Attitudes Towards Implementation of Evidence Based Practice


The term of evidence based practice (EBP) was firstly used in medicine as evidence based medicine, after that the term developed and being used in nursing with purpose of build up scientific database to improve nursing as science (Colyer and Kamath, 1999). Evidence based practice was passed through three stages; in which the EBP was appeared in Old Testament which was the first form and appearance of EBP; after that the EBP was developed in different form in middle ages, in which the period of middle ages was considered a stage of “renaissance” of the EBP which characterized by beliefs-related methods of treatment; the third stage of EBP was the modern stage, in which the modern stage considered the last version of EBP that began at 1972; in which the modern version of EBP was the EBP that widely known form among highly educated and professional nurses (Claridge and Fabian, 2005).

The Bible was the oldest known source in EBP documentation, in which the Bible contains a story that was represented as an interventional research that progress for ten days (Weingarten, 2003); the story in the Bible said ” Then Daniel said to the guard whom the master of the eunuchs had put in charge of Hananiah, Miscael and Azariah and himself “.Submet us lo this rest for ten days. Give us only vegetables to eat and water to drink: then compare our looks with those of the young men who have lived on the food assigned by the king and be guided in your treatment of us by what you see.” The guard listened to what they said and tested them for ten days. At the end of ten days they looked healthier and were better nourished than all the young men” (Claridge and Fabian, 2005, P. 548).

During the second stage of EBP (1700s-1900s), the EBP was restricted to believes-related methods of treatment; in which “Blood-letting” was the main treatment for many diseases in middle age period (Klar and Donner, 2002). Physicians and priests were used “Blood-letting”; in which Physicians and priests were believed that diseases caused by wicked souls; in which the diseased patients should be injured to expel the wicked souls with blood outside of patients’ bodies (Klar and Donner, 2002).

During the last four decades, the EBP was featured in a modern form; in which the borderline for modern period of EBP was began in 1972 by Archie Cochrane (Klar and Donner, 2002). Cochrane (1972) published a paper with title of “Effectiveness and efficiency: random reflections on health services”; in which the paper was discuss and evaluate the effect of randomization (the randomization was regard to patients and regard to intervention) on the outcomes of the patients’ health. The Cochrane’s paper was the first paper reflects the importance of randomized clinical trials; in which Cochrane was found that the randomization of the sample and intervention will exhibit evidence with high quality which improve the quality of health care provided and improve health outcomes of the patients (Cochrane, 1972).

Melnyk and Fineout-Overholt (2005) defined EBP as a knowledge-based conflict-resolving strategy that performed by adapting best available evidence to provide best possible care for patients and their families. Furthermore, Evidence Based Practice is a process of integration of research-based results which contribute to achieve best practice (Institute of Medicine, 2001). In addition, Sackett, Rosenberg, Gray (1996) estimated that evidence based practice is synchronous combination of professional nursing experience and research with high level of evidence under patient’s believes and values consideration. Besides that, Ingersoll (2000) documented that evidence based practice is “meticulous, unambiguous, and well-judged theoretical information and reliable research-findings to provide effective decisions about patients’ care regard to patients’ and organizational needs” (P. 152). Furthermore, evidence based practice defined as “Explicit and judicious decision making about health care delivery for individuals or groups of patients based on the consensus of the most relevant and supported evidence derived from theory-derived research and data-based information to respond to consumers’ preferences and societal expectations” (Driever, 2002, p. 593).

Evidence based practice is considered as a magical solution for complicated health problems (Institute of Medicine, 2001). Furthermore, evidence based practice considered wide discipline term used as a solution to clinical-related problems which began to provide findings and basics of clinical decision on best reliable and evident researches with purpose of improving health care provided (Sackett, Strauss, Richardson, Rosenberg, and Haynes, 2000). The Institute of Medicine (2001) was illustrated that EBP process provide intensive care to patients, using effective recent researches to achieve desired outcomes, and provide cost effective standard care. In addition, another study found that EBP enhance nurses’ professions by improving nurses’ knowledge and skills to analyze, understand and develop research (Melnyk and Fineout-Overholt, 2005). Evidence Based Practice improves nurses’ ability to be excellence profession in areas of practice, and improves patients’ health outcomes by providing high qualified nurses (Institute of Medicine, 2001).

