American Journal of Nursing Research
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American Journal of Nursing Research. 2023, 11(1), 21-45
DOI: 10.12691/ajnr-11-1-3
Open AccessArticle

Evidence-based Practice among Clinical Nurses in Bahrain: Basis for a Policy Brief

John Michael Madamba Ferrer1, and Joman Baliton2

1Graduate School, Saint Mary’s University, Bayombong, Nueva Vizcaya

2Professor, Graduate School, Saint Mary’s University, Bayombong, Nueva Vizcaya

Pub. Date: January 16, 2023

Cite this paper:
John Michael Madamba Ferrer and Joman Baliton. Evidence-based Practice among Clinical Nurses in Bahrain: Basis for a Policy Brief. American Journal of Nursing Research. 2023; 11(1):21-45. doi: 10.12691/ajnr-11-1-3

Abstract

The study aimed to determine clinical nurses' beliefs, knowledge, organizational readiness, and evidence-based practice implementation levels and identify the perceived factors affecting evidence-based practice implementation. A descriptive-correlational in quantitative approach with triangulation was used. Data were gathered through the administration of adapted survey questionnaires along with structured interviews and personal observation to supplement the data. Forty-two voluntarily participated and completed the survey. Frequency, percent, mean, and standard deviation were used to analyze and interpret the participants' demographic profile and evidence-based practice-related variables. Regression analysis was used to identify the predictors from the list of variables. For facilitating and hindering factors in the evidence-based practice implementation of clinical nurses, an open-ended question was asked to triangulate the quantitative data. Most of the nurses are female in their middle adulthood, have completed a bachelor’s degree in nursing, and have worked in the hospital as a senior staff nurse for considerable time. The result shows that nurses somewhat truly believe in evidence-based practice, have acceptable evidence-based practice knowledge, probably consider the culture and organizational readiness, and are interested in implementing specific evidence-based practice tasks. Also, it was found that only knowledge of evidence-based practice is a highly significant predictor of evidence-based practice implementation. Perceived facilitating factors include supportive policies, training opportunities, management, and peer support. At the same time, lack of knowledge and insufficient time were recorded as barriers to implementing evidence-based practice. The salient findings were used in crafting the policy brief.

Keywords:
EBP belief EBP knowledge EBP organizational readiness EBP implementation

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References:

[1]  Ramírez-Morera, A., Tristan, M., & Vazquez, J. C. (2019). Effects of evidence-based clinical practice guidelines in cardiovascular health care quality improvements: A systematic review. F1000Research, 8, 1041.
 
[2]  Norwich University Online. (2021, October 27). Why use evidence-based practice in nursing. https://online.norwich.edu/academic-programs/resources/evidence-based-practice-nursing.
 
[3]  Shayan, S. J., Kiwanuka, F., & Nakaye, Z. (2019). Barriers associated with evidence-based practice among nurses in low- and middle-income countries: A systematic review. Worldviews on Evidence-Based Nursing, 16(1), 12-20.
 
[4]  Weng, Y. H., Kuo, K. N., Yang, C. Y., Lo, H. L., Chen, C., & Chiu, Y. W. (2013). Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: A questionnaire survey in nationwide hospital settings. Implementation Science, 8(1).
 
[5]  Bakr, A. (2016). Exploring the factors affecting implementation of evidence-based nursing practice in King Fahd Hospital of the University/ Al Khobar/ K.S.A. IOSR Journal of Nursing and Health Science (IOSR-JNHS).
 
[6]  Alves S. L. (2021). Improvements in clinician, organization, and patient outcomes make a compelling case for evidence-based practice mentor development programs: An integrative review. Worldviews on evidence-based nursing, 18(5), 283-289.
 
[7]  Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). A test of the ARCC© model improves implementation of evidence-based practice, healthcare culture, and patient outcomes. Worldviews on Evidence-Based Nursing, 14(1), 5-9.
 
