review of literature. The that ranges from strongly agree (1) to strongly disagree (5).
 American Journal of Nursing Science 2015; 4(3): 73-83 77

There were six statements in the beliefs and attitude scale. 3.9. Variables
Scores could range between five and thirty.
The third component Adopting from Majid et al., 2011 3.9.1. Dependent Variables
modified to 27 statements to which Participants respond on a The dependent variables were nurses’ perception on EBP,
5-point Likert scale that ranges from strongly agree (1) to barriers on implementation of EBP, level of use of EBP
strongly disagree as (5). Scores could range from 27 to 3.9.2. Independent Variable
135.For qualitative study 7 questions were prepared with their Demographic variables: Age, sex, occupation, religion,
probes. Ethnicity, Educational level and marital status
To assure the quality of the data emphasis were given in Individual variables knowledge, skill, work load, years of
designing and translation of data collection instruments. The experience, educational level, available of research and
data was collected through self-administer questionnaires and attitude and confidence in practicing EBP, as well as
in-depth interview through audio recording. The questioner Organizational factors such as supportive leadership,
was prepared in English as study subjects were BSc and above. organizational climate and access to resources were
For in-depth interview the questionnaires were translated to independent variables.
local language (Amharic) for its simplicity, validity and clarity
the questionnaire. Prior to data collection pre-test was 3.10. Data Analysis Procedures
conducted on 10 %( 22) of study subjects on Zewditu Hospital
Nurses. Before the actual data collection, 3 data collectors First the data were coded and interred to epi info version
(BSc Nurses) and supervisors were trained thoroughly with 3.54 and exported to analysis in SPSS version 21 window7.
close supervision for 2 days on how to fill the questionnaires, Data analysis included descriptive statistics were used to
aim of the study, on confidentiality of the collected data from describe participants’ demographic characteristics, and texts,
respective nurses. To avoid low response rates the study was tables, and graphs were used to present the results. To
collected through three shift program of Tikur Anbessa determine statistically significant between dependent and
specialized hospital. Independent variables logistic regression was used. For the
The reliability of the tool was checked after the pre-test (22 qualitative the data Word processing and open code were used
nurses) for each sub-scale (three sections). The overall in the analysis. The data was Transcript in to English.
reliability cronbach alph coefficient (r=0.7). After pre-test and Following templates were prepared. The ideas were code in to:
revision from experts some modifications were incorporated 1) perception and attitude 2) barriers and facilitators 3)
for its validity. understanding/knowledge of EBP 4) future interventions.

3.8. Operational Definitions 3.11. Ethical Consideration

EBP: Evidence-based practice was an approach in which Institution Review Board (IRB) of Addis Ababa University,
critically examined literature and research findings are used to College of Health Science, School of Allied Health Sciences,
provide nursing care that is safe and modern. Department of Nursing and Midwifery was review the
Perception: how nurses’ perceive (beliefs and attitudes) the protocol to insure full protection of the rights of study subjects.
importance of EBP in their clinical setting.5-point Likert scale, Following the approval by IRB, Official letter of co-operation
that ranges from five or more answers agree or strongly agree was written to Tikur Anbessa Specialized Hospital from
have positive perception from nine questionnaires. Department of Nursing and Midwifery of AAU. After getting
Barriers: were obstacles for implementing EBP. These permission from Tikur Anbessa Specialized Hospital, data
barriers could be related to the nurses’ experience, the collectors were informed about the study, then after Verbal and
environment, resources, and lack of administrative support. written Informed consent obtained from study subjects,
Level of use EBP: Nurses used EBP in the clinical setting Confidentiality was assured for all the information provided,
self- rated by three options (Sometimes, usually, and always) no personal identifiers (anonymity) were used on the
Implementation: application of new research findings in questionnaires.
clinical practice.
Positive attitude and beliefs: three or more answers agree or 4. Result
strongly agree from six questionnaires
Negative attitude and beliefs: three or more answers 4.1. Socio-Demographic Characteristics
disagree or strongly disagree from six questionnaires Of the 217 nurses invited to participate, 210 (96.8) returned
Knowledgeable: Five and above questionnaires’ answers completed questionnaires. The response rate was 96.8%. The
from eight questionnaires’ agree or strongly agree unless not respondents were 156 (74.3%) female and 54 (25.7%)
knowledgeable. male.164 (70%) were staff nurses and 44(30%) were Case
Have Skill: Four and above questionnaires’ answers from team coordinator nurses. Of the 210 study subjects 133(63.3%)
seven questionnaires’ agree or strongly agree were orthodox followers. 119 (54.7 %) and 94(44.8%) of the
Have No Skill: three or more answers disagree or strongly study subjects were single marital status and Amharic
disagree from seven questionnaires’ ethnicity respectively. Most of the study subjects were BSc
78 G. Hadgu et al.: Assessment of Nurses’ Perceptions and Barriers on Evidence Based Practice in
Tikur Anbessa Specialized Hospital Addis Ababa Ethiopia

