Tehran University of Medical Sciences, Department of Community Health Nursing, Tehran, Iran.
Kabul University of Medical Sciences, Kabul, Afganistan.
Worldviews Evid Based Nurs. 2019 Feb;16(1):12-20. doi: 10.1111/wvn.12337. Epub 2019 Jan 3.
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.
To assess barriers to EBP among nurses in low- and middle-income countries.
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.
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.
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.
循证实践（EBP）既是一个目标，也是一种方法，即在医疗保健实践中做出决策时，需要将临床经验与最新的最可信研究证据相结合。这种方法已经得到了广泛的接受；然而，仍然存在证据与实践之间的差距。
评估中低收入国家护士实施循证实践的障碍。
本综述符合 PRISMA 声明。使用包含“障碍”、“循证实践”和“护士”的关键词组合，在 PubMed、Scopus、EMBASE 和 Web of Science/Knowledge 数据库中进行了搜索。还对选定文章的参考文献进行了手工搜索，以获取更多相关文章。纳入了在 2000 年至 2018 年期间以英文发表在同行评议期刊上的文章。
有 16 篇文章被纳入分析，共有 8409 名参与者。综述中包括定性和定量研究。从 8 个类别中出现了 3 个主要主题。这 3 个主要主题是机构相关障碍、跨学科障碍和护士相关障碍。机构相关障碍主题从包括资源匮乏、信息获取有限、人员配备不足和缺乏机构支持等 4 个类别中出现。跨学科障碍主题从包括学术和临床实践环境之间缺乏沟通、护理学科教育与实践之间的不一致、缺乏团队合作以及公众对护理职业的负面形象等亚类别中出现。最后，护士相关障碍主题从包括护士实践范围、时间、EBP 知识和个人相关障碍等类别的感知限制中出现。
这些发现可能为未来旨在促进 EBP 的干预措施的设计提供指导。在实践中实施 EBP 应该是系统的，需要机构的意愿和跨学科及个人的承诺。这应该是一个共同的目标，对护士、临床医生和医疗机构来说是双赢的局面。
