JNPD Journal for Nurses in Professional Development & Volume 31, Number 2, 73Y80 & Copyright B 2015 Wolters
ight B 2015 Wolters Kluwer Health, Inc. All rights reserved.
Utilization of Evidence-Based Practice
Knowledge, Attitude, and Skill of Clinical
Nurses in the Planning of Professional
Development Programming
Kathleen M. Williamson, PhD, MSN, RN ƒ Mohammed Almaskari, MSN, RN
Zanet Lester, MSHA, BSN, RN ƒ Deborah Maguire, BSN, RN, PCCN
This collaborative study explored nurses’ knowledge,
attitudes, and skills related to the evidence-based practice
(EBP) process. It also explored the nurses’ perceptions of
the barriers and facilitators that they face related to fully
using EBP in the workplace. Findings will afford the
healthcare system the information to develop, plan, and
restructure the educational services to meet the demand
of enhancing EBP strategies and utilization.
E
vidence-based practice (EBP) is a process and stra-
tegic component of providing quality care to patients.
EBP is defined as the use of scientific evidence, clin-
ical expertise, and patient preferences and values to make
a clinical decision that will impact care (Melnyk & Fineout-
Overholt, 2011). Despite the great efforts from nursing in
using EBP, there are many drawbacks and sacred cows that
get in the way of practice change. Utilizing the EBP process
allows nurses to engage in interdisciplinary work that in-
fluences patient outcomes. This collaborative study was
undertaken to identify EBP knowledge, attitude, and skills
of nurses and nurse leaders in clinical practice and the barriers
and facilitators they face in using it. It was to gain in-depth
information in order to develop strategic professional de-
velopment programs to meet the needs of the nurses.
Studies demonstrate that when a system-wide belief and
Kathleen M. Williamson, PhD, MSN, RN, is Chair and Associate Professor,
Wilson School of Nursing at Midwestern State University, Wichita Falls, Texas.
Mohammed AlMaskari, MSN, RN, is Graduate Student, Widener Uni-
versity, Chester, Pennsylvania.
Zanet Lester, MSHA, BSN, RN, is Independent Consultant. Previously:
CKHS Director of Nursing, Excellence, West Chester, Pennsylvania.
Deborah Maguire, BSN, RN, PCCN, is Staff Nurse and Co-chair of CKHS
EBP and Research Council, Drexel Hill, Pennsylvania.
The authors have disclosed that they have no significant relationship with,
or financial interest in, any commercial companies pertaining to this article.
ADDRESS FOR CORRESPONDENCE: Kathleen M. Williamson, PhD,
MSN, RN, Midwestern State University, 3410 Taft Blvd., Wichita Falls, TX
76308 (e<mail: kathleen.williamson@mwsu.edu).
DOI: 10.1097/NND.0000000000000140
Journal for Nurses in Professional Development
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
ƒ
change in culture toward EBP occurs it enhances the work
environment and provides nurses with an avenue to pro-
vide quality care (Johansson, Fogelberg-Dahm, & Wadensten,
2010; Wilkinson, Nutley, & Davies, 2011). When nurses be-
lieve in the importance of developing a skill set for utilizing
EBP and the work environment influences the use of best
practice (Estabrooks, Kenny, Adewale, Cummings, &
Mallidou, 2007; Melnyk et al., 2004; Upton & Upton, 2005),
then the best clinical decisions can be achieved (Melnyk
& Fineout-Overholt, 2011; Melnyk, Gallagher-Ford, Long,
& Fineout-Overholt, 2014; Upton, Upton, & Scurlock-Evans,
2014). The healthcare system highlighted in this study
recently restructured its shared governance process and
has established an EBP and Research Council. However,
the purpose of the study was to identify the nurses’ EBP
knowledge and the existing implementation gap as well
as the barriers and facilitators that nurses’ perceive when
utilizing and implementing EBP competencies. In addition,
this study was done to establish baseline data so that the
findings could be used to strengthen the implementation
of the EBP process in the healthcare system.