which accounts 202 (96.2%). 15 (3 heads and12 staff nurses) were taken for in-depth interview as the data were saturated.
Table 4.1. Socio-demographic characteristics of Nurses in TASH from April-May 2014 G.C.

Research Design
S,N Variables Quantitative Qualitative
Frequency (n=210) (%) Frequency (n=15) (%)
Age :20-24yr 42(20) 2(13.3)
25-29yr 84(40) 4(26.7)
30-34yr 33(15.7) 1(6.7)
35-39yr 11(5.2) 2(13.3)
40-44yr 15(7.1) 2(13.3)
1
45-49yr 14(6.7) 2(13.3)
50-54yr 5(2.4) 2(13.3)
55-59yr 4(1.9) ---
60-64yr 1(0.5) ---
>64yr 1(0.5) ---
Sex Male 54(25.7) 4(26.7)
2
Female 156(74.3) 11(73.3)
Marital status: Single 119(56.7) 9(60)
3 Married 87(41.4) 6(40)
Divorced 4(1.9) ---
Ethnicity: Oromo 63(30) 4(26.7)
Ahmara 95(95) 9(60)
4 Tigrie 23(11) 2(13.3)
Guarage 22(22) ---
Other 7(3.3) ---
Religion: Orthodox 133(63.3) 14(93.3)
Muslim 16(7.6) ---
5 Protestant 50(23.8) 1(13.3)
Catholic 4(1.9) ---
Other 7(3.3) ---
Year of experience:
1-5yr 134(63.8) 6(40)
6-10yr 38(18.1) 8(53.3)
6
11-15yr 4(1.9) ---
16-20yr 5(2.4) 1(13.3)
>20yr 29(13.8) ---
Education level: Degree (level-5) 202(96.2) 14(93.3)
7
Masters and above 8(3.8) 1(13.3)
Level of position: Staff Nurses 166(79) 12(80)
8
Head Nurses 44(21) 3(20)

4.2. Nursing Perception Towards Implementation of following illustrations support the welcoming attitude:
Evidence Based Practice “Knowing that you are doing EBP probably improves the
care and....intellectually you gain something from an
To address the perception of nurses towards implementation individual point.’’
of EBP 9 question were administered with likert-scale ranging “(All: nodding to this statement)....Knowledge on EBP in
from strongly agrees to strongly disagree for each question. nurses is available my practice is not all the time
Similarly their attitude and belief were assessed with similar evidence-based. There are times when I do not know things
fashion by 6 questions. A set of 15 statements were used to and I do not have even time to sit down.”
investigate the overall perception, beliefs and attitudes of “I think EBP is good for pt’s improvement, sometimes make
nurses toward integrating EBP into their patient care. use of the ward rounds to ask for information from the doctors
Similarly Open-ended questions were used to permit or other colleagues.”
participants to express their opinions, perceptions, attitude and “I do not use EBP practice because I don’t have knowing
belief towards EBP. For overall decision of perception to EBP, EBP implementation, there is no materials to practice on, for
total score of the statements were dichotomized to good example, no access to internet, training on EBP ….”
perception and not good perception based on the score. The attitude and believe of nurses were also welcoming or
Participants having more than half agree/strongly agree were positive which accounts 155 (73.8%). Only 55 (26.2%) have
considered have good perception. Half and below negative attitude and belief towards implementation of EBP.
disagree/strongly disagree were considered have not good This was well supported by the in-depth interview which
perception. 189 (90%) have good perception to EBP. Similarly resulted most were interested to implement if training was
from the in-depth-interview most nurses view EBP is good for given. Regardless of the high percentage of good perception
the quality of care but due to workload, lack of resources, and positive attitude, the correlation analysis showed no
having not knowledge the integration of EBP was poor .the
 American Journal of Nursing Science 2015; 4(3): 73-83 79

