Open Journal of Nursing
Vol.05 No.01(2015), Article ID:53639,10 pages

Barriers and Suggested Facilitators to the Implementation of Best Practice: An Integrative Review

Suhair H. Al Ghabeesh

Faculty of Nursing, Al-Zaytoonah University, Amman, Jordan


Copyright © 2015 by author and Scientific Research Publishing Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY).

Received 9 January 2015; accepted 25 January 2015; published 29 January 2015


It is well known that the incorporation of research findings into practice leads to less costs of health care, more personal productivity, longer and healthier lives for patients, and also will decrease pain and suffering of patients. Thus, the aim of this integrative review was to identify the barriers and facilitators of research utilization among the world and the best strategies used to overcome the barriers. A literature search was conducted by viewing relevant studies via computerized searching through EBSCO, Medline, Science Direct, Pub Med, Ovid, and Arabic Journals research databases. The number of reviewed studies was 192 and all of them in English, no studies in Arabic. Only 26 of them were selected based on inclusion criteria. Twenty six studies were included, with most using a cross-sectional survey design. The most identified barriers are lack of time, inadequate facilities and resources to implement new ideas, no enough authority to implement new ideas, lack of administrative support and others, while the most identified suggested that facilitators are improving the scientific knowledge of nurses and support from unit managers. The majority of these studies used Barriers scale which is not a standardized tool. However, there is a big gap between real situation and the identified evidences resulted from researches.


Research Utilization, Barriers, Facilitators, Nurses

1. Introduction

The “know-do gap” is a very important issue, many institutions work hard to bridge this gap. One of these institutes is “The World Health Report on Knowledge for Better Health” that encourages the investment in research on health system and to set knowledge translation as a priority. As a result to the United Nations Millennium Declaration about the importance of bridging the “know-do gap”, the Ministerial Summit on Health Research in collaboration with the Global Forum for Health Research was conducted in 2005. The summit involved more than 900 participants from 109 countries. Multiple important messages about how to achieve the Millennium Development Goals (MDGs) and the importance of real application of existing knowledge into practice were included [1] .

Additionally, in Geneva in the year 2005, many experts in research met to discuss the concept of knowledge translation and how they can set priorities of global health and strategies for knowledge translation and action [1] .

The Jordanian Nursing Council (JNC) responded to this recommendation by putting the support to scientific research as the most important priority [2] . However, nurses in clinical areas face many barriers to implement research findings [3] -[8] . These barriers differ from country to another and from clinical area to another. According to World Health Report on Knowledge for Better Health [1] , the presence of these barriers especially in developing countries will affect the achievement of the MDGs that must be achieved by 2015 mainly due to the lack of human, financial, and informational resources. Santesso and Tugwell stated that less than 10% of health research money is spent on diseases affecting developing countries [1] . Thus, this integrative review focused on barriers to RU and explored the facilitators to RU and the strategies used to increase RU.

2. Search Method

Research papers published between 1998 and 2014 were identified via searches from the following databases: EBSCO, Medline, Science Direct, Pub Med, Ovid, and Arabic Journals research databases. Searching was conducted using the following keywords: “Barriers to research utilization (RU)”, “Facilitators to RU”, “RU” and, “registered nurses”. Inclusion criteria: a study was eligible for inclusion if the study written in English and in Arabic, identify the barriers and facilitators of RU among nurses and used the words “research utilization” not “evidence based practice”. Exclusion criteria: a study was not eligible for inclusion if the study written in another languages, review papers, evidence reports, comparative studies, studies conducted in educational areas and the sample not nurses or other health professions with nurses.

2.1. Search Outcome

The search produced 192 studies, all of them written in English, no studies written in Arabic. All of 192 were assessed against the inclusion criteria. The researcher initially selected the papers by reading abstracts, in some cases; the full paper was required to determine if the study met the inclusion criteria. One hundred and sixty six studies, which failed to meet the criteria, were excluded, leaving 26 research studies summarized in Table 1.

2.2. Data Abstraction

From the 26 selected studies, the following data were abstracted and inserted into Table 1: author(s) and year of publication, purpose of the study, theoretical framework, country, sample size, design and finally the main findings. The process of selecting the final 26 studies is outlined in Figure 1.

Figure 1. The process of selecting studies.

Table 1. Chronological list of the studies that identified barriers and facilitators of research utilization.

3. Results

3.1. Characteristics of the Reviewed Studies

88% (23) of the studies used descriptive cross sectional survey design, two studies used qualitative design and only one study used retrospective design. The sample size ranged from 11 to 2600, the lowest sample size included in qualitative studies. The samples in all studies were only nurses working in various specialties and settings. Only 12% of the studies conducted in Arab countries.

3.2. Barriers to Research Utilization

Nurses in clinical areas face many barriers to implement research findings into their practice. These barriers are varying between different countries and from clinical area to another, but it’s clear that there is no changes in the barriers to RU between the years 1998 and 2014 and that most barriers are related to the characteristics of the organization, few studies tried to challenge these barriers.

