Competencias y barreras para Práctica Basada en Evidencias en la Enfermería: revisión integrativa

Camargo, Fernanda Carolina; Iwamoto, Helena Hemiko; Galvão, Cristina Maria; Pereira, Gilberto de Araújo; Andrade, Raymann Benzi; Masso, Giovanna Crispim

doi:10.1590/0034-7167-2016-0617

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Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 71 (4) • Jul-Aug 2018 • https://doi.org/10.1590/0034-7167-2016-0617 copiar

Competencias y barreras para Práctica Basada en Evidencias en la Enfermería: revisión integrativa

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Analizar conocimientos, actitudes, prácticas y barreras frecuentes para la implementación de la Práctica Basada en Evidencias entre enfermeros asistenciales en el contexto hospitalario.

Método:

Se trata de una revisión integrativa, cuya búsqueda de los estudios primarios ocurrió en las bases PubMed, CINAHL y LILACS. Para el análisis se incluyeron estudios observacionales, en corte transversal, en inglés, español, portugués y publicados en revistas de enfermería a partir del enero 2007 hasta el julio 2016.

Resultado:

La búsqueda resultó en 363 artículos, siendo incluidos nueve estudios primarios. Las fuentes de evidencia recurrentes entre los enfermeros asistenciales fueron: la experiencia personal y los protocolos asistenciales locales. Estos profesionales presentaron fragilidades para la implementación de la Práctica Basada en Evidencias relacionadas al poco conocimiento para evaluación de evidencias, sobrecarga de trabajo y resistencia al cambio de prácticas.

Consideraciones finales:

Los enfermeros presentaron actitudes favorables; sin embargo, tenían poco conocimiento para desempeñar la Práctica Basada en Evidencias. Los resultados pueden subsidiar intervenciones para su implementación en el ámbito hospitalario.

Descriptores:
Enfermería Basada en Evidencias; Práctica Clínica Basada en Evidencias; Hospitales; Enfermeras Clínicas; Investigación en Enfermería

