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Original Research: Facilitators and Barriers to Clinical Practice Guideline Use Among Nurses

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

AJN, American Journal of Nursing: July 2012 - Volume 112 - Issue 7 - p 26–35
doi: 10.1097/
Feature Articles

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.

This study examined survey responses of nurses to learn about their perceptions of facilitators and barriers to the use of clinical practice guidelines.

Kathleen A. Abrahamson is an assistant professor in the Department of Public Health at Western Kentucky University in Bowling Green. Rebekah L. Fox is an assistant professor in the Department of Communication Studies at Texas State University in San Marcos. Bradley N. Doebbeling is a senior research scientist at the Health Services Research and Development Center of Excellence in Implementing Evidence-Based Practice at the Indianapolis Veterans Affairs Medical Center, a professor of medicine and epidemiology at the Indiana University School of Medicine, and a senior scientist at Regenstrief Institute, Inc., all in Indianapolis. This project was funded by a grant from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (grant #CPI99-126). The authors have disclosed no potential conflicts of interest, financial or otherwise. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Contact author: Kathleen A. Abrahamson,

© 2012 Lippincott Williams & Wilkins, Inc.