Evidence-Based Practice Concepts and Barriers to Its Application in Clinical Practice
Evidence-based practice (EBP) is defined as the thorough use of the best available clinical evidence, aligned with the individual clinical expertise and patients’ values and choices, to guide decision-making in the healthcare field (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).
Critical thinking is a key element for EBP, whose practice can be summarized into five crucial steps:
Step 1: Formulate an answerable research question-based on the healthcare professional needs
Step 2: Detect the best evidence for answering the research question
Step 3: Critically assess the retrieved evidence and its value
Step 4: Apply the findings into clinical practice / decision-making
Step 5: Assess the performance
The development of these competences is crucial for practicing healthcare professionals to provide high-quality healthcare. Hence, it is necessary to effectively implement EBP in healthcare professionals’ curricula (Hung et al., 2019; Larsen, Terkelsen, Carlsen, & Kristensen, 2019; Young, Rohwer, Volmink, & Clarke, 2014).
Despite the positive attitude of healthcare professionals towards EBP for improving patient outcomes, several studies pointed to the little use of the evidence to guide their practice. For instance, literature shows that 66% of nurses only read health literature when needed, while around 27% of these professionals often use research findings in practice. Additionally, it is estimated that only one in four healthcare professionals incorporates EBP to guide decision-making in health settings (Andiwatir & Betan, 2019; Patelarou et al., 2017).
Once the number of EBP practitioners is increasing, it is assumed that evidence-based practice is a learnable competence. Nevertheless, significant barriers have been reported by healthcare professionals, specifically nurses, for not engaging in EBP. These barriers include lack of time, resources, and knowledge, difficulties in assessing research, and lack of perception of the benefits of applying EBP into clinical practice.
Moreover, most of the health students are taught only the first three steps of EBP, lacking the knowledge to perform the last two steps in clinical practice, which is, integrating evidence into clinical decision-making and evaluating changes in patients’ outcomes. In this sense, the most appropriate methods for teaching EBP in undergraduate, postgraduate, and continuing medical education programs have been explored over the years (Hatala & Guyatt, 2002; Horntvedt, Nordsteien, Fermann, & Severinsson, 2018; Larsen et al., 2019; Long et al., 2016).