[8]  Yurt, S., Kolac, N., & Sadi, E. D. (2021). Nurses’ views on the use of evidence-based practice in the clinic: A qualitative study. Journal of Education and Research in Nursing, 18(2), 210-215.
 
[9]  Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2016). Translating research findings to clinical nursing practice. Journal of Clinical Nursing, 26(5-6), 862-872.
 
[10]  Lunny, C., Ramasubbu, C., Puil, L., Liu, T., Gerrish, S., Salzwedel, D. M., Mintzes, B., & Wright, J. M. (2021). Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study. PLOS ONE, 16(4), e0250356.
 
[11]  Correa, V. C., Lugo-Agudelo, L. H., Aguirre-Acevedo, D. C., Contreras, J. A. P., Borrero, A. M. P., Patiño-Lugo, D. F., & Valencia, D. A. C. (2020). Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: A systematic metareview. Health Research Policy and Systems, 18(1).
 
[12]  Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. PloS one, 16(8), e0256600.
 
[13]  Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine, 98(39), e17209.
 
[14]  Cleary-Holdforth, J., O'Mathúna, D., & Fineout-Overholt, E. (2021). Evidence-Based practice beliefs, implementation, and organizational culture and readiness for ebp among nurses, midwives, educators, and students in the Republic of Ireland. Worldviews on evidence-based nursing, 18(6), 379-388.
 
[15]  Pitsillidou, M., Roupa, Z., Farmakas, A., & Noula, M. (2021). Factors Affecting the Application and Implementation of Evidence-based Practice in Nursing. Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH, 29(4), 281-287.
 
[16]  Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to implementation of evidence-based practice in Zahedan Teaching Hospitals, Iran. Nursing Research and Practice, 1-5.
 
[17]  Weng, Y. H., Chen, C., Kuo, K. N., Yang, C. Y., Lo, H. L., Chen, K. H., & Chiu, Y. W. (2015). Implementation of evidence-based practice in relation to a clinical nursing ladder system: a national survey in Taiwan. Worldviews on evidence-based nursing, 12(1), 22-30.
 
[18]  Lunden, A., Kvist, T., Teräs, M., & Häggman-Laitila, A. (2020). Readiness and leadership in evidence-based practice and knowledge management: A cross-sectional survey of nurses’ perceptions. Nordic Journal of Nursing Research, 41(4), 187-196.
 
[19]  Al-Busaidi, I. S., Al Suleimani, S. Z., Dupo, J. U., Al Sulaimi, N. K., & Nair, V. G. (2019). Nurses' knowledge, attitudes, and implementation of evidence-based practice in Oman: A multi-institutional, cross-sectional study. Oman Medical Journal, 34(6), 521-527.
 
[20]  Kaplan, L., Zeller, E., Damitio, D., Culbert, S., & Bayley, K. B. (2014). Improving the culture of evidence-based practice at a Magnet® Hospital. Journal for Nurses in Professional Development, 30(6), 274-280.
 
[21]  Aburuz, M., Abu Hayeah, H., Al-Dweik, G., & Al-Akash, Y. (2017). Knowledge, attitudes, and practice about evidence-based practice: A Jordanian study. Health Science Journal. https://www.researchgate.net/publication/319338352_Knowledge_Attitudes_and_Practice_about_Evidence-Based_Practice_A_Jordanian_Study.
 
[22]  Park, J. W., Ahn, J. A., & Park, M. M. (2014). Factors influencing evidence-based nursing utilization intention in Korean practice nurses. International Journal of Nursing Practice, 21(6), 868-875.
 
[23]  Zhou, F., Hao, Y., Guo, H., & Liu, H. (2016). Attitude, knowledge, and practice on evidence-based nursing among registered nurses in traditional Chinese medicine hospitals: A multiple center cross-sectional survey in China. Evidence-Based Complementary and Alternative Medicine, 2016, 1-8.
 