LITERATURE REVIEW
EBP has widely been accepted as an appropriate frame-
work for healthcare professionals to embrace and use as
a basis for their practice (Cleary, Walter, Horsfall, &
Matheson, 2009; Melnyk & Fineout-Overholt, 2011). It
has been shown to lead to higher quality of care, improved
patient outcomes, a culture of safety, and decreased cost
of health care (Melnyk et al., 2014; Melnyk & Fineout-
Overholt, 2011; Melnyk, Gallagher-Ford, Fineout-Overholt,
& Kaplan, 2012; Sammer, Lykens, Singh, Mains, & Lackan,
2010). However, research still identifies inconsistencies in
its adoption and implementation in the clinical workplace
(Heiwe et al., 2011; Jennings & Loan, 2001; Melnyk et al.,
2014; Penz & Bassendowski, 2006; Pravikoff, Pierce, &
Tanner, 2003; Pravikoff, Tanner, & Pierce, 2005). In addi-
tion, research suggests that nurses struggle to implement
the EBP process in practice even though they may have
learned it through their studies, inservices, and clinical
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experiences (Grant, Hanson, Johnson, Idell, & Rutledge,
2012; Hagler et al., 2012; Maben, Latter, & Macleod, 2006).
A variety of reasons have been proposed to account for this
incongruity, including the workplace may not embrace the
use of the EBP process (Maben et al., 2006; Mooney, 2007),
a lack of confidence, misperceptions about EBP, a lack of
EBP knowledge and skills (Melnyk et al., 2004; Upton &
Upton, 2005; Varnell, Hass, Duke, & Hudson, 2008), lack
of time (Fink, Thompson, & Bonners, 2005; Melnyk et al.,
2012; Pravikoff et al., 2003, 2005), resource demands
(Banks et al., 2011; Brown, Wickline, Ecoff, & Glaser,
2009; Varnell et al., 2008), and resistance from colleagues
and leadership/management (Linton & Prasun, 2013;
Melnyk et al., 2012). It is therefore crucial that nurses are
provided with the strongest foundation possible to engage
in the EBP process.
There are multiple models for EBP implementation and
utilization, such as the Ace Star Model, the Johns Hopkins
Nursing EBP Model, the Iowa Model, and the Advancing
Research and Clinical Practice Through Close Collaboration
(ARCC) Model (Melnyk & Fineout-Overholt, 2011). Changing
practice is daunting, and models provide a guide. The ARCC
model was used to guide this study. The ARCC model pro-
poses the first step to changing practice as an assessment of
the organization’s readiness for system-wide implementa-
tion (Melnyk & Fineout-Overholt, 2011). ‘‘The culture of an
organization can foster EPB or stymie it’’ (p. 259). This study
was the first step in the process to identify the needs of the
nurses (the culture) and perceived barriers and facilitators
(readiness) to develop professional development initiatives
to build nurse competency with the EBP process.
Raising awareness of EBP in the clinical setting has been
increasingly emphasized in the provision of nursing care
since the 1990s (Melnyk & Fineout-Overholt, 2011; Pravikoff
et al., 2005; Upton & Upton, 2006). EBP involves integrat-
ing the best available evidence with clinical expertise and
patients’ values and preferences in order to make a clinical
decision that will positively affect patient outcomes (Melnyk
& Fineout-Overholt, 2011; Sackett, Rosenberg, Gray, Haynes,
& Richardson, 1996; Shaneyfelt et al., 2006). Competency in
EBP, therefore, requires practicing nurses to develop a spirit
of inquiry (Melnyk, Fineout-Overholt, Stillwell, & Williamson,
2009), ask a clinical question, search relevant literature and
resources, appraise the evidence, integrate the findings effec-
tively and appropriately into practice, evaluate the outcomes,
and disseminate the EBP results (Brown et al., 2009; Ilic,
Tepper, & Misso, 2011; Melnyk et al., 2004; Melnyk & Fineout-
Overholt, 2011; Melnyk, Fineout-Overholt, Stillwell, &
Williamson, 2010; Upton & Upton, 2006).
