Table 5

Structural incorporation of EBP at various levels as stated by the authors of the individual studies

LevelIntervention byEffectAuthor
WorldwideInternational collaborationExpansion and acceleration of the production and maintenance of Cochrane Systematic ReviewsOliveri
Global and international associationsPromotion of EBP
Making EBP courses available
Olivieri
Sur
Scientific journalsEducational efforts
Publishing high quality research
Poolman, Veness
Scales, Sur
NationalGovernmental enforcementEBP in all undergraduate and postgraduate healthcare educational institutionsMelnyk, Ubbink
Installing and financing regulatory professional bodiesQuality assurance
Practicing EBP
Use of guidelines
Al-Almaie
Melnyk
Ubbink
Installing and financing a national instituteDevelopment of evidence based guidelinesAl-Almaie
Arranging and financingFree use of the Cochrane LibraryOliveri
Policy makers, professional associations, health insurance companies and regulatory bodiesPromotion of EBPScales, Oliveri, Poolman, Melnyk
Board of hospital directorsIncorporating EBP in strategic aimsGoals tailored on systematic evaluations
Implementation of EBP and research utilisation
Brown 2009, Ubbink
Installing research councilsHigh-quality researchBrown 2009, Melnyk
Allocating budgetHigh-quality researchMehrdad
Performing systematic evaluations during working visits, quarterly meetings with managersIncreased hospital‘s level of EBP implementation and quality of careUbbink
Incorporating performance of EBP activities by directors, managers and administrators in annual interviewsIncreased hospital‘s level of EBP implementation and quality of careUbbink
Providing management, administrators and directors with tools and meansEffective learning and practising EBPAl Ohmari 2006, Lai
ManagersIntegrating EBP and policy settingEvidence-based managementAl Ohmari 2009
Recruitment, selection, employment of new personnel Identifying EBP role models among current personnelEBP-minded working forceUbbink, Brown 2010
Building an infrastructure and environment with an atmosphere that supports, promotes and embraces EBP (ie, incentives, prizes or rewards, positive attitude)Effective tools for implementing, learning and practising EBP
Knowledgeable (nurse) researchers, (nurse) specialists, master’ prepared professionals, faculty, research departments
Al-Almaie, Al Ohmari 2006, Brown 2009, Chui, Gale, Gerrish, Melnyk, Mehrdad, Mittal, Oranta, Parahoo, Ubbink
Collaborating with educatorsOrganisational barriers and education addressedBrown 2009
Allocating budget(More) dedicated EBP personnel, education, activities, computers and facilities at each point of care. Attending continuous education, (inter)national conferencesBrown 2009, Gale, Gerrish, Mehrdad, Melnyk, Lai
Provide non-patient hours to personnelTime for EBP activities and implementation, changing practice, and quality care developmentBrown 2009, Gale, Mehrad, Palfeyman
Regular evaluation (audit and feedback) of ward-level EBP activities, knowledge, skills, behaviour and research utilisation during annual interviewsAnnual evaluation of implementing EBP-activitiesAhmandi, Al-Almaie, Al Ohmari 2009, Ubbink
EducatorsIncorporating and inflating time spent on EBP by refining and modifying curriculum and education style in postgraduate and undergraduate medical and nursing curriculaEach non-academic degree professional produces a Cochrane Systematic review
Improved audit and feedback, systematic evaluation, and needs assessment
Tiered, feasible and realistic education
Ahmandi, Al-Almaie, Al-Ohmari 2006, Amin, Andersson, Brown 2009,
Gale, Gerrish, Hadley, Kitto, Koehn, Lai, Mehrdad, Melnyk, Mittal, Nwagwu, Oliveri, Parahoo, Poolman, Scales, Sur, Ubbink, Upton
Formulating the curriculum and educating in collaboration with healthcare professionalsEBP integrationAl-Almaie, Al Ohmari 2006, Brown 2009, Gale, Gerrish, Lai
Interactive, face-to-face education in clinical practice and at the bed sideEBP integrationAhmandi, Al-Almaie, Amin, Al Ohmari 2006, Kitto, Melnyk, Poolman
Interactive educationE-learning modulesKitto, Poolman, Ubbink
EBP internship programme
In-service training
Extended EBP educationBrown 2009
Gerrish
Accessing, appraising and interpreting guidelines, research and protocols, basic statistical analysis, research training, IT-technology, quality development, change management, being a role model, English languageOptimum content of educationAl Ohmari 2006, Andersson, Gerrish, Lai, Mehrdad, Mittal, Nwagwu, Oranta, Parahoo
Educating all educators in EBPWell-equipped educatorsOranta
Emphasising professionals’ own responsibilityProfessional skills and competencies maintainedOranta
Evaluating effectiveness of EBP teachingOptimum EBP educationUlvenes, Veness
Faculty and researchersDocumenting, analysing and interpreting the effectiveness of actions undertakenEBP implementationBrown 2009
Support professionals in clinical setting by simple and clear (written) communicationEBP implementationMehrdad, Brown 2009
Using a variety of strategiesDissemination of research findings
Valorisation of results in practice
Brown 2009
Melnyk
Close collaboration with practicing professionalsShared language and understanding of concepts
Actual relevant clinical questions are addressed
Oranta 
Being a role modelReal-life discussions about patientsPoolman
Performing and promoting researchWell-designed high quality researchScales, Sur
ServicesMedical library facilitiesService for searching databases
Clinical letters, journals and guidelines
Al Ohmari 2006, Melnyk, Mittal, Parahoo, Ubbink, Al Ohmari 2006,
Computer and internet facilities at point of care, ward, or in EBP suitesLiberal access to databases
Tailored to EBP level of professionals
Al Ohmari 2006, Gale, Lai, Mehrdad, Nwagwu, Chui, Melnyk, Ubbink
Content management system allowing access to guidelines, protocols, critically appraised topics and condensed recommendationsUser-friendly and reliable, readable and pre-appraised information
Provide work-based information
Al Ohmari 2009, Gerrish, Lai, Ubbink
Computer based decision support system with priority to systematic reviews Computer-based guideline implementation
Alerts and reminders
Al-Almaie, Al Ohmari 2009
Accessible critical appraisal committeeEasy assessment of relevant literatureMehrdad
Implementation guidanceOvercomes obstacles to implement EBP or recommendation
Change in practice
Chui, Mehrdad
Local workplaceJournal clubs, grand rounds, handovers, regular (research) meetingsEBP implementationOranta, Poolman, Ubbink
Dedicated time and personnel for EBP activitiesIndividual support at the unitsAndersson, Ubbink
Easy access to EBP mentors, change mentors, innovators and educators, computers, databases and relevant EBP websites or linksEBP implementationAl-Almaie, Chui, Gale, Lai, Mehrdad, Ubbink, Veness
CultureEmphasis on EBP in day-to-day practiceAmin
Emphasis on patient benefit of EBPGale, Melnyk
Sharing experience, knowledge and supportAndersson
Activating autonomy and empower nurses to influence changeBrown 2009, Gerrish
Shared governance structuresBrown 2009
Engaging in researchGerrish
Willingness to facilitate the process of implementingKoehn
Innovative strategies including a culture of research implementationMehrdad
Displaying interest and belief in value of research utilizationMittal
Enlightening professionals to use EBP in decision makingNwagwu
Supportive culture to researchParahoo
  • EBP, evidence-based practice.