association with implementation of EBP(r=0.035, p=0.6). Only 19 (15.7%) use EBP in their clinical practice always.
4.3. Level of Use Evidence Based Practice in TASH 4.4. Barriers of Implementation of EBP among Nurses in
TASH

There are several barriers, which exist in preventing the

profession of nursing to transition from the use of ‘traditional’
methods to research-supported approaches to practice. Among
the determinants, supportive nursing managers have
significant association with implementation of EBP both in
bivariate and multi-variate analysis (OR: 2.5, 95%CI: 1.13-5.4
and AOR: 5, 95%CI: 1.7-14.5) respectively. Similarly age at
30-34yrs has association with EBP with (AOR: 3.74, 95%CI:
1.2-11.5). Those knowledgeable were3 times higher in
implementation of EBP than who have no knowledge for
implementation of EBP. Similarly those with skill were 2.4
times higher in implementation of EBP than have no skill.
Having free time was also has significant association with
Fig. 4.1. Level of use EBP in TASH by nurses in 2014G.C. implementation of EBP with AOR: 7.9, 95%CI: 3.5-17.6.
AOR: 5, 95%CI: 1.7-14.5, respectively.
Of the total 210 121(57.6%) of nurses were integrate EBP in
their clinical practice. Their levels of use were rated by
self-report with three options (sometimes, usually and always).
Table 4.2. Multi-variate analyses of barriers in relation to EBP among Nurses in TASH from April-May 2014 G.C. (n=210).

S.N Variables Frequency (%) Crude OR (95%CI) Adjusted OR (95%CI)

Age : 20-24yr 42(20) 1 1
25-29yr 84(40) 0.87(0.4-1.83) 1.5(0.59-4.1)
30-34yr 33(15.7) 3.7(1.32-10.4)* 9.47(2.4-36.7)
35-39yr 11(5.2) 1.14(0.3-4.35) 3.3(0.5-22.6)
40-44yr 15(7.1) 0.83(0.26-2.7) 1.9(0.19-19.5)
1
45-49yr 14(6.7) 6.0(1.2-30.2)* 10(0.45-223.7)
50-54yr 5(2.4) --- ---
55-59yr 4(1.9) 0.95(0.12-7.4) 2.2(0.06-79.5)
60-64yr 1(0.5) --- ---
>64yr 1(0.5) --- ---
Marital status: Single 119(56.7) 1 1
2 Married 87(41.4) 1.48(0.84-2.6)* 0.88(0.36-2.1)
Divorce 4(1.9) 0.86(0.1-6.3) 1.2(0.004-416.5)
Sex: Male 54(25.7) 1 ***
3
Female 156(74.3) 0.9(0.49-1.7)
Year of experience: 1-5yr 134(63.8) 1 1
6-10yr 38(18.1) 1.9(0.89-4.1)* 0.68(0.24-2.0)
4 11-15yr 4(1.9) 0.88(0.12-6.5) 0.07(0.001-3.96)
16-20yr 5(2.4) 0.59(0.1-3.65) 0.69(0.05-10.1)
>20yr 29(13.8) 2.0(0.84-4.6)* 0.48(0.035-6.5)
Educational level: BSc 202(96.2) 1 ***
5
MSc and above 8(3.8) 0.73(0.18-2.99)
Nurse : Staff nurse 166(79) 1 ***
6
Head nurse 44(21) 1.4(0.69-2.7)
Knowledge: Have no Knowledge 108(51.4) 1 1
7
Have Knowledge 102(48.6) 4.6(2.6-8.4)* 3.2(1.5-7.0)
Skill: Have no skill 102(48.6) 1 1
8
Have skill 108(51.4) 5.(2.77-9.15)* 2.4(1.1-5.4)
Time : Have no Free Time 159(75.7) 1 1
9
Have Free Time 51(24.3) 6.9(3.75-12.8)* 7.9(3.5-17.6)
Attitude : Negative Attitude 55(26.2) 1 ***
10
Positive Attitude 155(73.8) 1.3(0.7-2.4)
Perception : Negative perception 21(10) 1 ***
11
Positive perception 189(90) 1.26(0.5-3.1)
Nursing managers: not supportive 31(14.8) 1 1
12
Supportive 179(85.2) 2.5(1.13-5.4)* 5(1.7-14.5)

