Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action

Exploring Professional Practice Environments and Organisational Context Factors Affecting Nurses' Adoption of Evidence-Based Practice: A Scoping Review

This scoping review, conducted within the Joanna Briggs Institute (JBI) framework, analysed the recent literature (January 2018 to March 2023) addressing factors inherent to professional practice environments and organisational contexts influencing nurses' adoption of evidence-based practice (EBP). This review included studies involving nurses regardless of sector, practice setting, and scope of practice. A systematic search was undertaken across the PubMed, Web of Science, CINAHL, and MEDLINE databases, as well as the EThOS, OATD, and RCAAP platforms. The extracted textual elements underwent a content analysis, resulting in a coding structure established through an inductive approach that categorised information into main categories and subcategories linked by similarity and thematic affinity. Forty-one studies were included, revealing four main categories of factors impacting EBP adoption by nurses: (1) organisational dynamics, (2) management and leadership, (3) teamwork and communication, and (4) resources and infrastructure. The study's limitations acknowledge the subjective nature of categorisation, recognising potential variations based on individual perspectives despite adopting procedures to minimise the risk of bias. The results provide a substantial foundation for developing interventions to cultivate environments conducive to EBP adoption by nurses, thereby enhancing the integration of evidence into nurses' professional practice contexts. This review was prospectively registered on the Open Science Framework (registration no. osf.io/e86qz).

Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review

OBJECTIVE

A scoping review was undertaken to determine the extent to which existing studies have examined factors influencing healthcare providers' use of clinical guidelines in low and middle-income country (LMIC) settings and determine which factors constrain or facilitate the use of clinical guidelines by healthcare providers.

DESIGN

Scoping review.

DATA SOURCES

The literature search was conducted using PubMed in January 2021.

ELIGIBILITY CRITERIA

We identified empirical studies, published between 2011-2021 in English, which included clinicians and/or nurses as healthcare providers, used a health facility as the study site, and were located in an LMIC.

DATA EXTRACTION AND SYNTHESIS

Information extracted from the literature review was organised using themes and the findings synthesised using thematic analysis.

RESULTS

The review identified five types of interacting factors that influence healthcare providers' use of and compliance with clinical guidelines. The factors identified are organisational factors, factors relating to individual healthcare providers, attributes of the clinical guidelines, patient-related factors and institutional factors. Organisational factors can be further divided into the physical work environment, organisational culture and working conditions. The effective use of clinical guidelines in LMIC settings is greatly impacted by the contextualisation of clinical guidelines, end-user engagement and alignment of the implementation of clinical guidelines with the institutional arrangements in the broader health system.

CONCLUSION

The development and evaluation of concrete interventions is vital to facilitate the implementation of clinical guidelines and improve healthcare service quality. Further studies are necessary to examine the relative importance of the five identified factors on the effective use of clinical guidelines in different contexts.

The improvement in research orientation among clinical nurses in Qatar: a cross-sectional study

BACKGROUND

The main barrier to engaging nurses in research is the lack of research knowledge and skills.

AIM

To explore the influence of research workshops on the research orientation of nurses in a large referral hospital in Qatar.

DISCUSSION

This article describes a cross-sectional study involving 564 nurses working in 14 health facilities who attended research workshops in Qatar. The authors collected data using the Edmonton Research Orientation Survey (EROS) as well as questions considering support and barriers to research. Descriptive statistics were used to summarise and determine the sample characteristics and distribution of participants. The participants who attended the workshop were found to have a higher orientation towards the EROS sub-scales of evidence-based practice, valuing of research, involvement in research, being at the leading edge of the profession and support for research, compared to those who did not attend the workshop. There was no statistical difference between the groups in the research barrier sub-scale.

CONCLUSION

Despite significant improvements in their responses to the EROS research orientation sub-scales after attending the workshop, the nurses still reported many barriers to being actively engaged in research.

IMPLICATIONS FOR PRACTICE

Healthcare organisations should assist with integrating evidence-based practice into healthcare. There is a need for research education for clinical nurses to bring evidence into clinical practice to improve the quality of patient outcomes. Increasing the research capacity of nurses will lead to their emancipation in addressing the flaws in clinical practice and motivate them to use evidence in patient care.

Barriers and facilitators influencing EBP readiness: Building organizational and nurse capacity

BACKGROUND

Organizational supported evidence-based practice (EBP) enables nurses to be change agents and impact patient outcomes. Globally, a multitude of barriers limits EBP implementation, evaluation, and dissemination, which include time constraints, staff, resource access, education, technology, and fiscal support. These barriers and other disenfranchising elements hinder nurses' ability to actualize EBP and change practice within their workplace.

AIMS

This study describes the EBP readiness, barriers, and facilitators reported by inpatient registered nurses (RNs) employed in a nationwide healthcare system before COVID-19.

METHODS

The study employed a cross-sectional descriptive survey design using the 2005 Nursing EBP Survey for RN EBP readiness. The setting included 14 hospitals in Southern California. The survey was deployed in November 2016 and closed after 23 weeks. Descriptive statistics analyzed demographics and EBP scores, with inferential statistics for associations between demographics and EBP scores. ANOVA examined differences between EBP scores, service lines, years of employment, and education level. A content approach synthesized open-ended barrier and facilitator questions into seven specific themes.

