Aim and significance: The aim of this research was to investigate how evidence-based practice (EBP) in nursing homes is understood in the context of Taiwan, a non-Western country. There is a growing movement towards using research evidence to inform practice in the nursing profession with variable success. To date, factors that promote or inhibit implementation of EBP in health care have been investigated through research conducted in hospital settings in Western countries. Remarkably little is known about nurses’ experience and perceptions of EBP in residential aged care facilities (RACFs), especially in non-Western countries.
Method: The study adopted a mixed method approach. Subjects were recruited from six nursing homes in the Hsinchu district of Taiwan. In Stage 1, 89 registered nurses completed a comprehensive questionnaire specifically developed for this project. It was designed to elicit information about (1) their experience of and attitudes towards research and EBP; (2) the barriers they perceive to its implementation; and (3) what strategies they believe would enhance its implementation in the nursing home setting. In Stage 2, six nursing managers participated in semi-structured in-depth interviews that explored the same topic areas as those in the questionnaire but used an open-ended format which allowed for new themes to emerge.
Findings: The majority of nurses and nursing managers expressed positive attitudes towards research and EBP but reported relatively little experience in its implementation. Nurses relied most heavily on knowledge derived from past experience and on interactions with nursing colleagues, medical staff and patients to inform their clinical practice. They identified the main barriers to EBP as: insufficient authority to change practice, their own lack of research knowledge and insufficient time to implement new ideas in the workplace. They believed EBP would be facilitated by: improved access to computers and internet facilities in the workplace; more effective research training; collaboration with academics; and dedicated time to search for and read research articles. As anticipated, nurses viewed the issues from a practical stance in relation to their own time, resources and lack of authority to effect change. Nursing managers expressed similar views to the nurses in relation to attitudes towards EBP implementation. However, they identified barriers which related to aspects of the organizational framework. In particular, they expressed concerns about issues such as budgetary constraints, staff quality (notably the reliance on minimally trained assistants in nursing (AINs) for direct resident care), as well as factors that reflected the wider political and economic context of health care in Taiwan.
Conclusion: The findings of this study have implications for research, policy and practice in both Western and non-Western countries. Further research on EBP would be beneficial if conducted in settings other than hospitals, such as RACFs. There remains also the need to examine the potential for EBP in different social-cultural contexts, such as those in non-Western countries. Nursing managers have generally been excluded in previous research but, because of their particular role, there is a need to examine their perspectives of EBP and then compare these with those of the nurses. In Taiwan specifically, policy change is needed at both government and institutional levels to encourage and support the development of protocols and procedures for the implementation of EBP. If EBP was a government requirement for accreditation and a standard for protocols in hospitals and RACFs, it would lead to improved standards of care and cost effectiveness. This study supports the findings of a number of investigations conducted in Western countries which indicate that further education and training in research for nurses may lead to higher standards of patient care, greater job satisfaction and higher staff retention rates.