Barriers to Implementation of Evidence-Based Practice in Zahedan Teaching Hospitals

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Evidence-Based Practice in Zahedan Teaching Hospitals


Various health researchers have performed different studies and issued recommendations that can improve the health care system. Nurses must utilize the research evidence in practice to improve patient outcomes. However, translating research evidence into practice is not only a challenge for nurses in the United States but also in different countries across the world. Understanding the barriers that nurses experience regarding the translation of research into practice can help to issue recommendations that can improve the health care system. Khammarnia et al. (2015) identified the inadequate translation of research evidence into practice as a problem that health care researchers had to study in detail. According to Khammarnia et al. (2015), studying this problem can lead to recommendations that can assist nurses to adhere to current evidence-based guidelines. Although these authors do not provide a research question, the aim of the research shows that their primary concern was to comprehend the challenges that nurses encountered in their quest to translate research into practice. A critical analysis of the introduction part of the article indicates that the researchers supported the objective of the research properly. Therefore, the analysis of the literature review, relevance, and type of design, sample, and practicality of the research, necessary improvements, clarity, as well as a recommendation of further research can help in understanding the appropriateness of the utilization of the article in nursing practice.

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Literature Review

The authors provide a detailed literature review that supports the proper implementation of research evidence into nursing practice. For instance, Khammarnia et al. (2015) begin by acknowledging that translating research evidence into nursing practice can guarantee improved delivery of health services. Then, Khammarnia et al. (2015) cite various research studies that discuss the delivery of quality patient care, thus, providing a strong argument for the need to translate research evidence into nursing practice. Additionally, Khammarnia et al. (2015) cite further research evidence and indicate that proper implementation of evidence-based guidelines into nursing practice can reduce the costs associated with health care. Finally, Khammarnia et al. (2015) argue that the process can further lead to the professional development of nurses. Notably, Khammarnia et al. (2015) provide evidence of the benefits of research translation into practice to nurses, patients, and the health care system in general. Therefore, the readers of the article can understand that the recommendations of the authors can help nurses to enhance health care delivery through proper utilization of evidence-based practice.

Although the literature review provides much evidence on the importance of translating research into practice, the authors used some research studies that were published more than five years ago. For instance, Khammarnia et al. (2015) cite research written by Shortell, Rundall, and Hsu (2007), which provides evidence on the challenges that nurses encounter when translating research evidence into practice. Although this article is useful for the current research, changes might have happened in the health care system thus rendering it irrelevant. Additionally, Khammarnia et al. (2015) cite another research article written by Grimshaw et al. (2006), which provides confirmation on the implementation of evidence-based practice and enhanced quality of care. This article is equally important, but its recommendations might have been outdated. Therefore, the researchers needed up-to-date evidence within five years to ensure valid information to support the recent research.

The authors of this article continue to recognize more research studies conducted on evidence-based practice. Khammarnia et al. (2015) argue that the percentage of nurses is higher in the health care system compared to other health care providers. Therefore, nurses need to embrace the idea of translating research into practice to help other health professionals to follow suit. Additionally, Khammarnia et al. (2015) provide further evidence regarding the utilization of evidence-based practice and better decision-making in health care. The authors support these arguments with current research. For instance, Khammarnia et al. (2015) recognize research conducted by Stokke, Olsen, Espehaug, and Nortvedt (2014), which provides much information about the proportion of nurses in health care and better decision-making upon proper implementation of evidence-based practice. Khammarnia et al. (2015) further cite the research done by Thorsteinsson (2013), which indicates that proper implementation of evidence-based practice can improve the attitudes of nurses towards health care, thus, enhancing their job satisfaction. Utilization of the current research to support the previous studies in this article ensured a logical argument that provided a better rationale for the current study.

Finally, the authors identify from the literature search that little information exists regarding the beliefs of Iranian nurses regarding evidence-based practice. Additionally, the researchers note that the health care system in Iran does not provide significant support to nurses to implement research evidence into practice. Consequently, Khammarnia et al. (2015) arrived at the purpose of the study, which was to determine the barriers that nurses experienced regarding the implementation of evidence-based practice. Although the researchers do not identify the hypothesis of the research explicitly, an argument that leads to the aim of the study shows that individual barriers and organizational challenges might be contributing factors to the improper implementation of evidence-based practice among nurses in Iran. Considerably, the researchers synthesize the literature comprehensively and provide substantial evidence, consequently, providing a reliable argument of the aim of the research.

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The relevance of the Research

This research is relevant to address the current challenges, which nurses experience regarding the translation of research evidence into practice. Other current researchers from different countries including the United States have identified that nurses face challenges, which prevent them from complying with the relevant guidelines that can improve the health outcomes of patients. For instance, Tacia, Pheley, Biskupski, and Lehto (2015) performed a study in the United States which employed a focus group design to understand the views that nurses had about translating research into nursing practice. Tacia et al. (2015) identified that nurses had inadequate knowledge regarding the importance of evidence-based practice. Additionally, Tacia et al. (2015) ascertain that these nurses cited institutional barriers such as the inadequate provision of resources that can facilitate access to evidence-based practice information. This research is contemporary, and it indicates that many nurses in various health care settings are facing challenges when it comes to applying research evidence into nursing practice.

Translating research into practice is also relevant in managing some diseases that contribute to the current challenges in the health care settings. For instance, the American Diabetes Association (2015) ascertains that diabetes mellitus continues to present significant challenges such as increased costs of health care due to many complications associated with it. The American Diabetes Association (2015) further asserts that health care providers must utilize the current evidence-based guidelines to manage the disease properly. However, Tacia et al. (2015) provide evidence, which indicates that most nurses in the United States experience significant challenges to utilize such guidelines. Therefore, the current article written by Khammarnia et al. (2015) is relevant, because it addresses the widespread problem of inadequate implementation of evidence-based practice. Therefore, although the results of the current research are relevant in Iran, they can also be of interest in the United States and other countries for the reason that it addresses an ongoing problem that nurses face in many health care settings globally.