RESULTS

Seven hundred and twenty-four nurses completed the survey. Overall, the scores of inpatient RNs were highest scores for Practice Climate, suggesting the health system fosters a climate conducive to EBP. Scores were lowest for Data Collection and Implementation. Qualitative themes were: (1) Everyone Involved in EBP Implementation, (2) Fear and Resistance to Change, (3) Protected Release Time, (4) Knowing EBP Culture Outside of Current Organization, (5) Organizational Communication and Education, (6) Management and Leadership Support, and (7) Pragmatic Solutions to Facilitate EBP. Fear and Resistance to Change cut across all themes.

LINKING EVIDENCE TO ACTION

Nurses at all organizational levels from the C-suite to the bedside can create strategies to determine essential EBP readiness components, including EBP mentors to guide knowledge uptake activities. Pragmatic solutions for EBP capacity require frontline nurse feedback, commitment, and partnership with nursing leaders.

Knowledge, attitude and use of evidence based practice (EBP) among registered nurse-midwives practicing in central hospitals in Malawi: a cross-sectional survey

BACKGROUND

Even though evidence based practice (EBP) is being considered as a critical element in improving the quality of health services and achieving excellence in patient care, there is currently little knowledge of how EBP relates to nursing and midwifery in Malawi. This paper is a report of a study describing EBP knowledge, attitudes, and use of registered nurse-midwives practicing in central hospitals across Malawi.

METHODS

The descriptive, cross-sectional research design was conducted with a randomly selected sample of 183 nurse-midwives (response rate of 87.9%). The study used a paper version questionnaire to collect the data. The data were analysed using both descriptive and inferential statistics in the Statistical Product and Service Solutions version 23. Descriptive statistics were calculated to summarise overall knowledge levels, attitudes, and use of nurse-midwives as percentages based on their scores on the assessment scale (1 to 7 Likert scale) in the EBP questionnaire. Non-parametric Mann-Whitney and Kruskal-Wallis tests were carried out to compare evidence-based practice scores based on demographics. Pearson's correlation (r) and stepwise regression analysis were further performed to analyse the relationship between the knowledge, attitude and use of nurse-midwives on the overall EBP of nurse-midwives.

RESULTS

The average scores (mean±SD) of evidence-based practice amongst nurse-midwives were 78.7 ± 19.6 for attitude, 70.6 ± 15.1 for knowledge levels, 57.8 ± 23 for use, and 68.9 ± 14.2 for the overall EBP. Higher educational qualification was associated with higher scores in knowledge levels (P = 0.02). Research experience was associated with higher scores in nursing use (P = 0.005), and higher overall evidence-based practice were associated with both research experience (P = 0.035) and educational qualification (P = 0.004). Nurse-midwives attitude was affected by clinical experience (P = 0.006) and the hospital where nurse-midwives worked (P = 0.016). There was no significant difference in the EBP scores of nurse-midwives based on gender and/or their administrative roles in their respective central hospitals.

CONCLUSION

It is important to develop the knowledge or skills of nurse midwives in order to enhance evidence-based practice amongst nurse-midwives in Malawian hospitals. The results can be used by nurse managers, nurse educators, policy makers at the Ministry of Health and Nurses and Midwives Council of Malawi to enhance implementation of EBP.

Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs)

Background

Low‐to‐middle income countries (LMICs) experience a high burden of disease from both non‐communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice.

Aim

To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies.

Methods

A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6‐month, multi‐phase, intensive evidence‐based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy.

Results

A total of 60 implementation projects reporting 58 evidence‐based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process‐related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence‐based practice; most strategies were categorized as educational meetings for healthcare workers.

Linking Evidence to Action

Context‐specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low‐cost resources. Education for healthcare workers in LMICs is an effective awareness‐raising, workplace culture, and practice‐transforming strategy for evidence implementation.

The ripple effect of evidence implementation: a descriptive evaluation of JBI's Evidence-based Clinical Fellowship Program

BACKGROUND

Across healthcare there are acknowledged gaps in the translation of evidence into clinical practice. Undertaking a structured implementation program may assist clinicians to achieve this in their clinical practice setting.

AIMS/METHODS

The current study descriptively evaluates and analyzes the impact of JBI's (formerly known as the Joanna Briggs Institute) Evidence-based Clinical Fellowship program, since its inception in 2005.

RESULTS

Since its inception the JBI Evidence-based Clinical Fellowship Program has trained over 560 Clinical Fellows. The program consists of two 1-week intensive training workshops at JBI, collaborating with a JBI Research Fellow facilitator, with each participant then conducting a workplace evidence implementation project over the intervening 6 months in their own clinical setting. A 'train-the-trainer' program was established to provide accredited trainers to run the program through established JBI Collaborating Entities.

CONCLUSION

Implementation of research evidence into the clinical setting is challenging for health professionals. A pragmatic approach adopted through the JBI Evidence-based Clinical Fellowship Program ensures that the Clinical Fellow remains central as the program leader, but has direction and support from their team of various stakeholders, and ongoing collaboration with a JBI facilitator. This ensures increased capacity for engagement and ongoing sustainability of future implementation programs.