Barriers to Implementing Evidence-Based Practice in the Nursing Profession – A Systematic Review
DOI:
https://doi.org/10.55712/806w8016Keywords:
Evidence-based practice, Barriers, Nursing, Implementation, Systematic Review, Research UtilisationAbstract
Evidence-based practice (EBP) is central to the quality, safety, and efficiency of healthcare delivery. By integrating clinical expertise, patient values, and the best available evidence, EBP ensures informed decision-making and optimised patient outcomes. Despite its proven benefits, global evidence shows that nurses encounter persistent challenges in adopting EBP within clinical environments. This systematic review, guided by PRISMA framework, identifies and synthesises the barriers hindering nurses from implementing EBP in clinical settings and highlights strategies to strengthen EBP culture in nursing. Primary, peer-reviewed empirical research in English, published in CINAHL, PubMed, Medline, and the British Nursing Database between 2018 and 2024, was used for this review. The JBI critical appraisal tool was used to assess methodological quality. Fifteen studies (n = 4,641 participants) from twelve countries met the inclusion criteria. Inductive thematic synthesis revealed four overarching themes: (1) lack of time and resources, (2) insufficient managerial and leadership support, (3) limited authority to change practice, and (4) inadequate awareness, knowledge, and skills regarding EBP. These barriers reflect both individual-level and system-level constraints that undermine nurses’ ability to translate evidence into practice. Barriers to EBP are multifactorial and interlinked. Sustainable EBP integration requires leadership commitment, organisational readiness, protected time for research activities, and continuous capacity-building through education and mentorship. Embedding EBP into policy and nursing curricula is crucial for fostering a culture of evidence-informed decision-making.
References
[1] Aali, S., & Shokraneh, F. (2021). Publication date restrictions in systematic reviews: Impact on bias and comprehensiveness. Research Synthesis Methods, 12(3), 367–379. https://doi.org/10.1002/jrsm.1478
[2] Abu-Baker, N. N., Al-Hadid, L. A., Al-Azzam, M., & Al-Khawaldeh, O. A. (2021). Evidence-based practice beliefs and implementation among nurses: A cross-sectional study. BMC Nursing, 20, 10. https://doi.org/10.1186/s12912-020-00524-2
[3] Addis, A., Teklehaimanot, H., & Gebremedhin, T. (2023). Improving time management and patient outcomes among nurses: An intervention study. Nursing Open, 10(1), 48–58. https://doi.org/10.1002/nop2.1337
[4] Alaatawi, M. A., Aboshaiqah, A., & Al-Zahrani, E. (2020). Organizational barriers to implementing evidence-based practice among nurses in Saudi Arabia. Saudi Journal of Nursing and Health Care, 3(4), 34–43.
[5] Aljezawi, M., Al-Bashtawy, M., & Al-Rawajfah, O. M. (2019). Barriers to evidence-based practice among nurses in Jordan: A cross-sectional study. Nursing Forum, 54(4), 567–574. https://doi.org/10.1111/nuf.12369
[6] Alqahtani, N., Al Dossary, R., & Al Mutairi, H. (2022). Barriers and facilitators of evidence-based practice implementation among Saudi nurses. Journal of Nursing Management, 30(2), 456–465. https://doi.org/10.1111/jonm.13485
[7] Al-Yateem, N., Al-Shamsi, M., & Moustafa, M. (2019). Perceived barriers to evidence-based practice among nurses in the United Arab Emirates. BMC Nursing, 18, 66. https://doi.org/10.1186/s12912-019-0387-4
[8] Amir-Behghadami, M., & Janati, A. (2020). Population, Intervention, Comparison, Outcome (PICO) framework for structuring clinical questions. Journal of Advanced Nursing, 76(7), 1682–1684. https://doi.org/10.1111/jan.14388