Key: *(Nursing managers, time, marital status, age, experience, skill, knowledge) were have α < 0.3 analyzed in multi-variate and *** were not included in
multi-variate as α>0.3
80 G. Hadgu et al.: Assessment of Nurses’ Perceptions and Barriers on Evidence Based Practice in
Tikur Anbessa Specialized Hospital Addis Ababa Ethiopia

From the in-depth interview the top three prioritized they cannot keep up to date with new evidence. (65) Similarly
barriers for integration of EBP were: 1) lack of training, 2) one study agreed that nurses had a positive and welcoming
workload and insufficient time, 3) lack of role model. attitude toward EBP. Yet, relying on expert opinions rather
than EBP was the most common way nurses learn how to
5. Discussion practice nursing. Although there was much literature
regarding EBP, most of the surveyed nurses either did not
It has been noted in the last 30 years, the practice of nursing know of current evidence-based practices nor did they have
has been trending from relying on expert opinion to the the time or support to implement those practices.(51) similar
application of clinical research. The goal of EBP is to analyze Waters et al. (2009) found nurses generally had a positive and
research, examine its clinical relevance, and integrate the welcoming attitude toward EBP.(52)
findings into practice. (2) The EBP approach utilizes empirical, Furthermore, study from Finland and Iran also found the
verifiable and research supported data that ensure nursing majority of nurses had positive attitudes toward EBP.
practice is based upon the scientific method. (5) It is important However, patient load, heavy workloads and insufficient
that EBP data is current, relevant and applicable, and takes staffing inhibited the implementation of EBP. Additionally,
patient preferences in its application. This study assesses nurses in this study believed they did not have the power to
perception of nurses and barriers of implementation of EBP implement EBP. Nurses reported physician orders not nursing
with the research hypothesis of individual and organizational research-directed clinical practice. (49, 45)
factors affect the implementation of EBP. In this study nursing leaders have no significant difference
with nursing staff in perception towards implementation EBP.
5.1. Socio-demographic Characteristics This finding was contradicted the study in USA which resulted
The response rate (96.8%) obtained in this study was higher nurses in management positions significantly differed with
than that obtained in other studies which percentages of 60.9% staff nurses in perception. This may be related with lack of
(64) or even lowers (48). However, they are very similar, as far managerial skill and training on EBP. (43)
as the proportion of men and women 1 man for every 3 women 5.3. Barriers of Evidence Based Practice Among Nurses in
and 40% the age of the nurses surveyed were between 25-29 TASH
unlike the study conducted in Spain with mean age over 40
years and 1man for every 6 women. (64) Regarding to the The determinant factors of implementation of EBP were
professional experience 63% had 1-5yrs experience which is analyzed in both bivariate and multi-variate level. Similarly
analogues with Singapore which is (53%). (64) But study nurses were asked to indicate the importance of different
conducted in Spain have 53% over 20yrs. (64) With respect to factors through in-depth interview. Knowledge has significant
the academic level this study have BSc and MSc and above association with implementation of EBP. Those who have
which accounts 96.25 and 3.8%, respectively. unlike study knowledge were implementing EBP 3times than who have no
conducted in Singapore which includes diploma in nursing knowledge about EBP. This was also supported from the
(41.0% ), advanced diploma (14.8% ) ,bachelor’s nursing in-depth interview as most of them reported lack of
(41.4%) and master’s (2.3%,).(6) But the proportion of BSc knowledge as one factor. A similar significant differences in