Evidence based practice improve patients’ outcomes within four dimensions; clinical dimension (improve signs and symptoms of patients’ diseases), life quality dimension (improve patient satisfaction upon to life), functional dimension (improve patients ability to achieve daily living activity), and economic dimension (using EBP was prove ensure of cost effectiveness for patient and hospital) (Weaver, Warren, and Delaney, 2005). In addition, Newhouse, Dearholt, Poe, Pugh, and White (2005) demonstrated that the evidence based practice improve “efficacy” of health care provided to achieve pleasurable patient’s outcomes, save patients/nurse time, and use of EBP considered cost effective for patients, families, and hospitals.

Melnyk, Fineout-Overholt, Sadler, and Green-Hernandez (2008) documented that implementation of evidence based practice can be achieved by improving nurses’ knowledge and skills about research and evidence based practice, improve and strengthening nurses’ beliefs to reinforce nurses to be integrated within evidence based practice environment. Evidence based practice education allow nurses to formulate and answer any research question raised from clinical area by recent and reliable researches, allow nurses to critique and evaluate any research according to level of evidence, allow nurses to conduct researches according to patients’ needs; family; nurse; and hospital needs, and allow nurses to share research findings as journal club activity (Melnyk, Fineout-Overholt, Sadler, and Green-Hernandez, 2008).

Another study conducted by Wolf and Greenhouse (2007) documented that using of EBP is significantly needed in clinical practice, in which EBP pleasured to achieve improvement in patientfamilynurse education regard to condition and treatment, improve quality of health care provided by nurse and hospital, improve using new technology in clinical setting as computers, and build nurses community prepared with recent scientific information.

Most of health care provided by nurses nowadays is based on traditional practice with observable lacking in evidence-based practice (Mariano, Caley, Eschberger, Woloszyn, Volker, Leonard, et, al. 2009). Furthermore, an Iranian study was conducted to identify the Iranian nurses perception toward EBP, the Iranian study was conducted by using convenience sample of 21 nurses who undergone within qualitative research design; in which the Iranian study was documented that 21 participants from nurses did not listen about the concept of “evidence based practice” before and they did not implement EBP in clinical area (Adib-Hajbaghery, 2009).

American and Netherlandic studies conducted at 1998 and 2001 respectively; was estimated that about 35% of hospitalized patients do not receive evidence based care (the nurses treat patients according to traditional care that was not based on researches) (Schuster, McGlynn and Brook, 1998; Grol, 2001); in which Estrada (2009) conducted a descriptive study to assess nurses’ knowledge and attitudes toward EBP, in which the Estrada’s study was founded that 25% of sample did not hear about EBP previously. Moreover, Melnyk and Fineout-Overholt (2007) was conducted a study to develop two scales; attitude toward EBP scale and implementation of EBP scale, in which Melnyk’s and Fineout-Overholt’s study was estimated that 40% of collected sample did not listen and dealt with the concept of EBP previously. Evidence based practice improve patients’ outcome; in contrast, lack of nurses prepared evidence based practice will affect patients’ outcomes negatively (Institution of Medicine, 2001); in which, about 25% of health care provided was not sufficient to meet patients needs and the health care provided was not safe for hospitalized patients (Schuster, McGlynn and Brook, 1998; Grol, 2001). Furthermore, Pravikoff, Pierce, and Tanner (2005) conducted a study to evaluate nurses perception to integrate within EBP which conducted by random sample of 1,097 nurses, the researchers were found that more than half of the sample did not listened about EBP previously, more than half of the sample had a negative attitudes toward EBP and those nurses was not integrated within EBP activities, 73% of the nurses had not ability to use electronic database, and all 1,097 nurses had not sufficient information about choosing best researches.