[24]  Skela-Savič, B., Gotlib, J., Panczyk, M., Patelarou, A. E., Bole, U., Ramos-Morcillo, A. J., Finotto, S., Mecugni, D., Jarosova, D., Patelarou, E., Dolezel, J., & Ruzafa-Martínez, M. (2020). Teaching evidence-based practice (EBP) in nursing curricula in six European countries: A descriptive study. Nurse Education Today, 94, 104561.
 
[25]  Tomotaki, A., Fukahori, H., & Sakai, I. (2019). Exploring sociodemographic factors related to practice, attitude, knowledge, and skills concerning evidence-based practice in clinical nursing. Japan Journal of Nursing Science, 17(1).
 
[26]  Wu, Y., Brettle, A., Zhou, C., Ou, J., Wang, Y., & Wang, S. (2018). Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review. Nurse Education Today, 70, 109-114.
 
[27]  Skela-Savič, B., & Lobe, B. (2020). Differences in beliefs on and implementation of evidence‐based practice according to type of health care institution—A national cross‐sectional study among Slovenian nurses. Journal of Nursing Management, 29(5), 971-981.
 
[28]  Hasheesh, M.O.A. & Aburuz, Mohannad. (2017). Knowledge, attitude, and practice of nurses towards evidence-based practice at Al-Medina, KSA. Jordan Medical Journal. 51. 47-56.
 
[29]  Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence-Based Nursing, 13(1), 15-24.
 
[30]  Salem, A. (2019). Critical care nurses’ perceptions towards the challenges to adoption of evidence-based practice in the Intensive Care Units (ICUs). Alexandria Scientific Nursing Journal, 21(1), 93-107.
 
[31]  Cruz, J. P., Colet, P. C., & Alquwez, N. (2016). Evidence-based practice beliefs and implementation among the nursing bridge program students of a Saudi University. International Journal of Health Sciences, 10(3), 387-395.
 
[32]  Boström, A. M., Rudman, A., Ehrenberg, A., Gustavsson, J. P., & Wallin, L. (2013). Factors associated with evidence-based practice among registered nurses in Sweden: A national cross-sectional study. BMC Health Services Research, 13(1).
 
[33]  Patelarou, A. E., Mechili, E. A., Ruzafa-Martinez, M., Dolezel, J., Gotlib, J., Skela-Savič, B., Ramos-Morcillo, A. J., Finotto, S., Jarosova, D., Smodiš, M., Mecugni, D., Panczyk, M., & Patelarou, E. (2020). Educational interventions for teaching evidence-based practice to undergraduate nursing students: A scoping review. International Journal of Environmental Research and Public Health, 17(17), 6351.
 
[34]  Song, C. E., Park, H., Lee, M., & Stevens, K. R. (2021). Integrating EBP into an undergraduate research methodology course using the star model of knowledge transformation: A mixed-method study. Nurse Education Today, 105, 105021.
 
[35]  Rotor, E. R., Palad, Y. Y., Cayco, C. S., Perez, K., Tiu, C., & Gorgon, E. (2022). Physical therapists' evidence-based practice profile and perspectives of entry-level EBP education: a mixed methods study in the Philippines. Physiotherapy theory and practice, 38(10), 1407-1418.
 
[36]  Amit-Aharon, A., Melnikov, S., & Warshawski, S. (2020). The effect of evidence-based practice perception, information literacy self-efficacy, and academic motivation on nursing students’ future implementation of evidence-based practice. Journal of Professional Nursing, 36(6), 497-502.
 
[37]  Horntvedt, M. E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: A thematic literature review. BMC Medical Education, 18(1).
 
[38]  Cardoso, D., Rodrigues, M., Pereira, R., Parola, V., Coelho, A., Ferraz, L., Cardoso, M. L., Ramis, M. A., & Apóstolo, J. (2021). Nursing educators' and undergraduate nursing students' beliefs and perceptions on evidence-based practice, evidence implementation, organizational readiness and culture: An exploratory cross-sectional study. Nurse education in practice, 54, 103122.
 
