BARRIERS TO THE IMPLEMENTATION OF EVIDENCE-BASED PRACTICE AMONG NURSES: A NARRATIVE REVIEW WITH IMPLEMENTATION-FRAMEWORK INTERPRETATION

Abstract

Background: Evidence-based practice (EBP) is regarded as central to safe, high-quality nursing care, yet it is still not the standard of care delivered by clinicians worldwide, particularly in resource-constrained settings. Existing syntheses are mostly restricted by country, specialty or income setting. Aim: To map reported barriers to EBP implementation among nurses, together with the facilitators reported alongside them, and to interpret them through the Consolidated Framework for Implementation Research (CFIR) and the Iowa Model of Evidence-Based Practice. Methods: Narrative review structured by a Population–Concept–Context framework. Fifteen sources (six systematic or integrative reviews, one qualitative study and eight cross-sectional surveys) were identified by web-based searching of open bibliographic, publisher and repository sources and verified against journal or repository records (full text for one source). Findings were organised into eight barrier domains and interpreted post hoc using CFIR and the Iowa Model. No systematic multi-database search, duplicate screening or formal quality appraisal was undertaken, so the map is illustrative rather than exhaustive. Results: Lack of time and insufficient organizational or managerial support recurred across sources. Inadequate access to research (reported by 77% and 97.8% of nurses in two surveys), low confidence in appraising research, and concern about the reliability of research were prominent in Saudi and Pakistani surveys. Resource and facility constraints were reported in Pakistan and in reviews of low- and middle-income countries. Knowledge, attitudes and skills were linked to implementation, with attitudes partly mediating the effect of knowledge; leadership encouragement and Magnet recognition were associated with more favourable outcomes. Barriers clustered in the CFIR individuals and inner-setting domains and at the evidence-appraisal and integration steps of the Iowa Model. Pakistani evidence comprised three single-city, self-report cross-sectional surveys. Conclusion: Barriers appear to operate at the interface of individual capability and organizational support rather than in isolation. Interventions should therefore combine skills development with protected time, access to evidence and visible leadership sponsorship. Qualitative, multi-site and intervention-based evidence from South Asia is a priority gap, and a systematic scoping review is needed to test these preliminary conclusions.