Research progress on barriers to clinical application of evidence in nursing

doi:10.3761/j.issn.0254-1769.2024.18.016

Abstract

Abstract:

As an integral part of worldwide healthcare，nursing still has a big task to make in conducting implementation research. Addressing the pressing challenges of closing the gap between evidence and nursing practice，and effectively disseminating and applying evidence within the nursing discipline，remains a top priority. This paper presents a compilation of the status of evidence implementation in clinical nursing from an implementation science perspective，including the theoretical framework of barriers to evidence implementation，common research methodologies，and research progress of related factors in the field of nursing. The goal of this work is to bring more insights to further advance the implementation of evidence in nursing.

Key words: Implementation Science, Nursing, Evidence Implementation, Barriers Factor, Review

摘要：

护理工作作为全球卫生健康事业的重要组成部分，护理学科开展实施性研究任重而道远。如何减少证据与护理实践之间的差距，将证据传播和应用到护理实践中，是护理领域亟需解决的问题。该研究基于实施科学视角，梳理了护理领域证据临床实施现状、临床实施障碍因素的理论框架、临床实施障碍因素分析的研究方法及具体内容，并提出相关建议，以期为进一步推动护理领域证据的实施提供指导。

关键词: 实施科学, 护理学, 证据实施, 障碍因素, 综述

YANG Funa, XU Xiaoxia, SHI Hongying, Eva Ho Ka Yan, ZHU Ping, WANG Huilin. Research progress on barriers to clinical application of evidence in nursing[J]. Chinese Journal of Nursing, 2024, 59(18): 2290-2296.

杨福娜, 徐晓霞, 石红英, 何家欣, 邾萍, 王慧琳. 护理领域证据临床实施障碍因素的研究进展[J]. 中华护理杂志, 2024, 59(18): 2290-2296.