[39]  Abu-Baker, N. N., AbuAlrub, S., Obeidat, R. F., & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: A cross-sectional study among undergraduate nursing students. BMC nursing, 20(1), 13.
 
[40]  Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of evidence-based practice through undergraduate nurse education. BMC Nursing, 16(1).
 
[41]  Garcia-Alamino, J. M. (2020). Human biases and the SARS-CoV-2 pandemic. Intensive and Critical Care Nursing, 58, 102861.
 
[42]  Evidence-Based Practice Is More Important Than Ever. (2021, February 17). University of North Carolina Wilmington Online. https://onlinedegree.uncw.edu/articles/nursing/evidence-based-practice.aspx.
 
[43]  Sharplin, G., Adelson, P., Kennedy, K., Williams, N., Hewlett, R., Wood, J., Bonner, R., Dabars, E., & Eckert, M. (2019). Establishing and sustaining a culture of evidence-based practice: An evaluation of barriers and facilitators to implementing the best practice spotlight organization program in the Australian healthcare context. Healthcare (Basel, Switzerland), 7(4), 142.
 
[44]  Correa-de-Araujo, R. (2015). Evidence-based practice in the United States: Challenges, progress, and future directions. Health Care for Women International, 37(1), 2-22.
 
[45]  Buhaid, N., Lau, R., & O’Connor, M. (2014). A survey of nurses’ perceived barriers to research utilization in Bahrain in comparison to other countries. Middle East Journal of Nursing, 8(2), 3-9.
 
[46]  Mahmoud, M. H., & Abdelrasol, Z. F. M. (2019). Obstacles in employing evidence-based practice by nurses in their clinical settings: A descriptive study. Frontiers of Nursing, 6(2), 123-133.
 
[47]  Abuhammad, S., Alzoubi, K., Khabour, O., & Mukattash, T. (2020). Jordanian national study of nurses’ barriers and predictors for research utilization in clinical settings. Risk Management and Healthcare Policy, 13, 2563-2569.
 
[48]  Sutcliffe, S., Court, J., & Overseas Development Institute (London, E. R. P. D. P. (2006). A toolkit for progressive policymakers in developing countries. Overseas Development Institute.
 
[49]  Skaggs, M. K. D., Daniels, J. F., Hodge, A. J., & DeCamp, V. L. (2018). Using the evidence-based practice service nursing bundle to increase patient satisfaction. Journal of Emergency Nursing, 44(1), 37-45.
 
[50]  Masuda, C., Ferolin, S. K., Masuda, K., Smith, C., & Matsui, M. (2020). Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study. BMC pregnancy and childbirth, 20(1), 78.
 
[51]  Mohamed, H. M., & Mohamed, A. I. (2018). Nurses’ perception, self-efficacy, barriers, and training needs for implementing evidence-based practice: Is it time for a change toward safe care? American Journal of Nursing Research, 6(6). http://pubs.sciepub.com/ajnr/6/6/29/index.html.
 
[52]  Cleary-Holdforth, J. (2019). Beliefs, knowledge, and utilisation levels of evidence-based practice among nurses and midwives in the Republic of Ireland. BMJ Evidence-Based Medicine.
 
[53]  Saunders, H., & Vehviläinen-Julkunen, K. (2016). Nurses’ Evidence-Based Practice Beliefs and the Role of Evidence-Based Practice Mentors at University Hospitals in Finland. Worldviews on Evidence-Based Nursing, 14(1), 35-45.
 
[54]  Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PLOS ONE, 14(12), e0226742.
 
[55]  Roy, C. (2009). The Roy adaptation model. Pearson Education.
 
[56]  Labrague, L. J., McEnroe‐Pettite, D., Tsaras, K., D’Souza, M. S., Fronda, D. C., Mirafuentes, E. C., Yahyei, A. A., & Graham, M. M. (2018). Predictors of evidence‐based practice knowledge, skills, and attitudes among nursing students. Nursing Forum, 54(2), 238-245.
 