The results of the reviewed studies revealed that all the twenty three studies related to barriers to RU emphasized on organizational factors that it is the main factor inhibit RU. Lack of time is the mostmentioned barrier to RU and it is mentioned in more than 73.84% (17) of the studies [5] [8] -[17] [19] -[24] . Followed by inadequate facilities and resources also mentioned by 34.72% (8) of studies [5] [9] [14] -[16] [19] [21] [22] . Then, no enough authority to change practice mentioned by 30.38% (7) of reviewed studies [5] [12] [16] [20] [22] [25] [26] . The fourth most mentioned barrier is lack of support from administrators which mentioned by 26% (6) of reviewed studies [7] [11] [12] [15] [18] [19] . While other barriers such as unavailability of research reports, lack of staff, difficulties in understanding statistical analysis, using foreign language, routines in providing nursing care dominate, lack of cooperation from physicians, vast amount of research, low skills of nurses to understand research reports, and others [23] [27] [28] .

3.3. Facilitators to Research Utilization

Several studies have investigated the suggested facilitators to RU. Bostromand his colleagues stated that support from unit managers is the greatest facilitator to RU [15] . On the other hand, in Kajermo et al.’s study, nurses mentioned 290 suggestions to facilitate RU [9] . Those suggestions were categorized into five groups; knowledge, communication, resources, support and attitudes, and research. Improving the scientific knowledge of nurses was the most frequently mentioned facilitators to RU beside the availability of “user friendly” reported research. Education in scientific methods, developing skills in searching for appropriate literature, and guidance from knowledgeable colleagues were the most suggested facilitators related to the knowledge. Translation of the articles into understandable language, presenting the results in an understandable way, information about the researches that carried out in their country and the availability of specific scientific nursing journals were the most suggested facilitators related to communication. Time, money and staffing were the category of resources that the nurses emphasized as facilitators to RU related to resources. Respect from other professionals, and interest, courage, and willingness to carry out changes, and encouragement from managers were the most suggested facilitators related to support and attitudes. More realistic and relevant research closer to reality was the most suggested facilitators related to research. Other studies emphasized the key role that the organization can play to promote RU [8] [9] .

Tsai found that RU can be facilitated through the creation of a “research corner” in each clinical unit for poster display and discussion and presentation of research findings in an open debate [10] . On the other hand, Chau, et al. found that managerial support, colleague support, and increasing nursing knowledge about research were the three greatest organizational facilitators for RU [16] .

Parahoo asked an open ended question to identify the facilitators to RU as perceived by registered nurses [25] . The respondents reported 37 facilitators. The researcher carried out content analysis and the common themes emerged were: time, manager’s support, funding\resources, support from colleagues, education and training, research presentation, and motivation. Under the theme “education and training” the opportunities for study, study days and continuing education were identified as facilitators for RU.

The greatest facilitators to RU as identified in Hutchinson and Johnston included availability of more time to review and implement research findings, availability of more relevant research and colleague support [12] . On the other hand, Leasure et al. in their study identified that the facilitators to RU comprise reading journals that publish original research, establishing a journal club, the availability of a nursing research committee and easy access to the internet [29] . The establishment of small groups three to four staff members with evidence of critical appraisal abilities to review one procedure at a time and this review should be recognized in annual evaluation was also suggested as a facilitator to RU.

In Long dissertation, the evidence-based practice guidelines developed by the Registered Nurses Association of Ontario (RNAO) in Canada was used to improve the identification and management of women receiving postpartum care in a private obstetrical practice in the United States [30] . These evidence-based practice guidelines were operationalized by the use of the Edinburgh Postnatal Depression Scale (EPDS). Upon the implementation of the RNAO Guidelines, 96% of postpartum patients were screened by the EPDS and the number of patients at risk for postpartum depression (PPD) also increased from 4.7% to 11%. The greater facilitator to this success reported was the leadership style of the organization (autonomy), which encouraged role-modeling and increased RU. Additionally, Fink, Thompson, and Bonnesin their study found that post implementation of the multidimensional intervention [31] . Journal club participation was one of the key strategies that facilitated RU.

4. Discussion

This review demonstrated that nurses faced many barriers to RU. Some of them were identified by using specific instruments and others by conducting qualitative studies. The barriers to RU were the same in all units in hospitals and around the world and didn’t change since 1998 until now. Thirty three barriers were identified in the reviewed literature; most of these barriers were related to characteristics of organization. The most identified barriers are lack of time, inadequate facilities and resources, lack of authority to implement new ideas, and lack of managerial support.

On the other hand, there are several facilitators to RU that the literature revealed. The most frequently cited facilitators were the availability of enough time to read and implement research findings, the availability of managerial support and resources. The most important strategy suggested encouraging RU is the identification of the barriers to RU and the organization effort to overcome those barriers to achieve their goals.

The majority of these studies used Barriers scale which is not a standardized tool [32] . Thus, this review will add new items to the Barriers Scale based on literature to explore further barriers and facilitators to RU.

5. Conclusion

Nursing administrators must condense their efforts to resolve these big challenges to increase the quality of life of hospitalized patients. The application of suggested facilitators into real situation must be encouraged.


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