Author (year)	Objective	Questionnaire	Sample	Place	STROBE
Rolfe et al.(2008)⁽²²22 Rolfe G, Segrott J, Jordan S. Tensions and contradictions in nurses' perspectives of evidence-based practice. J Nurs Manag[Internet]. 2008 [cited 2016 Nov 17]; 16(4):440-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18405261 https://www.ncbi.nlm.nih.gov/pubmed/1840... ⁾	To identify the ability of nurses to interpret scientific evidence.	Created by the authors	n=189	United Kingdom	63.6%
McCloskey (2008)⁽²³23 McCloskey DJ. Nurses' perceptions of research utilization in a corporate health care system. J Nurs Scholarsh[Internet]. 2008 [cited 2016 Nov 17]; 40(1):39-45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18302590 https://www.ncbi.nlm.nih.gov/pubmed/1830... ⁾	To identify the characteristics of nurses related to the level of training, years of experience and performance in the hospital that may interfere with the ability to evaluate research, and in the Evidence-Based Practice.	The Research Utilization Questionnaire	n= 270	United State of America	68.2%
Bonner e Sando (2008)⁽²⁴24 Bonner A, Sando J. Examining the knowledge, attitude and use of research by nurses. J Nurs Manag[Internet]. 2008 [cited 2016 Nov 17]; 16(3):334-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18324993 https://www.ncbi.nlm.nih.gov/pubmed/1832... ⁾	To identify knowledge, attitude and use of research by nurses.	Edmonton Research Orientation Survey	n= 347	Australia	54.5%
Ofi et al.(2008)⁽²⁵25 Ofi B, Sowunmi L, Edet D, Anarado N. Professional nurses' opinion on research and research utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. Int J Nurs Pract[Internet]. 2008 [cited 2016 Nov 17]; 14(3):243-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18460066 https://www.ncbi.nlm.nih.gov/pubmed/1846... ⁾	To investigate knowledge of nurses in the evaluation of research, attitudes and barriers to its use.	The Research Utilization Questionnaire	n= 500	Nigeria	77.3%
Mashiach Eizenberg(2010)⁽²⁶26 Eizenberg MM. Implementation of evidence-based nursing practice: nurses' personal and professional factors? J Adv Nurs[Internet]. 2008 [cited 2016 Nov 17]; 67(1):33-42. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2010.05488.x https://onlinelibrary.wiley.com/doi/abs/... ⁾	To identify relationships between the professional and personal characteristics of nurses for the Evidence-Based Practice.	Attitudes Towards Research in nursing Barriers to Evidence-based Nursing Practice	n= 243	Israel	68.2%
Gerrish et al.(2011)⁽²⁷27 Gerrish K, Guillaume L, Kirshbaum M, McDonnell A, Tod A, Nolan M. Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey J Adv Nurs[Internet]. 2011 [cited 2016 Nov 17]; 67(5):1079-90. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2010.05560.x https://onlinelibrary.wiley.com/doi/abs/... ⁾	To identify factors that influence and promote Evidence-Based Practice among caregivers.	Self-reported Developing Evidence-based Practice Questionnaire	n= 855	United Kingdom	95.5%
Dalheim et al.(2012)⁽²⁸28 Dalheim A, Harthug S, Nilsen RM, Nortvedt MW. Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Serv Res[Internet]. 2012 [cited 2016 Nov 17];12(367). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557178/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	To determine factors that influence the Evidence-Based Practice in a university hospital.	Self-reported Developing Evidence-based Practice Questionnaire	n= 407	Norway	86.4%
Heydari et al.(2014)⁽²⁹29 Heydari A, Mazlom SR, Ranjbar H, Scurlock-Evans L. A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived. Worldviews Evid Based Nurs[Internet]. 2014 [cited 2016 Nov 17]; 11(5):325-31. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12052 https://sigmapubs.onlinelibrary.wiley.co... ⁾	To identify Knowledge, Attitudes, and Practices for Evidence-Based Practice.	Evidence Based Practice	n= 240	Iran	63.6%
Wilson et al.(2015)⁽³⁰30 Wilson M, Sleutel M, Newcomb P, Behan D, Walsh J, Wells JN, et al. Empowering nurses with evidence-based practice environments: surveying Magnet(r), pathway to Excellence(r), and non-magnet facilities in one healthcare system. Worldviews Evid Based Nurs[Internet]. 2015 [cited 2016 Nov 17]; 12(1):12-21. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12077 https://sigmapubs.onlinelibrary.wiley.co... ⁾	Identify the organizational and individual aspects that may influence the nursing Evidence-Based Practice.	Information Literacy for Evidence-Based Nursing Practice	n= 1977	United State of America	72.7%