There is a growing body of research and literature ex-
ploring the implementation, barriers, and facilitators of
EBP (Beskine, 2009; Pravikoff et al., 2005), nurse educators
involved in qualified staff training (Grant et al., 2012;
Hagler et al., 2012), and the impact of mentoring programs
74 www.jnpdonline.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
(Melnyk, 2007; Newhouse, 2009). Little if any research,
however, has explored the EBP practice, knowledge, skills,
and attitudes of nurses involved directly in all aspects of pa-
tient care, including leadership and management. Research
still identifies inconsistencies in EBP adoption and imple-
mentation in the workplace (Heiwe et al., 2011; Jennings
& Loan, 2001; Linton & Prasun, 2013; Melnyk et al, 2012;
Penz & Bassendowski, 2006; Pravikoff et al., 2005; White-
Williams et al., 2013). The research supports that nurses
struggle to implement EBP in the workplace and lack ad-
ministrative support (Fink et al., 2005). In order to overcome
this, clinical educators can develop training to build nurses’
knowledge, attitude, and skills in EBP, and leaders can re-
move the barriers that prevent nurses from developing
EBP competencies while promoting and supporting the
transition of evidence into practice (Johansson et al., 2010;
Linton & Prasun, 2013; Melnyk et al., 2014). This study adds
to the growing body of literature to understand the EBP
knowledge and implementation gap that nurses face in clin-
ical practice.
METHODS
Purpose of the Study
The purpose of this descriptive, mixed-method research
study was to identify nurses’ knowledge, attitude, and skills
with the EBP process and the perceived barriers and facil-
itators they face when using and implementing EBP
competencies. It was designed to find patterns of adoption
and implementation of EBP and highlight how nurses can
best be supported in their practice. The study aimed to pro-
vide insight into nurses’ patterns of adoption and
implementation of EBP and the perceived barriers and fa-
cilitators of fostering EBP competency. In combination, this
will help to identify those areas that need particular focus to
ensure the nurses’ learning needs are met by educational
programming.
Sample and Setting
The healthcare system and academic institution’s institu-
tional review boards approved the study to be conducted
in a healthcare system in the Mid-Atlantic region. The
healthcare system consists of four hospitals including
homecare and hospice services. A population of approxi-
mately 1,500 registered nurses was recruited to participate
in the study. Only 215 participants attempted the survey,
leading to a very low response rate. With efforts to increase
the sample size by extending the survey by 2 weeks and
sending e-mail reminders to the registered nurses encour-
aging them to complete the survey, 151 completed the
Evidence-Based Practice Questionnaire (EBPQ) section
of the survey (7% response rate). However, the qualitative
questions provided information rich details on the per-
ceived barriers and facilitators of EBP through saturation
March/April 2015
of concepts provided by the participants who completed
the qualitative questions on the survey (n = 173).
The online survey consisted of three parts: demographic
questions, the EBPQ, and five qualitative questions. The
demographic questions consisted of area of employment,
gender, age range, job title, and professional certification.
The 24-item EBPQ questionnaire is comprised of three sub-
scales: practice (self-reported implementation), attitude,
knowledge/skill, and four qualitative questions (Upton et al.,
2014). It was found to have evidence of both construct and
discriminate validity and has shown good internal reliability;
the entire questionnaire has previously reported a Cronbach’s
alpha of .87 and alphas ranging from .79 to .91 for the three
subscales (Upton et al., 2014; Upton & Upton, 2006). The
overall reliability reported for this study was .96. The authors
of the EBPQ tool provided permission to use the tool in this
study. The survey also asked participants about their opin-
ions of the key barriers and facilitators they experience with
the uptake of EBP in the workplace. The EBPQ tool has
been used in approximately 27 studies, translated into five
languages and used with variety of professional groups
(Upton et al., 2014). It is considered one of the well-known
tools to assess organizational culture and training needs
prior to developing professional development initiatives
(Upton et al., 2014).