The problems that impede of EBP for nursing and medical societies has been reported by Institution of Medicine (2001) in which around 45% of patient did not received professional health care; the implementation of new discovered evidence needs about two decades at least to let the recent of evident researches to be handled and public with nurses and medical stuff worldwide, and health care providers were not adequately prepared to translate recent researches in clinical practice.

Hunt (1996) concluded that there is a wide whole between using the findings of researches and clinical practice; in which an interventional study was conducted to evaluate the effect of educational intervention on nurses’ knowledge and attitudes toward EBP, the pre- test of these educational study was showed that 50% of 49 convenience sample of nurses did not listen about EBP and professional health care provided previously (Varnell, Haas, Duke, and Hudson, 2007). In addition, Melnyk (2006) concluded that the implementation of evidence based practice was little in nursing that explained by Hunt (1996) who documented that there are several factors prevent evidence based practice implementation as: disorientation toward research, lack of beliefs (attitudes) exhibited toward using research, and lack of understanding of research elements.

There are some barriers to EBP were appeared; these barriers limit nurses’ engagement within evidence based practice (Weaver and Sorrells-Jones, 1999). Funk, Champagne, Wiese, and Tornquist (1991) estimated that these barriers had been originated from different sources and organized within four categorical origins; characteristic of the nurse, characteristic of setting, characteristic of research and characteristic of presentation of research. Furthermore, Funk, Champagne, Wiese, and Tornquist (1991) documented that nurse can be considered as a barrier to implement EBP; in which nurses were unaware about principles of research and research process, and nurses had not sufficient time to implement EBP . Moreover, Funk, Champagne, Wiese, and Tornquist (1991) concluded that practice setting can be considered as a barrier to implement EBP; in which hospitals were not provided sufficient facilitation to implement EBP activity within clinical setting, and nurses had not ability to change patient-care procedure without getting permission from hospitals’ authority to change guidelines. Indeed, Funk, Champagne, Wiese, and Tornquist (1991) documented that research and research presentation can be considered as barrier to implement EBP; in which nurses were believed that research elements as introduction, literature review, methodology, statistical analysis, and conclusion were not understandable clearly within articles.

Melnyk (2006) concluded that nurses need applicable teaching strategies to provide nurses with adequate evidence based practice knowledge and skills and provide nurses with positive beliefs (attitudes) toward integration within evidence based practice activity. Di Leonardi (2007) documented that lecture presentation for educational intervention was considered most effective and appropriate teaching strategy; lectures were widely-spread and known perfectly to all universitiescolleges-certificated persons. In addition, Hart, Eaton, Buckner, Morrow, Barrett, Fraser, et, al. (2008) were conducted an educational intervention to teach nurses about nursing research and evidence based practice by using computer-based modules strategy; in which the result was exhibit that the educational intervention improve nurses’ knowledge and skills about using research and evidence based practice, and improve nurses’ attitude toward evidence based practice.

Lacey (1996) was evaluated 870 courses of the English National Board which contain materials enable student nurses to understand research and evidence based practice, with convenience sample of 30 nurses student; 65% of the students were demonstrated that knowledge, skills about research and evidence based practice were significantly improved after the educational intervention. Furthermore, Hundley, Milne, Leighton-Beck, Graham, Fitzmaurice (2000) compared between long term research course (six months) and short term research course (one month); the study conducted by convenience sample of 481 nurses and midwives; the result showed that nurses who integrated within long term research course were exhibited more knowledge, skills, and attitudes toward evidence based practice than respondent received short term research course.

The purposes of this study were to evaluate the effect of educational intervention about evidence based practice and nursing research lectures on the beliefs toward using evidence based practice, to evaluate the effect of educational intervention about evidence based practice and nursing research lectures on the frequency of the implementation of evidence based practice, to determine any differences between two groups (experimental and control group) regard to variables (age, gender, level of education, the experience in clinical area, and the effect of educational intervention that will be implemented), to investigate the variation among socio-demographic variables in response to evidence based practice beliefs and frequency of evidence based practice implementation, and to fixing first block in building EBP team in King Abdulla University Hospital.