[9] Birken, S. A., Powell, B. J., Shea, C. M., Husted, M., & Leeman, J. (2017). Criteria for selecting implementation frameworks and theories for evidence-based practice. Implementation Science, 12, 124. https://doi.org/10.1186/s13012-017-0656-y
[10] Buhaid, N., Miller, P. S., & Ho, K. (2014). Authority, autonomy, and the implementation of evidence-based nursing practice. Journal of Clinical Nursing, 23(15–16), 2215–2224. https://doi.org/10.1111/jocn.12546
[11] Camargo, F. C., Iglesias, A. A., & Riera, R. (2018). Barriers and facilitators to the use of evidence in clinical decision-making among nurses: An integrative review. Revista Latino-Americana de Enfermagem, 26, e2974. https://doi.org/10.1590/1518-8345.2114.2974
[12] Cardoso, D., Guerreiro, M., & Martins, M. (2021). Evidence-based practice in nursing: Current perspectives and challenges. International Journal of Nursing Studies, 119, 103929. https://doi.org/10.1016/j.ijnurstu.2021.103929
[13] Cebohin, N., Koric, T., & Prpic, S. (2021). Barriers to evidence-based practice among nurses in Croatian hospitals. Croatian Medical Journal, 62(3), 284–293. https://doi.org/10.3325/cmj.2021.62.284
[14] Chapman, S. J., Richards, C. H., & Stevenson, A. R. (2023). Systematic reviews: Current issues in methodology and reporting. World Journal of Surgery, 47(5), 1221–1231. https://doi.org/10.1007/s00268-023-06994-1
[15] Dagne, A. H., & Tebeje, B. (2021). Barriers to evidence-based practice utilization among nurses in Ethiopia: A cross-sectional study. Nursing Open, 8(6), 3454–3463. https://doi.org/10.1002/nop2.1002
[16] Dobrescu, A. I., Williams, M., & MacDonald, C. (2021). Language bias in systematic reviews: A methodological analysis. Journal of Evidence-Based Medicine, 14(4), 233–242. https://doi.org/10.1111/jebm.12413
[17] Elnaser, H., & Mohamed, N. (2019). Barriers to evidence-based practice among nurses working in Egyptian hospitals. Egyptian Journal of Health Care, 10(2), 44–57.
[18] Ezeruigbo, C. F. (2023). Challenges of implementing evidence-based practice among nurses in Nigeria. African Journal of Nursing Practice, 9(1), 27–36.
[19] Golge, H., Kaya, N., & Ersoy, A. (2024). Time as a determinant of EBP implementation: A global nursing perspective. Journal of Nursing Scholarship, 56(1), 45–57. https://doi.org/10.1111/jnu.12934
[20] Griffiths, P., Reed, J., & Bourne, T. (2020). Time, workload, and safety: Barriers to implementing EBP in healthcare. Health Services Research, 55(S3), 31–40. https://doi.org/10.1111/1475-6773.13594
[21] Hosseini-Moghaddam, S., Zare, F., & Shirazi, M. (2022). Nurses’ attitudes toward evidence-based practice and associated factors in Iran. Iranian Journal of Nursing and Midwifery Research, 27(4), 317–324. https://doi.org/10.4103/ijnmr.IJNMR_46_21
[22] Jylhä, V., Oikarinen, A., Perälä, M. L., & Holopainen, A. (2017). Nurses’ perceptions of evidence-based practice. Scandinavian Journal of Caring Sciences, 31(4), 767–774. https://doi.org/10.1111/scs.12393
[23] Kueny, A., Shever, L. L., Lehan Mackin, M. L., & Titler, M. G. (2015). Facilitating the implementation of evidence-based practice through contextual support. Worldviews on Evidence-Based Nursing, 12(1), 30–38. https://doi.org/10.1111/wvn.12080
[24] Lai, L., Zhou, L., & Liu, X. (2022). Barriers to implementing evidence-based practice among Chinese nurses: A cross-sectional study. Nursing Open, 9(3), 1849–1861. https://doi.org/10.1002/nop2.1160
[25] Mahboube, T., Karimi, M., & Nasiri, M. (2019). Professional autonomy and EBP implementation in Iranian hospitals. Iranian Journal of Nursing, 32(2), 24–32.