Procedure
The sample was recruited by e-mail and by a link placed on
the intranet of the workplace. Completion of the online sur-
vey was considered as consent to participate in the study.
Participants were informed that they could discontinue the
survey at any time. A recruitment letter was sent during the
first week the survey was open. Subsequent e-mail re-
minders were sent every week to maximize the participation
rate for the 6 weeks the survey was open. The survey was con-
fidential; no names, IP addresses, or e-mails of participants
were collected or linked to a unique ID that was created by
the participant. It took approximately 10 minutes to complete
the survey. Data analysis included descriptive statistics and
correlations for comparison across settings using SPSS 22,
and the open-ended questions were analyzed using thematic
content analysis (Braun & Clarke, 2006), which provides a
TABLE 1 Descriptive Statistics
n Minimum
EBPQ_MEAN 151 1.96
Knowledge_MEAN 151 1.00
Attitude_MEAN 151 2.00
Skill_MEAN 151 1.63
Valid N (listwise) 151
Journal for Nurses in Professional Development
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
means of identifying the most salient themes arising from
participants’ experiences. Because of the low response rate
on the EBPQ, only descriptive statistics could be computed.
This was a major limitation of the study, and therefore, data
findings were unable to be generalized.
Results
The results of this study have implications for nurses’ up-
take of EBP and the barriers and facilitators of implementing
EBP in the practice setting.
The demographic information showed that the nurses
were mostly female (94%); average age range for partici-
pants was 46Y55 years old. Staff nurses (76.5%) were the
majority; the remaining participants held a leadership posi-
tion (23.5%). The areas of critical care (39%), medical/
surgical/behavioral health (32%), maternal child health
(12%), perioperative (13%), and homecare/hospice (4%)
were represented. Nurses reported having a professional
certification (43%), although not as many nurses reported
enrolling in an academic nursing program (15%). Although
the sample size was small, the demographic data reflected
proportionately those of the organization. Table 1 demon-
strates the average scores of the EBPQ and its subscales of
knowledge, attitude, and skill.
Data Analysis
Because of the low number of participants, descriptive
statistics were applied. A MannYWhitney U test was
performed to explore if differences on the three EBPQ
subscales existed between staff nurses (n = 105) and those
in a management position (n = 35). There was a signifi-
cant difference between groups on the EBP subscale
knowledge (U = 1153, p = .001), EBPQ subscale attitude
(U = 1072, p = .000), and EBPQ subscale skill (U = 1123,
p = .001). This indicated that there is a significant differ-
ence between staff nurses and those in a management
position in knowledge, attitude, and skills in EBP. Partic-
ipants who are in a management position have a higher
median rank than staff nurses (see Table 2).
EBPQ. Even though the sample size was small and the
ability to generalize to a larger population is difficult, from
a professional development perspective, to have some
Maximum Mean Standard Deviation
6.92 4.74 1.16
7.00 4.54 1.63
7.00 5.39 1.21
7.00 4.65 1.21
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TABLE 2 Median Differences Between ceived a lack of research skills (27.1%), converting informa-
tion into a research question (39%), awareness of major
Groups on Self-Reported information types and sources (28%), how to retrieve evi-
Evidence-Based Practice dence (27.7%), ability to analyze evidence against a set
Questionnaire standard (28%), determine validity (26%), and reliability
(23%) of the evidence.
Mean Sum of
Q6Job title n Rank Ranks A concept analysis framework was used for analyzing
the qualitative part of the study (Grandeheim & Lundman,
Knowledge_MEAN Staff Nurses 105 63.99 6,718.50 2004). The findings emerged from the data by coding the
Manager/ 35 90.04 3,151.50 participants’ responses and categorizing them into specific
Leaders themes. To ensure trustworthiness, the researchers were in
Total 140
agreement with the identifying themes from the participants’
responses to the questions (Grandeheim & Lundman, 2004).
Attitude_MEAN Staff Nurses 105 63.21 6,637.00
Perceived Barriers
Manager/ 35 92.37 3,233.00 Regarding barriers to the EBP, five themes were found as
Leaders barriers for the EBP process: resources, knowledge, time,
Total 140 staffing and workload, and rules and regulation.
