Attitudes, awareness, and barriers regarding evidence-based surgery among surgeons and surgical nurses

World J Surg. 2009 Jul;33(7):1348-55. doi: 10.1007/s00268-009-0020-8.


Background: Evidence-based surgery (EBS) is stressed to increase efficiency and health care quality, but not all surgeons and surgical nurses use EBS in clinical practice. To define future tailor-made interventions to improve evidence-based behavior, the aim of this study was to determine the attitude and awareness among surgeons and surgical nurses as to the paradigm of EBS and the barriers experienced when practicing EBS.

Methods: In this cross-sectional study, surgeons and surgical nurses at a university hospital in Amsterdam were invited to complete the BARRIERS scale and McColl et al. questionnaire. An evidence quiz was composed for the surgeons.

Results: Response rates were 67% (29/43) for surgeons and 60% (73/122) for nurses. Attitudes toward EBS were positive. Among the surgeons, 90% were familiar with EBS terms, whereas only 40% of the nurses were. Common barriers for surgeons were conflicting results (79%, 23/29) and the methodologic inadequacy of research reports (73%, 21/29); and for nurses they were unawareness of EBS (67%, 49/73) and unclear reported research (59%, 43/73). Only about half of the convincing evidence presented in the quiz was actually applied.

Conclusions: Surgeons have a positive attitude toward EBS and are familiar with EBS terminology, but conflicting results and methodologic shortcomings of research reports are major barriers to practicing EBS. Continual confrontations with available evidence through frequent critical appraisal meetings or grand rounds and using more aggregate sources of evidence are advocated. Nurses can probably benefit from EBS training focusing on basic skills. Finally, collaboration is needed among surgeons and nurses with the same zest about EBS.

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Awareness
  • Clinical Competence*
  • Communication Barriers
  • Cross-Sectional Studies
  • Evidence-Based Medicine / education*
  • Evidence-Based Medicine / standards
  • Evidence-Based Nursing / education*
  • Evidence-Based Nursing / standards
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Perioperative Nursing / education
  • Perioperative Nursing / standards
  • Probability
  • Statistics, Nonparametric
  • Surgical Procedures, Operative / education
  • Surgical Procedures, Operative / standards
  • Surveys and Questionnaires