No one would ask a builder to construct a house without the correct tools, but nursing as a profession seems to be quite content to continually expect nurses to construct evidence-based practice (EBP) without the means to wield its most essential tool: the ability to read and understand research and be an active research consumer. There is no argument that nursing should be an evidence-based profession,1 nor that the acceptance of the idea of EBP is higher than it has ever been, but still we seem to be fighting the same battles - and publishing the same articles about the barriers to EBP - over and over again. Is there perhaps a piece missing from the conversation? Perhaps we need to find this piece before we can move on, and it might be closer than we think.

If we accept that it is realistic and appropriate to expect nurses to use evidence in practice, implement research findings and participate in practice development, and we see the same issue occurring across time and geography with no apparent correlation to demographic factors,2 it seems logical that we look elsewhere for the causes of the problem. I suggest that nurses have been telling us the root cause of the one of the problems all along and had we listened more closely to what they were saying the solution may have become clear sooner.

A brief perusal of EBP literature in nursing shows a persistent preoccupation with identifying the barriers to EBP, largely it seems, because nurses persist in not applying research evidence in practice. Research from as far back as 19923 to the present4-8 reports on the barriers to the use of research evidence in practice and repeatedly finds the same thing: one of the most common barriers to research utilization is that nurses feel that "evidence is written in a foreign language."^9(p7) It is far from being the only barrier, but it is a remarkably consistent one.2

If the perception that research is "written in a foreign language" is not just a metaphor but a genuine description of the experience of trying to read it, then it seems something needs to change in the way we teach nurses about research. You cannot teach a language the same way you teach a science. If the goal of educating nurses about research is for them to be able to read and understand research, then I suggest they need to be taught the language, using language-teaching techniques. While the process of learning a second language may not at first seem analogous to the process of learning to read research, closer examination of the process of language acquisition shows that, as with any language, there are rules of use in research which are consistent across different situations, a body of words with specific, culturally understood meanings, all of which form a "communication code" which can be learnt.10 Even if the language of research fails to meet the formal criteria for a language, the concept of research as a language is in current use in some educational settings11-13 and it is clear that nurses regard it as such.9

There is a convincing precedent for a literal interpretation of an apparent figure of speech. Weeks et al., in trying to address the difficulties many nurses experience in dealing with the mathematics involved with drug calculations, took nurses at their word when they reported they could not "see" how the calculation formula applied to the reality of working out dosages.14 Using visual representations of the actual products in commonly used drug calculation scenarios instead of just text, nurses were indeed able to "see" the problem clearly and had far greater success in performing the calculations correctly.14 The statement that previous researchers had considered purely figurative turned out to be a literal description of their problem in performing the task and led to the discovery of an effective solution.

My own experiences of teaching nurses about EBP over several years have highlighted this problem. Nurses of various ages and educational backgrounds come to us wanting to learn, but without the pre-existing research reading skills they do not have the tools to deal with the requirements of the process. Understanding a hierarchy of evidence assumes the knowledge to understand, for instance, what "randomized controlled trial" means and have some idea of the elements that this term describes, so that it makes sense to them why it is a higher level of evidence than an uncontrolled non-randomized study. Assessing the effectiveness of an intervention or strategy requires an understanding of basic statistical concepts like statistical significance, confidence intervals, standard deviations15 and so on. Without this knowledge, the critical appraisal exercise is largely meaningless, and critical appraisal is an essential element of the evidence-based practice process.16,17

It is certainly not all nurses who experience this difficulty; many of us have learned to speak the language of research through exposure, traditional education and/or research experience. But for nurses who have not had these opportunities or for whom these experiences have been ineffective in imparting enough research knowledge to cope with the demands of EBP, a new and different approach is surely warranted. What would nursing look like if research became accessible to us all because we all spoke the same language?

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