Resources. One of the main barriers to EBP that was re-
Skill_MEAN Staff Nurses 105 63.70 6,688.00 peated frequently in the study was the lack of resources.
Manager/ 35 90.91 3,182.00 Nurses expressed the feeling that the resources were lack-
Leaders ing, such as computers, access to Internet, training and
mentoring, and clinical educators. Nurses asked to have
Total 140 easy access to hospital library, to have time to search for
EBPQ_MEAN Staff Nurses 105 63.22 6,638.00 evidence, and to get more supplies and equipment.
(All quotes in italics are statements by participants in the
Manager/ 35 92.34 3,232.00 study).
Leaders
‘‘Not enough training opportunities and perception that
Total 140 it takes too much time.’’
‘‘The lack of educators in the system to introduce EBP.’’
Knowledge. Another barrier that faces nurses for
understanding of the gap in nurses’ EBP knowledge is es- implementing EBP is the lack of knowledge related to
sential for the development of appropriate educational the EBP process. Subthemes emerged and included lack
interventions. The participants in the EBPQ knowledge of EBP knowledge and its utilization, lack of the distribu-
scale showed that they were comfortable with formulating tion of knowledge, and lack of access to evidence. Nurses
a PICOT (Population, Intervention, Comparison, Outcome, specified the need for more education regarding the EBP
and Time) question as the beginning process of EBP (64%). and its utilization. The perception of lack of educators in
The ability to search for and collect the evidence from the the system to introduce EBP was a subtheme; it is important
PICOT question (61%) was followed by the ability to criti- to note that the clinical nursing education department was
cally appraise the evidence (54%) against a set criterion. staffed and utilized current tools and education methodolo-
The participants perceived the ability to integrate evidence gies such as access to health-related databases, computers,
(40.3%), evaluate outcomes (47.7%), and disseminate in- and computer-based educational programming. In addition,
formation with colleagues (40.7%) as being more difficult. proper communication of current evidence and coordination
The EBPQ attitude subscale showed that nurses were of training sessions are helpful in the adoption of EBP concept.
positive toward EBP with ‘‘my practice has changed be- Many nurses emphasized the role of inservice department in
cause of evidence I found’’ (90%) and that EBP is fundamen- increasing the awareness of EBP and its utilization.
tal to professional practice (93.3%). On the other hand, there ‘‘Staff lack of knowledge or misunderstanding of what
was the perception that the workload was too great, yet it is EBP is and how it should affect nursing practice; having
important to make time in the work schedule (67.5%) while strong leaders who are versed in researching and
questioning practice (85.4%) was positive. The EBPQ skills implementing EBP.’’
scale showed the nurses’ ability in areas such as monitoring ‘‘Lack of knowledge regarding the latest evidence. Lack
and reviewing of practice skillsVreflection (88.1%), shar- of institutional support.’’
ing ideas with colleagues (88.7%), and the ability to review Time. Many nurses articulated that time acted as a bar-
their own practice (87.4%). Areas noted that participants per- rier to implement EBP. The process of EBP can be time

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consuming, especially if a nurse is not aware of how to
search for articles using various types of databases. Time
constraints and high demanding work make it difficult for
the nurse to implement EBP. Nurses asked for more time to
search and to share knowledge among themselves.
‘‘Not enough time during working paying hours and em-
ployer not providing the time, and I don’t think they think
it’s important.’’
‘‘I feel that time is the biggest issue. There is a lot of time
devoted to paperwork/documentation instead of actual
bedside care.’’
Staffing and workload. Nurses’ perceived lack of proper
staffing, high nurseYpatient ratio, and workload represented
as barriers to EBP. Many nurses said that they are very busy
and overwhelmed with many responsibilities. As a result,
they feel more stress and lack the motivation to learn. They
request for more staffing, such as more supporting staff and
clinical educators.
‘‘The work load is a lot, so at times it kind of seems like
you are just doing what you know.’’