[57]  Sundberg, F., Olausson, S., Fridh, I., & Lindahl, B. (2017). Nursing staff’s experiences of working in an evidence-based designed ICU patient room: An interview study. Intensive and Critical Care Nursing, 43, 75-80.
 
[58]  Rudman, A., Boström, A., Wallin, L., Gustavsson, P., & Ehrenberg, A. (2020). Registered nurses’ evidence-based practice revisited: A longitudinal study in mid-career. Worldviews on Evidence-Based Nursing, 17(5), 348-355.
 
[59]  Chijindu, A., Samantha, E., & Nkechi, E. (2016). Evaluation of barriers to the implementation of evidence-based practice (EBP) among nurses working at Federal Teaching Hospital Abakaliki (Fetha Ii). International Journal of Nursing, Midwife and Health Related Cases, 2(1), 71-90.
 
[60]  Abuejheisheh, A., Tarawneh, O., Qaddumi, J. A. S., Almahmoud, O., & Darawad, M. W. (2020). Predictors of intensive care unit nurses’ practice of evidence-based practice guidelines. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 57, 004695802090232.
 
[61]  Haneef, S., Hameed, A., Sarwar, H., & Hanif, M. (2017). Evidence based practice: beliefs and implementation among nurses. Pakistan Journal of Nursing and Midwifery. https://www.researchgate.net/publication/337337013_Evidence_based_practice_beliefs_ and_implementation_among_nurses.
 
[62]  Schaefer, J. D., & Welton, J. M. (2018). Evidence-based practice readiness: A concept analysis. Journal of Nursing Management, 26(6), 621-629.
 
[63]  Green, S. A., Bell, D., & Mays, N. (2017). Identification of factors that support successful implementation of care bundles in the acute medical setting: a qualitative study. BMC Health Services Research, 17(1).
 
[64]  Rahmayanti, E., Kadar, K., & Saleh, A. (2020). Readiness, barriers and potential strength of nursing in implementing evidence-based practice. International Journal of Caring Sciences, 13(2), 1203.
 
[65]  Alqahtani, J. M., Carsula, R. P., Alharbi, H. A., Alyousef, S. M., Baker, O. G., & Tumala, R. B. (2022). Barriers to implementing evidence-based practice among primary healthcare nurses in Saudi Arabia: A cross-sectional study. Nursing Reports, 12(2), 313-323.
 
[66]  Melnyk, B. M., Fineout-Overholt, E., & Mays, M. Z. (2008). The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldviews on Evidence-Based Nursing, 5(4), 208-216.
 
[67]  Upton, D., & Upton, P. (2006). Development of an evidence-based practice questionnaire for nurses. Journal of Advanced Nursing, 53(4), 454-458.
 
[68]  Tavakol, M. & Dennick, R. (2011). Making sense of Cronbach's Alpha. International Journal of Medical Education. 2. 53-55.
 
[69]  Pereira, F., Pellaux, V., & Verloo, H. (2018). Beliefs and implementation of evidence-based practice among community health nurses: A cross-sectional descriptive study. Journal of Clinical Nursing, 27(9-10), 2052-2061.
 
[70]  Bane, J. (2021). Beliefs about evidence-based practice among new graduate nurses. Scholar Works. https://scholarworks.waldenu.edu/dissertations/10409/.
 
[71]  Squires, J. E., Moralejo, D., & LeFort, S. M. (2007, June 5). Exploring the role of organizational policies and procedures in promoting research utilization in registered nurses. Implementation Science, 2(1).
 
[72]  Clarke, V., Lehane, E., Mulcahy, H., & Cotter, P. (2021). Nurse practitioners’ implementation of evidence-based practice into routine care: A scoping review. Worldviews on Evidence-Based Nursing, 18(3), 180-189.
 
