Barriers to evidence-based care in nursing: historical legacies and conflicting cultures

The British National Health Service (NHS) has witnessed many fundamental changes over the last decade, one of the most significant of which is the imperative for health-care professionals to ensure that their clinical practice can be supported by research evidence. This move from intuition and historical ritual to scientific justification has not been fully successful in either the medical or non-medical professions, with the result that a great deal of research has been sponsored at both the national and local levels to investigate the reasons underlying the research/practice divide. Within nursing the problem has been particularly exacerbated by its ideological framework, the culture and tradition of the profession itself and the recent reforms that were intended to raise its professional status and autonomy. This paper considers the impact of nursing traditions and stereotypes and the bureaucratic structures of the NHS on the introduction of evidence-based nursing care. It is suggested that the essential nature of nursing, its legacy and philosophy, together with the health service's hidden agendas, have conspired to keep nursing in a subordinated, quasi-professional role as one means by which the workforce can be controlled. Because the nursing profession has colluded with this, albeit inadvertently, it now needs to re-establish its complementary functions, in order to salvage its position and truly establish nursing as a profession in its own right.