‘‘Understaffed nursing and understaffed ancillary help,
puts more responsibility on me to do other things that
take me away from the bedside.’’
Rules and regulations. Resistance to change and conflicts
with doctors or hospital staff are two subthemes that came
from the main theme, rules, and regulations. These can act
as positive or negative factors. Nurses believe that if there are
clear protocols and policies, then the process of implementing
EBP would be easier. In addition, administrative support is
very important to enhance change in practice and to alleviate
resistance.
‘‘Inconsistency of care among physicians and
AdministrationIlack of educators among staff.’’
‘‘Hospital policy, no one likes change, hard to break old
habits.’’
Perceived Facilitators
Five themes have emerged as facilitators for EBP process.
Nurses responded to a question regarding the factors that
support and help in utilizing EBP as noted by the following
themes: experience, knowledge, resources and time, and
support.
Experience. Nurse’s experience plays an essential role
in the implementation of EBP. With more experience, more
awareness of the process and more implementation may
take place. Experience can bridge the gap between theory
and practice.
‘‘Being informed how to change my practice and how
these changes are more beneficial than current practice.’’
Knowledge. Improving EBP knowledge and providing
resources for implementing EBP can help in effective utili-
zation of EBP process. In order to keep up-to-date knowledge,
nurses asked for more training, support, and dissemination
Journal for Nurses in Professional Development
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
of knowledge. Some nurses suggested the need to be in-
volved in professional committees, where they can help in
the process of change in practice.
‘‘Being informed how to change my practice and how
these changes are more beneficial than current prac-
tice.’’
‘‘Reading nursing journal article, attending nursing
conferences. Changing practice according to EBM [sic]
happening on my unit.’’
Resources and time. Having the required resources can
facilitate the process of EBP implementation greatly. Re-
sources can be in the form of having more computers, more
access to the Internet and databases, more time and staffing,
and having a mentoring program and clinical educators. In
addition, providing resources and time for nurses to search
for evidence and be involved in the process would have a
positive impact on EBP process. However, in some hospi-
tals, the perception of a lack of resources is determined by
the lack of budget awareness or whether the hospital is in a
union contract. In order to overcome the perception of a
lack of resources, an organization can work toward inclu-
sion of staff in the distribution of funds through a shared
governance process.
‘‘A certain dollar amount per year to spend on educa-
tional opportunities to keep up with the latest practices.’’
‘‘I think more resources would allow us to provide better
evidence-based care to our patients.’’
Support. Nurses believe that support from administrative
personnel, nursing managers, and peers are important for
the successful implementation of the EBP process. Support
can help in enhancing the attitudes toward EBP implemen-
tation and in reducing the resistance toward the change in
practice.
‘‘Having management take a look around and be real-
istic as to what needs to change in order to improve and
to support these changes.’’
‘‘Being encouraged and/or assisted to find EB articles,
and support when change in practice is warranted.’’
In general, the nurses have positive attitudes toward
implementing EBP. However, factors like time, resources,
knowledge, and support are important to be addressed.
Finding solutions to these factors are important if EBP is
to be successful. Having positive attitudes toward EBP
would increase nurses’ confidence in decision-making
and would improve the quality of care provided to patients.
Nurses in leadership positions can play a major role by be-
ing role models, building relationships, and advocating for
and cultivating an environment in which the EBP process is
utilized.
‘‘Collaborating with colleagues over an issue at work and
brainstorming and sharing new information and
questioning the way something has always been done by
looking into EBP articles.’’
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 ‘‘When policies are changed according to EBP, it facili-
tates better patient outcomes.’’
DISCUSSION
Limitations
The study is limited by its small sample size on the EBPQ
and the limited amount of data from only one healthcare
system, which includes three small hospitals and one large
unionized hospital indicating the potential for sampling bias.