[26] Mahmoud, M. H., & Abdelrasol, G. (2019). Barriers to research utilization among nurses in Egyptian hospitals. International Journal of Nursing Sciences, 6(4), 377–383. https://doi.org/10.1016/j.ijnss.2019.07.007
[27] Mathieson, A., Foster, C., & Dixon, R. (2019). Implementing evidence-based practice education: A systematic review. Nurse Education Today, 76, 118–128. https://doi.org/10.1016/j.nedt.2019.02.009
[28] Mlambo, M., Ndebele, C., & Hadebe, N. (2021). Professional development for nurses: Enhancing EBP capacity. International Journal of Nursing Education Scholarship, 18(1), 1–9. https://doi.org/10.1515/ijnes-2020-0024
[29] Naghibi, S. A., Sadeghi, M., & Sadeghi, R. (2021). Nursing workload and time constraints: Impact on EBP implementation. Journal of Nursing Management, 29(6), 1583–1593. https://doi.org/10.1111/jonm.13308
[30] Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
[31] Pinto, A., Cardoso, D., & Martins, M. (2023). Barriers to evidence-based nursing in Portugal: A cross-sectional survey. Nursing Open, 10(1), 317–329. https://doi.org/10.1002/nop2.1302
[32] Pitsillidou, M., Karanikola, M., & Papathanassoglou, E. (2021). Barriers and facilitators to EBP among nurses in Cyprus. BMC Nursing, 20, 86. https://doi.org/10.1186/s12912-021-00610-2
[33] Rahmayanti, R., Suharsono, T., & Putri, S. (2020). Barriers to evidence-based practice among nurses in Indonesia. Belitung Nursing Journal, 6(3), 123–131. https://doi.org/10.33546/bnj.1112
[34] Rockliffe, L. (2022). Language bias in health research: Challenges in excluding non-English studies. Systematic Reviews, 11, 47. https://doi.org/10.1186/s13643-022-01940-2
[35] Sharplin, G., Adams, R., & Leach, M. (2019). The role of leadership in fostering EBP in nursing. Contemporary Nurse, 55(4–5), 432–446. https://doi.org/10.1080/10376178.2019.1664203
[36] Shifaza, F., & Hamiduzzaman, M. (2021). Barriers to implementing evidence-based nursing in Maldives hospitals: A qualitative study. BMC Nursing, 20, 233. https://doi.org/10.1186/s12912-021-00747-0
[37] Smith, J., & Johnson, P. (2023). Institutional frameworks for evidence-based nursing: Linking policy to practice. Journal of Nursing Administration, 53(5), 245–252. https://doi.org/10.1097/NNA.0000000000001214
[38] Swito, K., & Sidin, A. (2020). Organizational readiness and leadership support for EBP implementation. Nurse Leader, 18(6), 561–566. https://doi.org/10.1016/j.mnl.2020.06.003
[39] World Health Organization. (2017). Strengthening health systems through evidence-informed policy and practice. WHO Press. https://apps.who.int
[40] Zeb, H., Khan, A., & Rehman, M. (2018). Barriers to implementing EBP among nurses in Pakistan: A cross-sectional survey. International Journal of Nursing Practice, 24(3), e12648. https://doi.org/10.1111/ijn.12648
[41] Zhang, Y., Hu, X., & Li, S. (2024). Training interventions for EBP knowledge and competency among nurses: A systematic review. BMC Nursing, 23, 34. https://doi.org/10.1186/s12912-024-01109-9
[42] Zhou, Y., Yang, F., & Liu, H. (2022). Evidence-based nursing competencies and public health response. Journal of Clinical Nursing, 31(21–22), 2984–2997. https://doi.org/10.1111/jocn.16202
Downloads
Published
Data Availability Statement
The data presented in this study are available on request from the corresponding author due to privacy and institutional restrictions.
Issue
Section
License
Copyright (c) 2026 International Journal of Social Research & Innovation
This work is licensed under a Creative Commons Attribution 4.0 International License.
CC Attribution-International 4.0
