Study Limitations
The search was limited to three databases, CINAHL,
MedLine and Cochrane Library, but these are the major
databases for health care. At an early stage of the search
process it became apparent that RU was a commonly used
term, hence this concept was also included in our search
strategy. The rationale for this was based on the fact that
RU initiatives began as early as the 1970s and RU was originally
defined as the use of research findings in all aspects of
nurses’ work. Estabrooks (1998) identified RU as a dimension
of EBP, and since both concepts embrace the usage of
research findings for the benefit of patients, practitioners
and health care organisations, they were included in this
review.
The inclusion criteria allowed for all types of studies,
but their focus had to be implementation, EBP and leadership.
The fact that some scientific studies addressing the
relationship between implementation, leadership and EBP
failed to define the terms might have led to relevant studies
being missed. However, the literature search identified
some relevant articles written by well-known researchers
in the area. A manual examination of the references of the
41 articles that resulted from second screening added only
two papers, indicating that the literature search covered
the topic and that the search terms used were the right
ones. When reading and judging this review, it is important
to bear in mind that only seven studies were identified
and, as shown in our tentative explanatory model
(Figure 2), only the study by Gifford and colleagues (2007)
was judged to be of high scientific quality and most of the
other six as moderate. Nevertheless, this review can be
viewed as an indication of what still remains to be done in
the field to improve EBP practice. Finally, our decision to
synthesise the findings from the included studies, regardless
of study design, could be questioned. However, this
approach was supported by the fact that the same factors
in the areas of leadership, organisation and culture were
found to be of importance for the implementation process
despite of study design.