to MSc was comparable. the Knowledge (p = 0.023) was reported in Spain. (64)
In this study skill was also significant with EBP with AOR:
5.2. Perception and Attitude of Nurses Towards Evidence 2.4, 95%CI 1.1-5.4. This finding was consistent with finding
Based Practice of Straus et.al 2013 with p=0.023 and nurses with better skills
The perceptions of nurses towards integration of evidence reported fewer barriers to evidence-based practice. (63)
based practice in their clinical practice were good which Furthermore study conducted in Australia also shows the low
accounts (90%)? There was also a positive attitude (73.8%) use of online medical databases due to lack of adequate search
towards EBP. This result was also supported from the in-depth skills and searching experience is a barrier to implementing
interview in which most of the respondents suggest “it is evidence-based medicine. (67)
important for the quality of care but the workload, lack of This study also ends up with statistical significant
knowledge and training makes us to follow the prior difference in availability of time and implementation of EBP
experience or rely on experts opinions”. This finding was with AOR: 7.9, 95%CI: 3.5-17.6. This finding was analogous
similar The study was conducted In South Africa trained ICU with the integrative review and single study from South Africa
nurses had well coming attitude towards EBP (75%) University highlighted lack of time as a major barrier to
However there was no association in both perception (OR: adopting EBP (68-69). Similarly study from Finland indicates
1.26, 95%CI: 0.5-3.1) and attitude (OR: 1.3, 95%CI: 0.7-2.4) head nurses do not have the time to study research articles and
with implementation of EBP that was rare for head nurses to discuss article findings with
Additionally, Study done in Singapore which found more staff and even staff nurses do not have the time to search
than 64% of the nurses expressed a positive attitude toward researching findings. (49). Moreover study on Iranian nurses
EBP. However, they pointed out that due to heavy workload, shows patient load, heavy workloads and insufficient staffing
inhibited the implementation of EBP. (45) But study from
 American Journal of Nursing Science 2015; 4(3): 73-83 81

Australia shows no significant association between time and and insufficient time were the three top prioritized obstacles.
implementation of EBP. (44) This difference may be related 57.6% of nurses were integrated EBP in their clinical practice.
with patient load. Only 19 (15.7%) use EBP in their clinical practice always.
In any sub-scales of the clinical experiences there was no Knowledge, skill, time and supportive nursing managers
association with implementation of EBP as this study have significant association with the implementation of EBP.
indicated. This was Similar with the study conducted on USA Those who had knowledge, skill, free time and supportive
found no significant differences in any of the subscales based nursing managers implement EBP than those who have no
on years of nursing experience.(43) similarly other study also knowledge, skill, free time and supportive nursing managers.
shows not a statistically significant relationship between the Generally, both individual (knowledge and skill) and
use of EBP and years of experience as a head nurses.(49). organizational (lack of training, workload, insufficient time
But one study shows junior clinical nurses have reported and supportive managers) factors are the predominant factors
more barriers compared with senior clinical nurses in regard to that hinders implementation of EBP. Hospital management
accessing organizational information such as clinical needs to make necessary adjustments in the work schedule of
guidelines and protocols, access to EBP resources, and having nurses to ensure sufficient time for them to learn and
time for practicing EBP. (50) This may be related with few implement EBP.
observations of experience in the sub-scale of clinical
experience.
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