System Factors Influencing the Australian Nurses' Evidence-based Clinical Decision Making: A Systematic Review of Recent Studies

Abstract

Background: There is growing attention to evidence-based practice in Australian clinical contexts and nursing literature. Recent research explores the dimensions of evidence-based practice; however, the implementation of evidence-based clinical decision making has been identified as a cumbersome process. Aim: This study aimed to review the literature systematically regarding the system factors and their possible impacts on the process of evidence-based practice implementation. Method: Anelectronic search on major databases, including MEDLINE, PsycINFO, PubMed, ProQuest, Google Scholar, and CINAHL was conducted from January 2018 to March 2018. A rigorous selection process focusing on the inclusion of nurses in the study population and the system factors related to their practices resulted in the selection of 18 articles. Data were extracted from the studies and grouped into categories using a thematic analysis. Results: The factors affecting the nurses' evidence-based practice were identified at the individual, team, and organizational culture levels. The individual domain included a lack of education and clinical expertise, inadequate research skills, time constraint, and low levels of confidence and autonomy in changing practices. The factors identified at the team level associated with a lack of research orientation and peer support. At the organizational culture level, poor research culture and infrastructure were identified as important factors. Implications for Practice: The findings of the system factors would help policymakers to redefine the nursing practice. Moreover, the results raise the nurse's awareness about the importance of using evidence-based practice in decision making.

Keywords

• clinical decisions
• Evidence-based practice
• health system factors
• Nurses