Implementation of evidence-based practice (EBP) is a critical step in ensuring that nurses deliver high-quality care. More research is being done in many clinical situations leading to the publishing of many research articles. Nurses are expected to read research reports and apply the recommendations of researchers appropriately in healthcare settings. Conversely, many nurses in various parts of the world have not embraced EBP due to the barriers they experience. Khammarnia et al. (2015) conducted an analytical cross-sectional study to examine some of the obstacles that are leading to the implementation of the EBP. This paper provides a critique of the research article and discusses if it is credible to be utilized by those in the nursing profession.
Purpose of the Study
The aim of the study can be understood by reading the abstract of the article. The authors introduce the articles by stating that they aimed to establish the barriers that led to the implementation of EBP among nurses. Additionally, the purpose of the study corresponds with the main topic, which shows that the research article is about the barriers to implementation of EBP. However, the authors do not provide a research question that they are planning to address in the study. Similarly, they do not provide a problem statement. Interestingly, the reader of the article can understand that the survey was about the barriers that led to the implementation of EBP. However, readers cannot know the research question that the authors are aiming to address. Despite that, the objective of the article is clear, and the readers of the article can find it easy to understand that the article is about the barriers to implementing EBP.
The study involved five investigators who set out to collect data. The setting and the collection of the sample is explained comprehensively on the second page. The target population was all nurses who worked in the aforementioned hospitals. The sample for the study was nurses who were at work during data collection. Additionally, the authors explain that they obtained lists of all nurses in the six hospitals. The lists were the sampling frame. From the lists, they performed a stratified random sampling for each list from each hospital. Then, the investigators calculated a sample size of 270 at 95% significant level and error level of 0.005. Then, they added 10 participants to the sample, which brought the total sample size to 280. The inclusion criteria involved all nurses who were at work, and the exclusion criteria were individuals who were not at work during data gathering. The authors considered the demographic variables such as age, gender, educational status, job experience, and employment status. In the results section, the response rate was 93.9%. Seventeen nurses did not return the questionnaire. Considerably, the method used to collect data by the researchers was convenient for this study since nurses work in shifts. Additionally, the selection of the sample in all six hospitals would make the study appropriate to apply in various healthcare settings.
The authors state in the article that data collection was done in healthcare settings using questionnaires. First, in the abstract, the authors ascertain that questionnaires on the barriers to the implementation of EBP consisted of 27 statements. However, they do not provide the questions and the 27 statements distinctly. In the measurement section on page 2, the investigators state that 18 statements were about the organizational aspects and nine statements were about the individual elements. The respondents were to score the level to hich they agreed. The responses were 'agree' as ‘1’, ‘no opinion' as ‘2,’ and 'disagree' as ‘3’. The investigators took the questionnaires and gave them to nurses who were at work (the selected sample). The data collected in the hospital was analyzed using descriptive statistics (mean, frequency table, and standard deviation). Then, the statistical software ‘STATA II' was employed in the Chi-square analysis at 0.05 significance levels. These analyses were adequate for this study because the readers of the article can understand how the barriers vary among nurses demographically.
The intervention could not be tested on the participants because the study was qualitative. Additionally, the study was not testing a hypothesis. Furthermore, the participants in the research were nurses, the investigators could not control the variables and thus, had difficulty in carrying out intervention testing.
In the results section, more than half of the respondents agreed that 56% of barriers to implementation of EBP related to organizational aspects and 57% of the barriers were related to individual aspects. Organizational aspects considered as the barriers to the implementation of EBP include nursing shortages (78.3%), an excess of work during shifts (70.0%), and a lack of Internet access at work (72.2%). The most significant individual obstacles to implementation of EBP are a lack of ability to work with the computers (68.8%), insufficient proficiency in the English language (62.0%), and lack of time to read related literature (83.7%). Consequently, the authors achieved the primary aim of the study. Based on the selection of the sample and the settings that the survey was carried out with, these findings are reliable.
This research study is published in the Nursing Research and Practice Journal. In the left corner of the article, it is indicated that the research article is from the Nursing Research and Practice Journal. The digital object identifier on the article redirects to the journal. Additionally, the article was found among other articles from Google Scholar, which were in the Nursing Research and Practice Journal.
Appropriateness of the Research Question
The authors did not provide a research question. However, the aim of the research is clear. The investigators were seeking to identify barriers to implementation of EBP. The analytical cross-sectional study was appropriate for this research because the study was supposed to take a short time. Additionally, the authors could analyze the responses of the nurses from the questionnaires and come up with valid results.
Data Collection and Analysis Appropriateness
The data obtained addresses the aim of the study. According to the research article, 93.9% of nurses returned their questionnaires. The analysis focused on the individual and organizational aspects, putting demographic variables into consideration. The analysis of this data using descriptive statistics and Chi-square adequately addresses the aim of the study.
Characteristics of the Participants and Their Influence on the Findings
The respondents were chosen considering their gender, educational status, job experience, and employment status. These factors were considered because they could affect the outcome of the research.
The measuring instrument used was a questionnaire. It had both organizational and individual aspects that were considered to be barriers to the implementation of EBP. Therefore, it was valid in assessing the barriers to implementation of EBP.
Control of Extraneous Variables and Potential Biases
The investigators envisioned that some demographic variables would affect the outcome of the research. Therefore, they put them into consideration when collecting the data. Additionally, reviewing demographic variables as well as carrying out a study in six hospitals was effective in reducing biases. Considerably, the data collection process had a proper response, and there was no bias.
Anything that Could Have Influenced the Findings
The data collection process only considered nurses that were on shift. Usually, only a few nurses are on shift at a particular time. Therefore, the investigators risked getting insufficient information that could have led to wrong results.
The results were consistent with previous findings on the topic of barriers to implementation of EBP. For instance, Wallis (2012) carried out a descriptive survey to examine why nurses were not implementing EBP. It was found that there were individual aspects, such as attitude and education level, which played a key role in not implementing EBP. Similarly, Khammarnia et al. (2015) identifiedthe attainment of education as one of the aspects influencing implementation of EBP.
Credibility of the Study Findings
The findings of this research were credible. Nursing shortages usually lead to few nurses caring for many patients, Therefore, the medical personnel is left with no time to implement EBP. The Internet is important because it can enable nurses to access EBP materials. Lack of it is a relevant reason why nurses cannot implement EBP. Additionally, the heavy workload is also associated with the shortage of nurses and can, therefore, be considered a reliable cause. Lack of time to read literature is a reliable finding since most of the nurses who participated in the study had families to take care of after work. Furthermore, the inability to work on a computer is a reliable reason since most literature is online in journals. Finally, a lack of proficiency in the English language is a reliable factor because most research articles are published in English for people in English speaking countries.
The discussion section in the study is relevant for nurses and organizations that want to examine the barriers to the implementation of EBP. The authors state that the implementation of EBP faces challenges, both based on the individual and organizational aspects. The authors also ascertain in the discussion section that this study is consistent with other research findings, which is relevant. Additionally, the discussion section explains the way 56% of individual aspects affect the implementation of EBP. That is related to the fact that each nurse has personal issues affecting them. Since older nurses indicated that organizational aspects were more relevant than individual aspects when it came to barriers in implementing EBP, additional research should be done on the same issue to establish the role of the organization in EBP implementation. Finally, the findings would be similar if conducted in the USA since most nurses face similar challenges in healthcare settings. However, there will be slight differences because the USA is more developed than Iran.