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barriers, clinical practice guidelines, evidence-based practice, facilitators, implementation



  1. Abrahamson, Kathleen A. PhD, RN
  2. Fox, Rebekah L. PhD
  3. Doebbeling, Bradley N. MD, MSc, FACP


Background: Clinical practice guidelines, which are designed to encourage consistent, efficient applications of scientific evidence in the daily practice of clinicians, are often underutilized. The majority of research concerning their implementation and use has focused on the work of physicians; more research concerning their use by nurses is needed.


Objectives: We sought to learn more about nurses' perceptions of facilitators and barriers to the use of clinical practice guidelines.


Methods: This study examined free-text responses to two open-ended survey questions provided by 575 RNs working at 134 Veterans Affairs medical centers nationwide. We performed conventional content analysis on these data, which allowed thematic categories and subcategories of responses to emerge.


Results: A majority of identified facilitators and barriers to nurses' use of clinical practice guidelines were external (outside the individual nurse's control). The most frequently mentioned facilitators and barriers were in the categories of communication, education/orientation/training, and time/staffing/workload.


Conclusions: Social and organizational factors appear to play critical roles in nurses' adoption and use of guidelines. Health care leaders seeking to improve clinical practice guideline use among nurses should ensure that facilitators and barriers-particularly those that are social and organizational-are considered and addressed.