title: A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived.
abstract: BACKGROUND
  Evidence-based practice (EBP) leads to enhanced quality of care, and the individual and professional development of nurses and midwives. Therefore, it is important for nurses and midwives as well as all other healthcare providers and stakeholders to inform clinical decision-making and implement EBP.
  
  
  OBJECTIVE
  This study aimed to determine the EBP knowledge, attitudes, and practice of clinical nurses and midwives in Mashhad public hospitals in Iran.
  
  
  METHODS
  The descriptive cross-sectional study was conducted with a stratified cluster, random sample of 240 employed nurses and midwives (response rate of 96%) in Mashhad, who held a Bachelor of Science degree and had at least 1 year of clinical experience. Two valid and reliable questionnaires were used to collect demographic and EBP data. Data were analyzed using SPSS version 11.5 software and descriptive and inferential statistics calculated.
  
  
  RESULTS
  Participants' mean age was 31.0 (SD = 5.5) years and 80% (n = 194) were female. Most participants reported low knowledge or skills and practice of EBP, but moderate attitudes toward EBP. Significant differences between the mean scores on knowledge or skills, attitudes, and practice were identified by field of study. Nurses reported higher knowledge or skills and practice of EBP than midwives (p < .001). Nurses and midwives with master-s degrees displayed greater knowledge or skills and practice of EBP, and more positive attitudes than nurses with bachelor-s degrees (p < .001).
  
  
  CONCLUSIONS
  Although clinical nurses and midwives apply EBP in clinical settings, it is necessary to develop their knowledge or skills and practice. The results of this study can be applied by educational planners, educational managers, and authorities to enhance the quality and consistency of EBP implementation. The results provide a base for future studies in this field.
authors.affiliation: Associate Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Heydari
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Mazlom
authors.forename: Hossein
authors.initials: H
authors.lastname: Ranjbar
authors.forename: Laura
authors.initials: L
authors.lastname: Scurlock-Evans
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D055318:Evidence-Based Nursing / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration / Q000592:standards*; D009732:Nursing Care / Q000458:organization & administration* / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000592:standards; D009936:Organizational Innovation; D011247:Pregnancy; D011795:Surveys and Questionnaires
keywords: evidence-based practice; midwifery; midwives; nurses; nursing