IntroductionEvidencedbased practice was popularly defined as “conscientious explicit and judicious use of

IntroductionEvidenced-based practice was popularly defined as “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individuals/ clients. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71). Over this 20 years, the efficacy of EBP has been widely discussed that whether it is practical to apply on the reality. Undoubtedly, there are plenty of barriers that must be solved in the very first step before moving forward to implementation of EBP. A study (Brown, Wickline& Ecoff, 2009) identified four themes of barriers including time, knowledge, support and culture that will be concluded as nurse-related barriers, organizational barriers and research-related barriers. After exploring the root of problems, we will look into the potential resolutions. 1. Nurse-related barriersTimeIn this decade, lack of time is still the obstacles of the majority of nurses. According to Brown et al. (2009), insufficient time was the top one barrier regarding to implementing EBP whereas a recent study (Sadoughi, Azadi & Azadi, 2017) showed almost 81% of interviewed nurses indicate not having enough time as the major problem. Both studies (Brown et al., 2009; Sadoughi et al., 2017) stated that interviewer do not have time to search relevant study for patient specific needs while patient is waiting too long or nurses taking care of patient. Worse still, the working hours must be extended to personal time which is unreasonable considering the heavy workload of nurses and the significance of having enough rest.Though the mentioned studies are focused on US, nurse-to-patient ratio in Hong Kong (1:12) is way more serious than US (1:5). Thus, nurses in Hong Kong are also impossible to have an extra time for studying research, not to mention initiating new research. KnowledgeA survey study (Dalheim, Hartthug, Nilsen & Nortvedt, 2012) found that university hospital professional nurses rarely utilize research findings as they usually rely on personal experience and colleagues’ communications. Actually, Time constraints to read research findings and lack of knowledge to judge the quality of research were the major barriers for using EBP (Maaskant, Knops, Ubbink & Vermeulen, 2012). “Lack of knowledge related to difficulty in finding and understanding research reports and data, as well as how to change nursing practice.” (Brown et al. 2009). Hamaideh (2017) claimed that most of the respondents have trouble in understanding English-language reports. I believe the situation also fit in Hong Kong. Although Hong Kong is an international city, English is only the second language of the citizens. Understanding research findings with difficult words and unfamiliar sentences takes longer time or even make people to give up. According to statistics from Hong Kong Nursing Council (2017), furthermore, over 30% of nurses are enrolled nurses who have lower educational level and have never contacted EBP in their courses. Also, “People educated 20 years ago didn’t learn an EBP approach to care” (Melnyk, Fineout-Overholt, Gallagher-Ford & Kaplan, 2012). That means they would be much more difficult to utilize research evidence with insufficient knowledge and exposure to EBP.2. Organizational barriersSupportMany studies found that nurses shows positive attitude towards implementing EBP. (Brown et al., 2009; Foo et al.,2011; Sadoughi et al., 2017). However, support from organization is the foundation of the success to apply EBP to reality. Support can be identified as resources. “Resources involved logistics of accessing information and administrative support by the organization” (Brown et al., 2009). Sadoughi et al. reported that 38% of reviewed studies has revealed access requirements as one of the barriers to be solved. In Hong Kong, there are limited access to full text articles as hospitals rarely purchase database for nurses. What’s more, hospitals rather put resources on upgrading instruments or recruiting more workforce than providing enough resources to implement new ideas which seems to be less effective on enhancing patient care. Brown et al. also point out mentoring is another kind of support. Nurses need to be guided by knowledgeable people through the process of finding, acquiring, critiquing, and applying information in the practice environment.(Brown et al., 2009) However, people who can read research or know how to apply the findings would not share to their colleagues in HK. So, we can see mentoring as a way to contribute the knowledge of and the ways to apply EBP. CultureAs aforementioned, nurses mostly acquire knowledge by colleagues’ interactions and their previous experiences. As we can see, the culture does not motivate nurses to participate in research studying with no incentive. O’Connor & Pettigrew(2009) stated that the culture of using tradition interventions is an important barrier. They also claimed that professional focused on hands on treatment of patient and therefore there is no questioning of treatment (O’Connor & Pettigrew, 2009)From my own observation and experience, we have no doubt that authority is the core value among nursing field. Being a nurse, they usually have no rights to change clinical practice which is always inspected by senior nurse/ advanced practice nurses/ ward manager. As time passes, nurses are used to follow instructions rather than have continue efforts on improving patient care. They will use interventions that are widely accepted to avoid any unnecessary dispute with senior or even physicians because they are not supportive of new way. We call it inertia. (Brown et al., 2009) 3. Research-related barriersSadoughi et al. reported that 24% of reviewed literature mentioned distrusting the quality of information and not knowing how to critically appraise the research as a major barrier. Firstly, Research findings are not always trustworthy as limitations are always exist in every single report. Accordring to O’Connor & Pettigrew(2009), 62.5% of respondents agreeing with the statement “the research has methodological inadequacies”. Secondly, every units in hospital have their own characteristics, not to mention different countries. As stated by O’Connor & Pettigrew(2009), 56.3% of respondents would not implement the research because “the research has not been replicated”. Considering this situation, the reports are not perfectly fit in every unit though it showed positive result at that time. Also, nurses always feel the gap between the ideal condition and the reality when it applies on clinical practice as the study also showed that 53.1% of respondents reported that “implications for practice are not made clear”.SolutionsAfter identify the major obstacles of implementing EBP, we can now come up FIVE efficient solutions.Firstly, HA should take the initiative to hire more workforce. As we mentioned the nurse-patient ratio in Hong Kong is 1:14 which does not meet the standard of 1:4-6. Facing over 100% usage rate of wards, many nurses have no extra time during working hours to read research findings or even implement new ideas as they might have no time to go toilet due to the workload. Therefore, solving manpower demand is absolutely the utmost needs before facilitate the utilization of EBP. Secondly,

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