References 46

[1]	Zhao JQ, Demery Varin M, Graham ID. Guidelines do not self-implement:time for a research paradigm shift from massive creation to effective implementation in evidence-based medi-cine research in China[J]. BMJ Evid Based Med, 2020, 25(4):118-119.
[2]	Elliott JH, Turner T, Clavisi O, et al. Living systematic reviews:an emerging opportunity to narrow the evidence-practice gap[J]. PLoS Med, 2014, 11(2):e1001603.
[3]	Ayatollahi H, Zeraatkar K. Factors influencing the success of knowledge management process in health care organisations:a literature review[J]. Health Info Libr J, 2020, 37(2):98-117. DOI PMID
[4]	Zhao JQ, Bai WH, Zhang Q, et al. Evidence-based practice implementation in healthcare in China:a living scoping review[J]. Lancet Reg Health West Pac, 2022,20:100355.
[5]	周英凤, 黄娜, 胡雁, 等. 我国护理领域证据临床转化研究的范围综述[J]. 中国护理管理, 2020, 20(4):513-518.
	Zhou YF, Huang N, Hu Y, et al. Studies on evidence imple-mentation in clinical nursing practice in China:a scoping review[J]. Chin Nurs Manag, 2020, 20(4):513-518.
[6]	Hill JE, Stephani AM, Sapple P, et al. The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes:a systematic review[J]. Implement Sci, 2020, 15(1):23.
[7]	赵俊强. 引入复杂科学理念,推动实施科学研究范式的多样化[J]. 医学新知, 2020, 30(5):364-375.
	Zhao JQ. When complexity science meets with implementation science:a call for paradigm diversification in implementation research[J]. N Med, 2020, 30(5):364-375.
[8]	胡雁, 周英凤, 邢唯杰, 等. 循证科学与转化科学:助力护理学科发展和实践变革[J]. 军事护理, 2022, 39(8):3-6.
	Hu Y, Zhou YF, Xing WJ, et al. Evidence-based science and translation science:facilitating the development of nursing practice[J]. Mil Nurs, 2022, 39(8):3-6.
[9]	沈伟杰, 顾莺, 胡雁, 等. 基于i-PARIHS框架的儿科重症监护室中心静脉导管维护证据应用的障碍因素评估分析[J]. 中国护理管理, 2020, 20(8):1132-1137.
	Shen WJ, Gu Y, Hu Y, et al. An analysis of barriers assess-ment to evidence implementation of central venous catheter maintenance in PICU based on i-PARIHS framework[J]. Chin Nurs Manag, 2020, 20(8):1132-1137.
[10]	Hamilton KE, Jones SJ, Gardner CL. Factors affecting nurse practitioners’ integration of evidence into practice[J]. J Am Assoc Nurse Pract, 2021, 34(2):275-283. DOI PMID
[11]	张静, 梁士楚, 陈忠兰. 护理领域中临床实践指南依从性的研究进展[J]. 中华护理杂志, 2023, 58(6):758-763. DOI URL
	Zhang J, Liang SC, Chen ZL. The adherence of clinical practice guidelines in nursing fields:where things stand[J]. Chin J Nurs, 2023, 58(6):758-763.
[12]	Liu MY, Zhang C, Zha QL, et al. A national survey of Chinese medicine doctors and clinical practice guidelines in China[J]. BMC Complement Altern Med, 2017, 17(1):451.
[13]	Brenner S, Oberaigner W, Stummer H. Should we care to ad-here? Guideline adherence rates,glycemic control and phy-sician perspective on adherence for type-2 diabetes[J]. J Public Health, 2021, 29(3):709-718.
[14]	吴明珑, 周雁荣, 詹雪, 等. 颈椎手术患者气道梗阻预防及管理的最佳证据应用[J]. 中华护理杂志, 2023, 58(2):133-140. DOI URL
	Wu ML, Zhou YR, Zhan X, et al. Evidence-based nursing practice of airway obstruction prevention and management in patients undergoing cervical spinal surgery[J]. Chin J Nurs, 2023, 58(2):133-140. DOI URL
[15]	黄娅若, 李彦林, 杨琼君, 等. 膝关节置换术患者运动干预的最佳证据总结[J]. 中华护理杂志, 2023, 58(18):2265-2272. DOI URL
	Huang YR, Li YL, Yang QJ, et al. Evidence summary of exercise intervention in patients undergoing knee arthroplasty[J]. Chin J Nurs, 2023, 58(18):2265-2272. DOI URL
[16]	陈文嘉, 徐东, 李慧, 等. 实施科学理论的分类与介绍[J]. 中国循证医学杂志, 2020, 20(8):986-992.
	Chen WJ, Xu D, Li H, et al. Theories,models and frameworks of implementation science[J]. Chin J Evid Based Med, 2020, 20(8):986-992.
