The nurse carries personal responsibility and accountability for nursing practice and for maintaining competence by continual learning and being active in developing a core of research-based professional knowledge that supports evidence-based practice (Ayandiran et al., 2013; Berland et al., 2012; ICN, 2012). It could be said that for this single reason, nurses should be adept at identifying clinically relevant questions and have the knowledge and skills to determine the best approach for patient management (Breimaier et al., 2011; Gibbins, 2008). It is therefore not surprising that the importance of understanding and using research as an essential step in the process of EBP is well documented in nursing literatures (Chan et al., 2011b; Sables-Baus and Zuk, 2012).
In exploring nurses‟ levels of knowledge with respect to evidence-based practice, researchers have documented various sources of knowledge. Studies by Berland et al. (2012); Bertulis (2008); Rane (2005) and Thompson et al. (2005) found that for their daily practice, nurses typically use knowledge acquired from school, from experiences during practice and from their professional colleagues. Similarly, in their studies, Berland et al. (2012); Bertulis (2008); Bethabile and Simeon (2011) and Thompson et al. (2005) revealed that most nurses practices in making clinical decisions about the patient are determined by the instructions of physicians rather
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than the use of available evidence. The dominant role of the physician in the health care institutions does not only impede EBP uptake, but can also lead to poor quality care in the health industry (Berland et al., 2012; Bertulis, 2008; De Pedro-Gómez et al., 2012). This may explain why nurses find it difficult to implement EBP even although they agree with the concept (Berland et al., 2012; Van Achterberg et al., 2008).
Some studies have shown that most nurses are not comfortable with the term EBP and have difficulty defining or expressing an understanding of the concept (Berland et al., 2012; Koehn and Lehman, 2008). In a similar study to determine the readiness of US nurses for EBP, nurses expressed lack of value for and knowledge about research much less EBP, which is a more technical term (Berland et al., 2012;
Pravikoff et al., 2005). One may then conclude that the view of using the understanding and application of EBP in determining promotion of nurses, appointment of nurse leaders (Agbedia, 2012; Chan et al., 2011b) and increasing their payment (Chan et al., 2011b) may be a welcome idea. This is because positive attitudes, knowledge and skills in appraising research findings are necessary for nurses to be able to implement EBP in clinical practice (Scott and McSherry, 2009;
Van Achterberg et al., 2008). Additionally, the translation of evidence into practice requires the ability to ask focused clinical questions, locate relevant evidence, appraising the evidence and putting the evidence into practice while integrating patient‟s values and evaluating the process (Scott and McSherry, 2009; Shaneyfelt et al., 2006).
Some findings showed that nurses generally lack basic knowledge of EBP. For example, in their studies of evidenced based practice among nurses, Burney et al.
(2012) and Chan et al. (2011b) found knowledge about EBP to be overwhelmingly lacking among their participants. Similarly, while a good number of nurses reported lacking knowledge of identifying appropriate research designs (Chan et al., 2011b;
Pravikoff et al., 2005), others reported lack of skills for conducting research, which is an important element of EBP (Burney et al., 2012; Chan et al., 2011b; Pravikoff et al., 2005; Ubbink et al., 2011; Bonner and Sando, 2008), thus creating a gap between knowledge and practice. However, Ofi et al. (2008) found that a good number of the nurses studied expressed good research and EBP skills. A study by
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Sherriff et al., 2007) found that nurses did integrate research findings into practice, while other studies (Bartelt et al., 2011; Maaskant et al., 2013; Pravikoff et al., 2005) found that nurses indicated that they and their colleagues did not integrate research findings into practice and lacked knowledge of generating relevant information through electronic data bases such as the CINAHIL and Medline. This is considered important as background knowledge of research conduct is necessary for the integration of evidence into daily clinical nursing practice.
It is important to note that some studies showed that nurses expressed high levels of knowledge regarding EBP (Bartelt et al., 2011). The different findings show that although many nurses may not be able to monitor, review their practice, formulate a research question (Boström et al., 2009a; Yip Wai et al., 2013) or identify sources of evidence (Ozsoy and Ardahan, 2008; Ubbink et al., 2011), others expressed high levels of knowledge of EBP (Bartelt et al., 2011). This may be due to the years of experience and educational levels that vary among nursing staff. In studies conducted by Bartelt et al. (2011) and Bonner and Sando (2008), the nurses knowledge of research was found to be statistically significant and associated with high nursing ranks, with senior nurses having more knowledge than their junior colleagues. The studies also showed significant relationships between knowledge of EBP and nurses‟ attitudes and practice.
Other findings have also revealed that educational qualifications play a role in nurses‟ understanding of EBP. Education equips individuals with knowledge and skills to render care to individuals and the community in complex situations and settings (Agbedia, 2012; Ayandiran et al., 2013; Bethabile and Simeon, 2011). This can be seen in several studies (Bonner and Sando, 2008; Estabrooks et al., 2003;
Hutchinson and Johnston, 2004; Kajermo et al., 2008; Melnyk et al., 2008), which concluded that nurses who received lessons in research during their undergraduate training or have higher educational qualification are more likely to appreciate research designs, the use of empirical studies in journals, statistical analysis and ethical research. Also of note is the organizational atmosphere. If the organizational atmosphere is friendly, individuals will be eager and willing to update their knowledge on research and may be more willing to incorporate evidence into practice (Chan et al., 2011b; De Pedro-Gómez et al., 2012; Turan et al., 2006).
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In their study of nurses in Southern Nigeria, Ofi et al. (2008) found that although there has been an improvement in nurses‟ involvement in research and application have, there are still remarkable gaps in research knowledge and experience, which requires urgent attention. Findings by Uneke et al. (2010) indicated that most care providers in Nigerian health institutions are not highly knowledgeable about research and its findings. The authors added that even those who are responsible for the health policies of the country have little or no knowledge of sound evidence, which has a negative consequence on the health of individuals.