Author	Aspects^* * Free translation;	n(%)	Mean (sd)		Likert^b
Most used sources of evidence
Rolfe et al.⁽²²22 Rolfe G, Segrott J, Jordan S. Tensions and contradictions in nurses' perspectives of evidence-based practice. J Nurs Manag[Internet]. 2008 [cited 2016 Nov 17]; 16(4):440-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18405261 https://www.ncbi.nlm.nih.gov/pubmed/1840... ⁾	Reflection on own experience in the care	200(93.9)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Co-workers	190(89.2)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Intuition	174(81.7)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
Dalheim et al.⁽²⁸28 Dalheim A, Harthug S, Nilsen RM, Nortvedt MW. Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Serv Res[Internet]. 2012 [cited 2016 Nov 17];12(367). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557178/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Guidelines information	705(82.9)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Information on graduate programs	658(77.2)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Local protocol information	620(72.9)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
Gerrish et al.⁽²⁹29 Heydari A, Mazlom SR, Ranjbar H, Scurlock-Evans L. A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived. Worldviews Evid Based Nurs[Internet]. 2014 [cited 2016 Nov 17]; 11(5):325-31. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12052 https://sigmapubs.onlinelibrary.wiley.co... ⁾	Information I learned about each patient	-	4.3(0.8)		5
	My personal experience in caring for patients	-	4.1(0.7)		5
	Information I get from local policies and protocols	-	4.1(0.7)		5
Knowledge. Attitudes and Practices
McCloskey⁽²³23 McCloskey DJ. Nurses' perceptions of research utilization in a corporate health care system. J Nurs Scholarsh[Internet]. 2008 [cited 2016 Nov 17]; 40(1):39-45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18302590 https://www.ncbi.nlm.nih.gov/pubmed/1830... ⁾	Research helps to build scientific bases for Nursing knowledge	-	4.0(0.92)		5
	Research is necessary for the continuous improvement of	-	4.0(0.91)		5
	I would change my practice according to scientific evidence	-	3.9(1.04)		5
Ofi et al.⁽²⁵25 Ofi B, Sowunmi L, Edet D, Anarado N. Professional nurses' opinion on research and research utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. Int J Nurs Pract[Internet]. 2008 [cited 2016 Nov 17]; 14(3):243-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18460066 https://www.ncbi.nlm.nih.gov/pubmed/1846... ⁾	Research usually contributes to advances in nursing care	455(91.0)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Nursing practice should be evidence-based	438(87.6)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Knowledge about research values nursing practice	433(86.6)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
Heydari et al.⁽²⁹29 Heydari A, Mazlom SR, Ranjbar H, Scurlock-Evans L. A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived. Worldviews Evid Based Nurs[Internet]. 2014 [cited 2016 Nov 17]; 11(5):325-31. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12052 https://sigmapubs.onlinelibrary.wiley.co... ⁾	Evidence-Based Practice Favoring Attitude	221(92.1)
Barriers
McCloskey⁽²³23 McCloskey DJ. Nurses' perceptions of research utilization in a corporate health care system. J Nurs Scholarsh[Internet]. 2008 [cited 2016 Nov 17]; 40(1):39-45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18302590 https://www.ncbi.nlm.nih.gov/pubmed/1830... ⁾	I have time to read some resarch while on duty	-	1.7(0.936)		5
	Nursing research is conducted in my care area	-	2.4(1.12)		5
	My co-workers draw my attention to current research	-	2.7(1.12)		5
Bonner & Sando⁽²⁴24 Bonner A, Sando J. Examining the knowledge, attitude and use of research by nurses. J Nurs Manag[Internet]. 2008 [cited 2016 Nov 17]; 16(3):334-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18324993 https://www.ncbi.nlm.nih.gov/pubmed/1832... ⁾	Understanding the research design	124(37.4)	-		-
