<b>ASSESSMENT OF BARRIERS TO EVIDENCE-BASED PRACTICE AMONG STAFF NURSES WORKING AT MEDICARE HOSPITAL: A CROSS-SECTIONAL STUDY</b>

Background: Evidence-Based Practice (EBP) is widely recognized as a cornerstone of high-quality, safe, and effective patient care. It involves the integration of the best available research evidence with clinical expertise and patient preferences. Despite its established benefits and the mandate from professional bodies and healthcare accrediting organizations, the consistent implementation of EBP in clinical settings remains a global challenge. The gap between research evidence and clinical practice, often termed the "know-do" gap, persists, potentially compromising patient outcomes and healthcare quality. Identifying the specific barriers that nurses face in their unique work environments is the first critical step in developing targeted, effective strategies to promote EBP uptake and sustainability. Aim: This study aimed to comprehensively assess the barriers to Evidence-Based Practice among staff nurses working at Medicare Hospital, a tertiary care facility participating in the Medicare program. The study sought to identify the most significant barriers across three key domains: the organization, the leader, and the individual nurse, and to examine the association between these perceived barriers and selected demographic characteristics of the nurses. Methods: A quantitative, descriptive, cross-sectional research design was employed. The study was conducted at Medicare Hospital, a tertiary care hospital. A convenience sample of 150 registered staff nurses working in various inpatient and outpatient departments (including Medical-Surgical, Critical Care, Emergency, and others) was recruited. Data were collected over four weeks using a structured, self-administered, three-part questionnaire. Part A collected demographic information (age, gender, educational qualification, years of experience, department). Part B consisted of a 21-item Barriers to Evidence-Based Practice Questionnaire, adapted from recent literature, which assessed barriers related to the organization (8 items), the leader (6 items), and the nurse (7 items) on a 5-point Likert scale (1=To no extent to 5=To a very great extent). The instrument was tested for content validity by a panel of experts and for internal consistency reliability (Cronbach's alpha = 0.89). Ethical approval was obtained from the hospital's IRB, and participation was voluntary and anonymous. Results: The study achieved an excellent response rate of 86.7%, with 130 completed questionnaires returned and analyzed. The majority of participants were female (78.5%), aged between 20 and 30 years (55.4%), and held a Bachelor of Science in Nursing degree (53.8%). The descriptive analysis revealed that organizational factors were perceived as the most significant category of barriers, with a mean score of 3.52 (SD = 0.58), indicating they impede EBP to a "great extent." This was followed by barriers related to the leader (M = 3.18, SD = 0.67) and barriers related to the individual nurse (M = 2.92, SD = 0.63), both falling into the "moderate extent" category. The single highest-rated individual barrier across all items was "lack of time to read research/implement new ideas," which had a mean score of 4.28 (SD = 0.52), placing it in the "very great extent" category. Other prominent organizational barriers included "insufficient resources (access to journals, internet, library)" (M = 3.75) and "lack of authority to change patient care procedures" (M = 3.62). Within the leader-related domain, the most significant barrier was "leaders do not role-model EBP" (M = 3.45). For nurse-related barriers, the highest-rated items were skill-based, including being "unclear about how to critically appraise research" (M = 3.20) and a "lack of awareness of the research evidence available" (M = 3.10). The inferential analysis revealed a statistically significant association between educational qualification and perceived overall barriers (F = 3.85, p = 0.03). Post-hoc analysis (Tukey's HSD) indicated that nurses with a diploma qualification perceived significantly higher overall barriers (M = 3.35, SD = 0.51) compared to those with a bachelor's degree (M = 3.12, SD = 0.48). No statistically significant associations were found for years of experience (p = 0.12), clinical department (p = 0.23), age (p = 0.18), or gender (p = 0.45). Conclusion: This study provides robust empirical evidence that staff nurses at Medicare Hospital face substantial and multifaceted barriers to implementing Evidence-Based Practice. The findings unequivocally demonstrate that the most formidable obstacles are deeply rooted in the organizational context, with a critical lack of dedicated time being the paramount issue. While barriers related to leadership (particularly a lack of role-modeling) and individual nurse competencies (especially critical appraisal skills) are also significant, they are often exacerbated by the unsupportive organizational environment. The study also revealed that nurses with lower educational qualifications (diploma) perceive these barriers more acutely, suggesting a need for targeted support. Addressing the identified barriers, particularly the pervasive issue of time, is not merely an option but an ethical and professional imperative to ensure the delivery of safe, effective, and high-quality, evidence-based patient care at Medicare Hospital.