[73]  Pueyo-Garrigues, M., Pardavila-Belio, M., Canga-Armayor, A., Esandi, N., Alfaro-Díaz, C., & Canga-Armayor, N. (2022, January). Nurses’ knowledge, skills and personal attributes for providing competent health education practice, and its influencing factors: A cross-sectional study. Nurse Education in Practice, 58, 103277.
 
[74]  Bahadori, M., Raadabadi, M., Ravangard, R., & Mahaki, B. (2016). The barriers to the application of the research findings from the nurses' perspective: A case study in a teaching hospital. Journal of education and health promotion, 5, 14.
 
[75]  Sadoughi, F., Azadi, T., & Azadi, T. (2017, July 20). Barriers to using electronic evidence-based literature in nursing practice: A systematised review. Health Information &Amp; Libraries Journal, 34(3), 187-199.
 
[76]  Mallion, J., & Brooke, J. (2016). Community- and hospital-based nurses' implementation of evidence-based practice: Are there any differences? British Journal of Community nursing, 21(3), 148-154.
 
[77]  Asurakkody, T. A., & Kim, S. H. (2020). Effects of knowledge sharing behavior on innovative work behavior among nursing students: Mediating role of self- leadership. International Journal of Africa Nursing Sciences, 12, 100190.
 
[78]  Kaseka, P. U., & Mbakaya, B. C. (2022). Knowledge, attitude and use of evidence-based practice (EBP) among registered nurse-midwives practicing in central hospitals in Malawi: A cross-sectional survey. BMC Nursing, 21(1), 144.
 
[79]  Belowska, J., Panczyk, M., Zarzeka, A., Iwanow, L., Cieślak, I., & Gotlib, J. (2018). Promoting evidence-based practice – perceived knowledge, behaviours and attitudes of Polish nurses: a cross-sectional validation study. International Journal of Occupational Safety and Ergonomics, 26(2), 397-405.
 
[80]  Malik, G., McKenna, L., & Plummer, V. (2014, October 30). Perceived knowledge, skills, attitude and contextual factors affecting evidence-based practice among nurse educators, clinical coaches and nurse specialists. International Journal of Nursing Practice, 21, 46-57.
 
[81]  Zammar, A. M. A. (2022). Nurses’ knowledge and attitude regarding evidence-based practice: An integrative review. Open Journal of Nursing, 12(02), 103-112.
 
[82]  Ahmad, M. M., Musallam, R., & Habeeb Allah, A. (2018). Nurses and internet health-related information: Review on access and utility. Medicine and Pharmacy Reports, 91(3), 266-273.
 
[83]  Naeem, S. B., Bhatti, R., & Ishfaq, K. (2017). Nurses’ attitude and belief toward evidence-based nursing practices in tertiary care hospitals of Multan, Pakistan. Isra Med J, 9(2), 101-105.
 
[84]  Zarghani, M., Nemati-Anaraki, L., Dinpajoo, Z., Ghamgosar, A., Khani, S., & Khazaee-Pool, M. (2021). Skills and key education needed for clinical librarians: an exploratory study from the librarians' perspectives. BMC medical informatics and decision making, 21(1), 240.
 
[85]  Ginex, P. K., Hernandez, M., & Vrabel, M. (2016). A clinical librarian-nursing partnership to bridge clinical practice and research in an oncology setting. Oncology Nursing Forum, 43(5), 549–552.
 
[86]  Dhakal K. (2018). Librarians collaborating to teach evidence-based practice: exploring partnerships with professional organizations. Journal of the Medical Library Association : JMLA, 106(3), 311-319.
 
[87]  Gard Marshall, J., Morgan, J., Klem, M. L., Thompson, C., & Wells, A. (2014). The value of library and information services in nursing and patient care. Online journal of Issues in Nursing, 19(3), 8.
 
[88]  Gerber A. L. (2017). The librarian's contribution to continuing medical education. Medical Reference Services Quarterly, 36(4), 408-414.
 