[17]	Damschroder LJ, Aron DC, Keith RE, et al. Fostering implemen-tation of health services research findings into practice:a consolidated framework for advancing implementation science[J]. Implement Sci, 2009,4:50.
[18]	张秋雯, 庞冬, 胡嘉乐, 等. 实施性研究综合框架的发展及其应用[J]. 中国护理管理, 2021, 21(2):257-260.
	Zhang QW, Pang D, Hu JL, et al. The development and application of the consolidated framework for implementation research[J]. Chin Nurs Manag, 2021, 21(2):257-260.
[19]	Birken SA, Powell BJ, Shea CM, et al. Criteria for selecting implementation science theories and frameworks:results from an international survey[J]. Implement Sci, 2017, 12(1):124. DOI PMID
[20]	张兰萍, 吕森森, 何文俊, 等. 实施性研究综合框架(CFIR)更新版的解析和应用[J]. 护理学报, 2023, 30(11):47-52.
	Zhang LP, Lü SS, He WJ, et al. Analysis and application of the updated comprehensive framework for implementation research(CFIR)[J]. J Nurs(China), 2023, 30(11):47-52.
[21]	Meshkovska B, Gebremariam MK, Atukunda P, et al. Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs):a qualitative systematic review using the Consoli-dated Framework for Implementation Research(CFIR)[J]. Im-plement Sci Commun, 2023, 4(1):73.
[22]	Cardona MI, Monsees J, Schmachtenberg T, et al. Implementing a physical activity project for people with dementia in Germany-identification of barriers and facilitator using con-solidated framework for implementation research(CFIR):a qua-litative study[J]. PLoS One, 2023, 18(8):e0289737.
[23]	Wang HX, Zhang YY, Yue SW. Exploring barriers to and fa-cilitators of the implementation of home rehabilitation care for older adults with disabilities using the consolidated fra-mework for implementation research(CFIR)[J]. BMC Geriatr, 2023, 23(1):292.
[24]	Kitson AL, Harvey G. Methods to succeed in effective know-ledge translation in clinical practice[J]. J Nurs Scholarsh, 2016, 48(3):294-302.
[25]	Bergström A, Ehrenberg A, Eldh AC, et al. The use of the PARIHS framework in implementation research and practice:a citation analysis of the literature[J]. Implement Sci, 2020, 15(1):68. DOI PMID
[26]	Qin X, Yu P, Li HL, et al. Integrating the “best” evidence into nursing of venous thromboembolism in ICU patients using the i-PARIHS framework[J]. PLoS One, 2020, 15(8):e0237342.
[27]	孙月萍, 周蓉, 蒙莉萍, 等. 妊娠期糖尿病结构化教育临床实践促进与阻碍因素分析[J]. 中华护理教育, 2023, 20(9):1100-1106.
	Sun YP, Zhou R, Meng LP, et al. Factors that promote and hinder clinical practice of structured education in gestational diabetes mellitus[J]. Chin J Nurs Educ, 2023, 20(9):1100-1106.
[28]	Trochim W, Kane M. Concept mapping:an introduction to struc-tured conceptualization in health care[J]. Int J Qual Health Care, 2005, 17(3):187-191.
[29]	张小艳. 脑卒中吞咽困难识别与管理循证实践方案社区医院推广的实施性研究[D]. 北京: 北京中医药大学, 2020.
	Zhang XY. Implementation of evidence-based practice scheme for identification and management of dysphagia after stroke in community hospitals[D]. Beijing: Beijing University of Chinese Medicine, 2020.
[30]	Tipre M, Hardy C, Bowman T, et al. Concept mapping with black men:barriers to prostate cancer screening and solutions[J]. J Cancer Educ, 2023, 38(6):1808-1815.
[31]	张小艳, 尹依依, 郑莉萍, 等. 概念图在证据转化与应用项目中的研究进展[J]. 中华护理杂志, 2022, 57(13):1649-1654. DOI URL
	Zhang XY, Yin YY, Zheng LP, et al. Research progress of concept mapping in evidence transformation and application projects[J]. Chin J Nurs, 2022, 57(13):1649-1654.
[32]	王钰, 徐园, 邓海波, 等. 关节置换术后深静脉血栓预防审查指标的制订及障碍因素分析[J]. 中华护理杂志, 2022, 57(24):2949-2956. DOI URL