	Ethical review	122(36.6)	-		-
	Statistics	91(27.3)	-		-
Ofi et al.⁽²⁵25 Ofi B, Sowunmi L, Edet D, Anarado N. Professional nurses' opinion on research and research utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. Int J Nurs Pract[Internet]. 2008 [cited 2016 Nov 17]; 14(3):243-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18460066 https://www.ncbi.nlm.nih.gov/pubmed/1846... ⁾	Statistical analyses are not comprehensible	250(50.0)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Implications for practice are unclear	178(35.6)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Research is not reported clearly	132(26.4)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
Gerrish et al.⁽²⁷27 Gerrish K, Guillaume L, Kirshbaum M, McDonnell A, Tod A, Nolan M. Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey J Adv Nurs[Internet]. 2011 [cited 2016 Nov 17]; 67(5):1079-90. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2010.05560.x https://onlinelibrary.wiley.com/doi/abs/... ⁾	Work overload during daily care actions makes it difficult to incorporate evidence into practice	432(51.1)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	My workload is too heavy for me to be able to influence practice as I would like	333(39.3)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	There are not enough resources to be effective in promoting Evidence-Based Practice	270(31.8)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
Dalheim et al.⁽²⁸28 Dalheim A, Harthug S, Nilsen RM, Nortvedt MW. Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Serv Res[Internet]. 2012 [cited 2016 Nov 17];12(367). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557178/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	My team's culture is not receptive to changes of practices.	-	3.8(0.8)		5
	I do not know how to do proper research search	-	3.4(1.1)		5
	I do not have authority in my workspace to propose changes	-	3.3(0.8)		5
Heydari et al.⁽²⁹29 Heydari A, Mazlom SR, Ranjbar H, Scurlock-Evans L. A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived. Worldviews Evid Based Nurs[Internet]. 2014 [cited 2016 Nov 17]; 11(5):325-31. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12052 https://sigmapubs.onlinelibrary.wiley.co... ⁾	Little knowledge and skills for evidence-based practice	215(89.6)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
	Practice Evidence-Based Practice	199(83.3)^a a Participants could mark different options in a single question; Likert Scale measure.	-		-
Author	*Aspects^ * Free translation;**	Regression (β)	OR	OR CI95%	p
Mashiach Eizenberg⁽²⁶26 Eizenberg MM. Implementation of evidence-based nursing practice: nurses' personal and professional factors? J Adv Nurs[Internet]. 2008 [cited 2016 Nov 17]; 67(1):33-42. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2010.05488.x https://onlinelibrary.wiley.com/doi/abs/... ⁾	Research skills	-	1.9	(1.3-2.3)	0.00
	Knowledge of bibliography	-	2.5	(1.6-3.9)	0.00
	Formal education	-	3.2	(1.4-7.5)	0.01
	Research Support	-	1.48	(1.1-2.1)	0.02
	Support from co-workers and the organization	-	0.4	(0.2-0.7)	0.01
	Experience of acting	-	1.7	(1.0-2.9)	0.04
Wilson et al.⁽³⁰30 Wilson M, Sleutel M, Newcomb P, Behan D, Walsh J, Wells JN, et al. Empowering nurses with evidence-based practice environments: surveying Magnet(r), pathway to Excellence(r), and non-magnet facilities in one healthcare system. Worldviews Evid Based Nurs[Internet]. 2015 [cited 2016 Nov 17]; 12(1):12-21. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12077 https://sigmapubs.onlinelibrary.wiley.co... ⁾	History of having participated in research project	7.6	-	-	0.0001
	Frequent need for information to practice	2.9	-	-	0.0001
	Not understanding the search process	-1.5	-	-	0.0001
	Difficulty in understanding the scientific article	-1.8	-	-	0.0001
	Realize that nurses do not wish to change practice	0.6	-	-	0.001
	Difficulty in finding research	-0.7	-	-	0.004