[89]  Schuler, E., Mott, S., Forbes, P. W., Schmid, A., Atkinson, C., & DeGrazia, M. (2021). Evaluation of an evidence-based practice mentorship programme in a paediatric quaternary care setting. Journal of Research in Nursing, 26(1-2), 149-165.
 
[90]  Spiva, L., Hart, P. L., Patrick, S., Waggoner, J., Jackson, C., & Threatt, J. L. (2017). Effectiveness of an evidence-based practice nurse mentor training program. Worldviews on Evidence-Based Nursing, 14(3), 183-191.
 
[91]  Stokke, K., Olsen, N. R., Espehaug, B., & Nortvedt, M. W. (2014). Evidence based practice beliefs and implementation among nurses: A cross-sectional study. BMC nursing, 13(1), 8.
 
[92]  Valenstein-Mah, H., Greer, N., McKenzie, L., Hansen, L., Strom, T. Q., Wiltsey Stirman, S., Wilt, T. J., & Kehle-Forbes, S. M. (2020, May 27). Effectiveness of training methods for delivery of evidence-based psychotherapies: A systematic review. Implementation Science, 15(1).
 
[93]  Sindi, N. A., Hamouda, G. M., & Bankhar, M. (2017, July). Factors affecting implementation of evidence-based practice as perceived by nurses. IOSR Journal of Nursing and Health Science, 06(04), 53-57.
 
[94]  Kalaldeh, M. A., Watson, R., & Hayter, M. (2014). Jordanian intensive care nurses’ perspectives on evidence-based practice in nutritional care. British Journal of Nursing, 23(19), 1023-1029.
 
[95]  Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20, e6.
 
[96]  Alshammari, M. S., Alshurtan, R., Alsuliman, G., Alshammari, M., Alhamazani, H., Alshammry, S., Dayrit, R. D., & Alkwiese, M. (2021). Factors affecting the implementation and barriers to evidence-based practice among nurse practitioners in hail region, Saudi Arabia. Nurse Media Journal of Nursing, 11(2), 187-196.
 
[97]  Michel, O., Garcia Manjon, A., Pasquier, J., & Ortoleva Bucher, C. (2021). How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit. Journal of Advanced Nursing, 77(11), 4459-4470.
 
[98]  Antinaho, T., Kivinen, T., Turunen, H., & Partanen, P. (2014). Nurses’ working time use - how value adding it is? Journal of Nursing Management, 23(8), 1094-1105.
 
[99]  McArthur, C., Bai, Y., Hewston, P., Giangregorio, L., Straus, S., & Papaioannou, A. (2021). Barriers and facilitators to implementing evidence-based guidelines in long-term care: A qualitative evidence synthesis. Implementation Science, 16(1).
 
[100]  Paci, M., Faedda, G., Ugolini, A., & Pellicciari, L. (2021). Barriers to evidence-based practice implementation in physiotherapy: A systematic review and meta-analysis. International Journal for Quality in Health Care, 33(2).
 
[101]  Toklu, H. (2015). Promoting evidence-based practice in pharmacies. Integrated Pharmacy Research and Practice, 127.
 
[102]  Ahmad, F., & Karim, M. (2019). Impacts of knowledge sharing: A review and directions for future research. Journal of Workplace Learning, 31(3), 207-230.
 
[103]  Abou Hashish, E. A., & Alsayed, S. (2020). Evidence-based practice and its relationship to quality improvement: a cross-sectional study among ‎Egyptian nurses. The Open Nursing Journal, 14(1), 254-262.
 
[104]  Zhou, F., Maier, M., Hao, Y., Tang, L., Guo, H., Liu, H., & Liu, Y. (2015). Barriers to research utilization among registered nurses in traditional Chinese medicine hospitals: A cross-sectional survey in China. Evidence-Based Complementary and Alternative Medicine, 2015, 1-8.