Participants who were more confident in using a computer
and taking online surveys or who held a strong belief one
way or another regarding EBP may have been more likely
to participate. The response rate was quite low as noted by
the small sample (n = 151) who completed the quantitative
part of the survey. The constraints due to the sample size
and sensitivity for the t test allowed for our sample to detect
a modest effect size (0.03) based on a confidence interval of
95%, a margin of error of 0.05, and a moderate target sample
of 111 (using G*Power; Faul, Erdfelder, Buchner, & Lang, 2009).
Strengths of the study are in the themes generated from
the qualitative data collected, saturation, consistency of
themes, and the positive attitude of the nurses toward EBP.
To avoid confirmation bias, there was prolonged engage-
ment with the data, selection of the units of meaning, peer
checking, and providing rich descriptions the participants
provided.
Implications: System Culture
There are many suggestions for identifying ways to support
nurses, nurse educators, and nurse leaders in their roles in
enhancing the work environment in the development of a
culture of inquiry and in the use of evidence in establishing
best practice. Sammer et al. (2010) in a systematic review
with meta-analysis points out that in order to develop a cul-
ture of safety, leadership needs to align its mission and
vision, develop staff competency, and provide adequate
fiscal and human resources. In order to provide this sys-
tematic change, other factors such as teamwork and EBP
are a necessity (Sammer et al., 2010). In order for systems
to change, an organization must learn from its mistakes and
put in process that improve the delivery of care (Sammer et al.,
2010). Coomarasamy and Khan (2004) noted that improv-
ing the knowledge base is not likely to change skills,
attitudes, and behavior. They believe that, to foster change
and encourage practice of EBP, clinical educators need to
integrate teaching the EBP process into clinical practice.
‘‘This is because the ultimate aim on improving care could
not be achieved with changes in knowledge and skill
aloneVit would also require changes in attitudes and be-
havior’’ (Coomarasamy & Khan, 2004, p. 4). Responsiveness
of the nursing organization to the survey results will poten-
tially enhance education on and implementation of EBP,
improve patient outcomes, optimize the work environ-
ment, and contribute to the nurses’ job satisfaction.
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Organizational Implications
There are many lessons learned from this study for the fea-
tured healthcare system. The results of the study helped the
researchers from the healthcare system identify factors that
act either as barriers or facilitators toward implementing
EBP. In addition, the results recognized areas of focus to
ensure nurses’ learning needs are met by educational pro-
gramming. Therefore, ways to support nurses, nurse
educators, and nurse leaders in their roles of implementing
EBP were identified. There are measures that need to be
established to enhance the EBP utilization, such as enhanc-
ing the work environment (Johansson et al., 2010; Linton &
Prasun, 2013; Melnyk et al., 2009), developing a culture of
inquiry (Melnyk et al., 2009), providing resources and sup-
port (Sammer et al., 2010), and utilizing the EBP process to
establish best practices (Melnyk et al., 2014). Utilizing all
these measures will aid in improving quality outcomes.
There are many steps that nurses in the clinical education
department need to implement for effective EBP utilization.
For example, the work environment needs to be enhanced
by identifying opportunities for staff professional develop-
ment, encouraging networking and electronic applications
that might support EBP, and identifying strategic organiza-
tional initiatives associated with EBP.
Nursing administration can make a concerted effort to
enculturate EBP into shared governance councils in their
organizations. The opportunity for each council to begin
a meeting with an appraisal of a current journal article on
a clinical issue affecting nursing is a key to getting nurses
reading, understanding, and learning how a body of evi-
dence can influence care. As a result, potential EBP projects
can be constructed when nurses communicate and share
issues, research studies, and projects. Furthermore, work
needs to be done to integrate EBP knowledge and dissem-
inate into the workplace. Additional opportunities exist at
the administrative level for professional development and
in subsequent implementation of EBP projects. Leaders in
the organization are major stakeholders in the encultura-
tion and execution of EBP. Administrative leaders along
with staff nurses should select the right EBP model for im-
plementation in their organization. Selecting the right
model can lead to the development of role models and
mentors who can help in facilitating the uptake of EBP
and connecting it to outcomes (Melnyk & Fineout-Overholt,
2011).