Dimensions	n^c	Authors
Most used sources of evidence
Personal experience	3	Rolfe et al.⁽²²22 Rolfe G, Segrott J, Jordan S. Tensions and contradictions in nurses' perspectives of evidence-based practice. J Nurs Manag[Internet]. 2008 [cited 2016 Nov 17]; 16(4):440-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18405261 https://www.ncbi.nlm.nih.gov/pubmed/1840... ⁾; Gerrish et al.⁽²⁷27 Gerrish K, Guillaume L, Kirshbaum M, McDonnell A, Tod A, Nolan M. Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey J Adv Nurs[Internet]. 2011 [cited 2016 Nov 17]; 67(5):1079-90. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2010.05560.x https://onlinelibrary.wiley.com/doi/abs/... ⁾; Dalheim et al.⁽²⁸28 Dalheim A, Harthug S, Nilsen RM, Nortvedt MW. Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Serv Res[Internet]. 2012 [cited 2016 Nov 17];12(367). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557178/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾
Local protocols	3
Knowledge, Attitudes and Practices
Research contributes to the advancement of Nursing	2	McCloskey⁽²³23 McCloskey DJ. Nurses' perceptions of research utilization in a corporate health care system. J Nurs Scholarsh[Internet]. 2008 [cited 2016 Nov 17]; 40(1):39-45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18302590 https://www.ncbi.nlm.nih.gov/pubmed/1830... ⁾; Ofi et al.⁽²⁵25 Ofi B, Sowunmi L, Edet D, Anarado N. Professional nurses' opinion on research and research utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. Int J Nurs Pract[Internet]. 2008 [cited 2016 Nov 17]; 14(3):243-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18460066 https://www.ncbi.nlm.nih.gov/pubmed/1846... ⁾
Assistance practice should be evidence-based	2
Barriers
Work overload	3	McCloskey⁽²³23 McCloskey DJ. Nurses' perceptions of research utilization in a corporate health care system. J Nurs Scholarsh[Internet]. 2008 [cited 2016 Nov 17]; 40(1):39-45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18302590 https://www.ncbi.nlm.nih.gov/pubmed/1830... ⁾; Gerrish et al.⁽²⁷27 Gerrish K, Guillaume L, Kirshbaum M, McDonnell A, Tod A, Nolan M. Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey J Adv Nurs[Internet]. 2011 [cited 2016 Nov 17]; 67(5):1079-90. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2010.05560.x https://onlinelibrary.wiley.com/doi/abs/... ⁾; Heydari et al.⁽²⁹29 Heydari A, Mazlom SR, Ranjbar H, Scurlock-Evans L. A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived. Worldviews Evid Based Nurs[Internet]. 2014 [cited 2016 Nov 17]; 11(5):325-31. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12052 https://sigmapubs.onlinelibrary.wiley.co... ⁾
Nurses do not wish to change practice	3	Dalheim et al.⁽²⁸28 Dalheim A, Harthug S, Nilsen RM, Nortvedt MW. Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Serv Res[Internet]. 2012 [cited 2016 Nov 17];12(367). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557178/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾; Heydari et al.⁽²⁹29 Heydari A, Mazlom SR, Ranjbar H, Scurlock-Evans L. A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived. Worldviews Evid Based Nurs[Internet]. 2014 [cited 2016 Nov 17]; 11(5):325-31. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12052 https://sigmapubs.onlinelibrary.wiley.co... ⁾; Wilson et al.⁽³⁰30 Wilson M, Sleutel M, Newcomb P, Behan D, Walsh J, Wells JN, et al. Empowering nurses with evidence-based practice environments: surveying Magnet(r), pathway to Excellence(r), and non-magnet facilities in one healthcare system. Worldviews Evid Based Nurs[Internet]. 2015 [cited 2016 Nov 17]; 12(1):12-21. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12077 https://sigmapubs.onlinelibrary.wiley.co... ⁾;
Do not understand the research design	3	Bonner & Sando⁽²³23 McCloskey DJ. Nurses' perceptions of research utilization in a corporate health care system. J Nurs Scholarsh[Internet]. 2008 [cited 2016 Nov 17]; 40(1):39-45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18302590 https://www.ncbi.nlm.nih.gov/pubmed/1830... ⁾; Heydari et al.⁽²⁸28 Dalheim A, Harthug S, Nilsen RM, Nortvedt MW. Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Serv Res[Internet]. 2012 [cited 2016 Nov 17];12(367). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557178/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾; Wilson et al.⁽²⁹29 Heydari A, Mazlom SR, Ranjbar H, Scurlock-Evans L. A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived. Worldviews Evid Based Nurs[Internet]. 2014 [cited 2016 Nov 17]; 11(5):325-31. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12052 https://sigmapubs.onlinelibrary.wiley.co... ⁾
Do not understand the statistical analyses	3	Bonner & Sando⁽²⁴24 Bonner A, Sando J. Examining the knowledge, attitude and use of research by nurses. J Nurs Manag[Internet]. 2008 [cited 2016 Nov 17]; 16(3):334-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18324993 https://www.ncbi.nlm.nih.gov/pubmed/1832... ⁾; Ofi et a.l⁽²⁵25 Ofi B, Sowunmi L, Edet D, Anarado N. Professional nurses' opinion on research and research utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. Int J Nurs Pract[Internet]. 2008 [cited 2016 Nov 17]; 14(3):243-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18460066 https://www.ncbi.nlm.nih.gov/pubmed/1846... ⁾; Heydari et al.⁽²⁹29 Heydari A, Mazlom SR, Ranjbar H, Scurlock-Evans L. A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived. Worldviews Evid Based Nurs[Internet]. 2014 [cited 2016 Nov 17]; 11(5):325-31. Available from: https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12052 https://sigmapubs.onlinelibrary.wiley.co... ⁾

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[1] CORRESPONDING AUTHOR: Fernanda Carolina Camargo. E-mail: leticiapontes@ufpr.br