	Wang Y, Xu Y, Deng HB, et al. Evidence application review and obstacle factors analysis for prevention of deep venous thrombosis after joint replacement[J]. Chin J Nurs, 2022, 57(24):2949-2956. DOI URL
[33]	周英凤, 钟婕, 李丽, 等. 妊娠期糖尿病临床护理实践指南实施的障碍因素分析[J]. 护士进修杂志, 2021, 36(4):307-310,316.
	Zhou YF, Zhong J, Li L, et al. Barriers analysis of imple-mentation of clinical nursing practice guideline for gestational diabetes mellitus[J]. J Nurses Train, 2021, 36(4):307-310,316.
[34]	王钰, 徐园, 马玉芬, 等. 基于最佳证据的预防关节置换术后深静脉血栓护理工作内容的田野研究[J]. 中华护理杂志, 2021, 56(4):521-526. DOI URL
	Wang Y, Xu Y, Ma YF, et al. A field research based on the best evidence of nursing care for the prevention of deep vein thrombosis after joint replacement[J]. Chin J Nurs, 2021, 56(4):521-526. DOI URL
[35]	Grady A, Jackson JK, Lum M, et al. Barriers and facilitators to the implementation of healthy eating,physical activity and obesity prevention policies,practices or programs in family day care:a mixed method systematic review[J]. Prev Med, 2022,157:107011.
[36]	郭员志, 张红梅, 赵培, 等. 乳腺癌术后淋巴水肿预防与护理的循证实践[J]. 中华护理杂志, 2023, 58(7):773-781. DOI URL
	Guo YZ, Zhang HM, Zhao P, et al. Evidence-based practice of lymphedema prevention and nursing care after breast cancer surgery[J]. Chin J Nurs, 2023, 58(7):773-781. DOI URL
[37]	周英凤, 朱政, 胡雁, 等. 推动证据向临床转化(七)证据的可用性评价[J]. 护士进修杂志, 2020, 35(13):1193-1196.
	Zhou YF, Zhu Z, Hu Y, et al. Implementing evidence into practice:how to evaluate the applicability of evidence[J]. J Nurses Train, 2020, 35(13):1193-1196.
[38]	Jin YH, Li ZM, Han F, et al. Barriers and enablers for the implementation of clinical practice guidelines in China:a mixed-method study[J]. BMJ Open, 2019, 9(9):e026328.
[39]	Fischer F, Lange K, Klose K, et al. Barriers and strategies in guideline implementation-a scoping review[J]. Healthcare, 2016, 4(3):36.
[40]	Correa VC, Lugo-Agudelo LH, Aguirre-Acevedo DC, et al. Indi-vidual,health system,and contextual barriers and facilitators for the implementation of clinical practice guidelines:a syste-matic metareview[J]. Health Res Policy Syst, 2020, 18(1):74.
[41]	付艳芬, 王春青, 胡雁. 证据临床转化中障碍因素和促进因素的内容分析[J]. 护理学报, 2022, 29(5):64-68.
	Fu YF, Wang CQ, Hu Y. Content analysis of obstacles and promoters in clinical transformation of evidence[J]. J Nurs (China), 2022, 29(5):64-68.
[42]	Melnyk BM, Fineout-Overholt E, Gallagher-Ford L, et al. The state of evidence-based practice in US nurses:critical implications for nurse leaders and educators[J]. J Nurs Adm, 2012, 42(9):410-417.
[43]	Muirhead R, Kynoch K. Implementation of an opioid weaning protocol to improve pain management,and to prevent or decrease iatrogenic withdrawal syndrome in the neonatal intensive care[J]. Int J Evid Based Healthc, 2019, 17(3):147-156.
[44]	张梦杰, 张建霞, 杨振楠. 急诊护士中心静脉导管维护循证实践影响因素的质性研究[J]. 中华急危重症护理杂志, 2020, 1(4):298-302.
	Zhang MJ, Zhang JX, Yang ZN. Qualitative study on influen-cing factors to implement the best practice of central venous catheter maintenance among emergency nurses[J]. Chin J Emerg Crit Care Nurs, 2020, 1(4):298-302.
[45]	Nilsson K, Brulin C, Grankvist K, et al. Senior nursing students’ reflections on deviations from guideline adherence regarding venous blood specimen collection practice:a qualitative study[J]. Nurse Educ Today, 2022,115:105375.
[46]	Willis E. Applying the health belief model to medication adhe-rence:the role of online health communities and peer reviews[J]. J Health Commun, 2018, 23(8):743-750. DOI PMID