Nursing Implications
The findings of this study can be utilized in the process of
strategic planning for the staff development department. As
professionals, nurses must keep their knowledge up-to-
date and be involved in the EBP process (Melnyk et al.,
2014). The development and utilization of EBP validates
the nursing contribution to the healthcare team and its ul-
timate goal of improving patient outcomes with value-
March/April 2015
based outcomes. Implementation of EBP, as reflected in
the study, will require partnerships among bedside nurses,
nurse educators, and administration (Hagler et al., 2012;
Linton & Prasun, 2013; Melnyk et al., 2012). The four main
nursing implications identified include the following: edu-
cation on the evidence-based process, staying up to date,
development of EBP projects, and sharing and dissemina-
tion of information. Education on the EBP process can be
accomplished through the utilization of evidence in the de-
velopment of policies and procedures, staff inservices,
computer-based learning programs, educational support
at the unit council level, and partnerships at the collegiate
level. Staff should be encouraged to question practice,
share ideas and knowledge, and be supported by nurse
leaders in the effort to create change.
Time and workload has been identified as a barrier in
this study as well as many others (Fink et al., 2005; Pravikoff
et al., 2003, 2005). Staying up to date on new information
can be a challenge. This requires individual engagement.
Health systems provide opportunities for staff input
through practice councils, unit councils, research days,
inservices, and continuing education opportunities for staff
to grow professionally. Nursing must find these opportuni-
ties valuable and participate in them.
Implementation of EBP can be aided by resources such
as computers, educational programs, journal clubs, and
unit council support to help facilitate and infuse the bed-
side nurse with the tools to question practice at the
bedside (Hagler et al., 2012; Melnyk, 2007; Varnell et al.,
2008). Nursing ownership for improved outcomes along
with the tools and support for EBP implementation can
strengthen the use of EBP at the bedside. Finally, the shar-
ing and dissemination of information challenge can be met
through utilizing software to share and collaborate online,
strong unit council leadership communication skills, iden-
tification of change champions, and a dedicated team of
professionals leading the way for EBP at the bedside.
EBP knowledge can be emphasized, disseminated, and uti-
lized in many work settings, such as in council meetings,
nurses’ week, and nursing conferences.
Conclusion
If we are going to meet the Institute of Medicine’s 2020
goal, 90% of all clinical decisions be evidence-based, then
we need to ‘‘build organizational cultures that support EBP,
implement strategies to enhance nurses’ EBP knowledge
and skills, and provide environments where EBP can thrive
and be sustained’’ (Melnyk et al., 2012). EBP needs to be a
required component of nursing practice for providing quality
care (Upton & Upton, 2005). This study has indicated that
nurses’ attitude toward EBP is positive; however, many fac-
tors act as barriers to the implementation of EBP process.
Identifying barriers and/or facilitators toward implementing
EBP will provide a starting point for any healthcare system to
Journal for Nurses in Professional Development
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
review their education and training programs (Upton et al.,
2014). Therefore, a collaborative work among various
health systems’ personnel (i.e., nurses, clinical educators,
and managers) is crucial (Melnyk et al., 2012, 2014).
Many steps are needed to enhance the uptake of EBP,
such as enhancing organizational culture and workforce
training to developing EBP interventions (Melnyk et al.,
2014; Upton et al., 2014). Nurses in a leadership position
may be a key in accelerating a more rapid shift toward
EBP and in strengthening the beliefs about the benefits of
evidence-based care (Fink et al., 2005; Melnyk et al., 2014).
In addition, access to EBP mentors should be provided as
well as interactive educational workshops (Fink et al.,
2005; Hagler et al., 2012; Melnyk, 2007; Melnyk & Fineout-
Overholt, 2011). Upton and Upton (2005), along with
Melnyk et al. (2014), acknowledge that in order to sustain
EBP leaders need to find the required funding and time to
overcome the challenges to foster the culture and imple-
ment EBP in healthcare settings. As leaders, educators,
and nurses, we need to ensure the care we provide is unique
yet consistent for every patient, and it is the best possible
way to provide that care.
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