Research Type

The researchers employed an analytical cross-sectional design, which was appropriate because it could answer the research question and further meet the objective of the study. Khammarnia et al. (2015) do not provide the period they intended to conduct the research. However, utilization of a cross-sectional design indicates that the study could take place for a short time. Zheng (2015) ascertains that cross-sectional designs are the most appropriate in health sciences when the researchers seek to understand any phenomenon in its entirety for a short time. In this case, Khammarnia et al. (2015) sought only to understand the challenges that nurses experienced regarding the implementation of evidence-based practice. Therefore, the choice of this appropriate methodology could guarantee reliable results. Additionally, Besen and Gan (2014) argue that a cross-sectional approach to any research guarantees minimum costs, accordingly, enabling the researchers to focus on the outcomes of the research without worrying about the expenses. As a result, although the current authors do not provide a budget that they used for the entire research, this design provides evidence of cost-friendly research that helped them to focus on the research process.

Then, this research was non-experimental, because it did not employ any intervention. Khammarnia et al. (2015) explain that they used questionnaires that nurses had to answer, and then the researchers had to analyze them later. This analytical approach could help the researchers to understand the barriers that nurses experienced regarding the implementation of evidence-based practice. Therefore, the analytical cross-sectional design that Khammarnia et al. (2015) utilized was appropriate for the current research. Consequently, the readers of this research article can understand that reliability of the results could be high due to the right choice of the research design. However, this design needs an appropriate sample, and thus, a proper analysis of the sample can provide a better judgment of the reliability and validity of the study.

Sample Characteristics

The sample that the researchers chose for this study is appropriate because it could be analyzed thoroughly as per the research methodology. Khammarnia et al. (2015) ascertain that they took into consideration all nurses who were at work at the time of data collection in six different hospitals. The sample of nurses was useful because the aim of the research targeted nurses. Additionally, all nurses in the current research were licensed to practice with the expectation of employing the evidence in their nursing practice. Therefore, the researchers chose the right population for the study.

Then, the choice of six hospitals was essential, because it could minimize bias in the data significantly. Khammarnia et al. (2015) assert that they used stratified sampling to identify those six hospitals. Then, all nurses in the identified six hospitals became the sampling frame, but the questionnaires were issued to nurses who were at work during the time of data collection. Consideration of nurses with different qualifications indicates that Khammarnia et al. (2015) ensured that the research could result in findings, which could be applied in various health care settings with nurses who have different qualifications. Therefore, the findings of this research are applicable to many health care settings.

The Practicality of the Research

The entire research is practical because the researchers employed the right approaches to meeting the aim of the study. Khammarnia et al. (2015) analyzed the responses of the nurses and found out that the nurses had personal limitations such as the time that prevented them from utilizing the research efficiently. The authors further noticed that nurses cited institutional challenges such as the inadequate provision of the mediums that could facilitate access to evidence-based practice materials. These results are similar to the results of the research conducted by Tacia et al. (2015) in the United States. Therefore, Khammarnia et al. (2015) came up with reliable findings that could guarantee appropriate recommendations. Khammarnia et al. (2015) suggest that nurses must have adequate information on the importance of implementing evidence-based practice and that health care institutions must help nurses to utilize research evidence properly. Therefore, the application of these commendations can happen through continuous medical education by sensitizing nurses and administration of health facilities on the importance of evidence-based practice.

Necessary Improvements

This study employed the right approaches, but the researchers should have conducted face-to-face interviews with nurses who were not on duty to understand their views. Khammarnia et al. (2015) used nurses who were on duty and, thus, they might have been busy answering the questions in the self-report questionnaires properly. Notably, Khammarnia et al. (2015, p.2) assert that 6% of nurses failed to participate. Therefore, analyzing verbal responses of nurses who would not have been worried about their shifts could have provided considerable credible information.


The authors present the information in the article in a simple manner to enable the readers to understand what actually took place. Khammarnia et al. (2015) begin with the abstract. Then, they provide details of the contents of the abstract comprehensively but precisely. The entire article is limited to five pages with relevant information about an introduction, research process, and conclusion. Therefore, the writing of the article is straightforward and easily understandable.

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Further Research

Although various studies have been done on this subject, further research can be conducted in order to understand the progress that nurses have made regarding the implementation of evidence-based practice. The previous research has focused on the challenges of translating research into practice. Additionally, previous research has issued various recommendations to utilize research evidence in nursing practice. The current research and the research conducted by Tacia et al. (2015) are examples of research studies that have issued such recommendations. Therefore, future researchers can examine health care facilities that have embraced the recommendations and assess the progress they have made regarding implementing the research into practice. Future research can help in coming up with appropriate recommendations, which can further help nurses to utilize research evidence properly.


The recommendations of the current research are useful for an application not only in Iranian health care settings but also in other health care facilities globally. The literature review is comprehensive and logical to support the research problem. Additionally, the research addresses the current challenge that affects many health care facilities globally, particularly nursing practice. Therefore, the research design and the sample that the researchers used were efficient in minimizing bias and arriving at reliable conclusions to improve the health care system. Furthermore, this work is practical, and various health care facilities must embrace the recommendation of sensitizing nurses on the importance of applying an evidence-based practice approach to nursing care. The health facilities must also provide necessary resources such as computers and access to databases to help them utilize the approach efficiently. These recommendations can improve nursing\g care and further enhance the quality of health care in many facilities.

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