Barriers to evidence-based medicine among nurses in LMICs

6 January, 2019

Dear HIFA colleagues,

This new paper is written by researchers from Afghanistan, Iran and Uganda. Unfortunately the full text is restricted access. The abstract describes emerging themes, but these are not prioritised and the conclusion is generic. The review appears to include 'nurses' generally, which would embrace a huge range of educational/training levels. It would be interesting to know more about the level of understanding of what EBM is (and what it isn't) - among both nurses and doctors in different countries/settings.

CITATION: Shayan SJ(1)(2), Kiwanuka F(3), Nakaye Z(4).

Barriers Associated With Evidence-Based Practice Among Nurses in Low- and Middle-Income Countries: A Systematic Review.

Worldviews Evid Based Nurs. 2019 Jan 3. doi: 10.1111/wvn.12337


BACKGROUND: Evidence-based practice (EBP) is both a goal and an approach that requires a combination of clinical experience with the most credible recent research evidence when making decisions in healthcare practice. The approach has been widely embraced; however, an evidence-to-practice gap still exists.

AIM: To assess barriers to EBP among nurses in low- and middle-income countries.

METHODS: This review conforms to the PRISMA statement. Databases PubMed, Scopus, EMBASE, and Web of Science/Knowledge were searched using a combination of keywords that included "barriers," "evidence-based practice," and "nurses." The references of the selected articles were also hand-searched to obtain additional relevant articles. Studies published in peer-reviewed journals in English between 2000 and 2018 were included in the review.

RESULTS: Sixteen articles were included in the analysis, with a total number of 8,409 participants. Both qualitative and quantitative studies were included in the review. Three main themes emerged from eight categories found. The three main themes were institutional-related barriers, interdisciplinary barriers, and nurse-related barriers. The theme of institutional-related barriers emerged from four categories, which included scant resources, limited access to information, inadequate staffing, and lack of institutional support. The theme of interdisciplinary barriers emerged from subcategories that included lack of communication between academic and clinical practice environments, inconsistency between education and practice in the nursing discipline, lack of teamwork, and the public's negative image about the nursing profession. Finally, the theme of nurse-related barriers emerged from categories including perceived limitations in the scope of nurses' practice, time, knowledge of EBP, and individual-related barriers.

LINKING EVIDENCE TO ACTION: These findings may guide the design of future interventions aimed at fostering EBP. Implementing EBP in practice should be systematic and requires institutional will and interdisciplinary and individual

commitment. It should be a collective goal and a win-win situation for nurses, clinicians, and healthcare organizations.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: