Letter to the Editor: Evidence-based practice for nursing profession: Barriers and teaching strategies solutions.

Dear Editor,

We have read the article entitled “Improve nursing in evidence-based practice: How Chinese nurses' read and comprehend scientific literature” by Huang et al. [1] published in the International Journal of Nursing Sciences. We would like to appreciate and strongly support the authors' efforts in pointing out the importance of Evidence-Based Practice (EBP) in nursing. Nurses are required to adhere to accepted standards of practice and professional performance. As a professional, nurses need to use evidence-based intervention and the integration of research findings into practice [2,3]. EBP is an approach to nursing care that is very important for improving patient outcomes [4], however, the previous studies have been suggested that health professional does not always use the evidence to guide their practice [1,[5], [6], [7]]. Huang et al. state that only 3.5% of nurses read literature regularly on a daily, 9.8% on a weekly, 9.3% on a monthly and 66% only read when needed [1]. Further, O'lynn et al. also state that “in terms of actual use of research findings in practice, small range of nurses (27.1%) reported using research “often” or “very often" in the past year; whereas 30.0% reported using research “rarely” or “never” in the past year” [6].

Many barriers for nurses to integrate the EBP in clinical and community setting are identified. The barriers are described as follows: (1) Human Resources: lack of knowledge about English, how to access the evidence, skill in critical appraisal of evidence and lack of time/heavy workload, lack of confidence. (2) Technology: some hospital and primary health care do not have internet network particularly in rural area. It makes the nurses difficult to access evidence from online database. (3) Material Resources: lack of training in informatics that enables easy access to the literature review, do not have critical tools for appraising the quality of research and do not have the library or limited of literature. (4) Policy: some hospitals or primary health care do not have a policy or protocol for using EBP intervention [1,[5], [6], [7], [8], [9]].

Nursing educators play an important role in mediating between research and practice, and ensuring that nursing students can access, understand, appraise, apply, and support research in practice. The teaching strategy that has proven to be effective is integrating EBP concepts into a clinical practicum. This strategy can be used to decrease the barriers in human resources (lack of knowledge to access the evidence and lack of skill in critical appraisal of evidence) and also increases EBP efficacy in nursing students [10]. The following steps are the strategies used to integrate EBP into academic nursing education: (1) Cultivate inquiry. (2) Ask a clinical question or formulating the question. (3) Searching for the best evidence. (4) Critically appraise the evidence. (6) Disseminate the findings. (7) Integrate the evidence into practice. (8) Evaluate the outcome (effectiveness and efficiency) [5,11]. In addition, Huang et al. suggest that it is also important to improve research education for nurses, create a climate that is friendly for research, make a concerted effort to provide protected time, and establish a system for nurses to access, read, communicate, evaluate and utilize research articles in hospital or medical institutional settings [1].

Nowadays nurses are facing many challenges. One of the challenges is patient more concern about their health status and quality of health care. Teaching the nursing students about the processes and skills to access, appraise, and integrate evidence into practice is essential to professional nursing in the 21st century to improve the quality of health care [2,3,11].