Background
Evidence-based-practice (EBP), the conscientious use of the current and
best evidence to make decisions about patient
care,1 may represent a
breakthrough that can respond to the health concerns of low- and
middle-income countries (LMICs). In Bolivia, an LMIC, the EBP movement
is relatively new, but effective health practices might be able to
address the country’s current pressing health concerns, including
decreasing the nation’s maternal and infant mortality rates. Currently,
200/100,000 live births and 31/1,000 live births, respectively—numbers
that are among the highest in South
America.2 Additionally,
EBP would mitigate the proliferation of sexually transmitted diseases,
and prevent adolescent pregnancy
complications.3,4
Nurses make up the largest sector of the Bolivian healthcare workforce,
although baccalaureate-prepared nurses are a smaller group within this
labor-pool.5 Nurses that
hold bachelors’ degrees—the product of a five-year competency-based
curriculum—face particular challenges to improve their practice,
primarily stemming from the disconnect between university-based nursing
education and the health system organizations where nurses work.
Furthermore, there is a paucity of on-site training for nurses to
utilize the most recent research; a lack of available location to use
relevant medical databases; a lack of infrastructure to develop their
own research; and, most importantly, a lack of doctoral prepared nurses
leading research.6 An
international tripartite group of researchers from high-income countries
(HICs) and LMICs undertook this
study to explore Bolivian nurses’
readiness, and the specific challenges they face when implementing EBP
in acute and ambulatory settings in the city of La Paz.
Collaborating to Assess Best Practices. While collaboration
among health practitioners and researchers in Western countries
increasingly involves nurses to enhance best
practices,7 partnerships
between Latin American HICs and LMICs are emerging at a slow
pace.8 There have been
several notable HIC-LMIC collaborations, for instance, between Canadian
and Colombian scholars who teamed up to assess both the facilitators and
barriers for EBP adoption by nurse researchers, educators, and graduate
students. Although this study did not involve clinical nurses, it did
highlight various needs, including greater communication between
academic and clinical practice nurses, increase advanced education, and
greater international research
collaboration.9 The
university of South Florida and the University of Panama also partnered
to introduce EBP to Panamanian nurse leaders via a conference-based
approach, which positively affected nursing curricula and
practice.10 In Ecuador,
nursing researchers investigated faculty and students’ beliefs,
opportunities, and organizational culture required to implement EBP.
This last study showed that the
beliefs the participants held about EBP were critical for EBP
implementation.11Additionally, in a literature review focused on primary care revealed a
number of published studies by Brazilian scholars who identified the
most accomplished EBP studies by
specialty.12 A single
search of CINAHL yielded 92 Brazilian EBP-related articles on nursing
published since 2006, whereas, in Bolivia, a similar search yielded zero
published articles, organizational or government reports about EBP
initiatives in the country.
In the last three years, collaboration have taken place between the
Higher University of Saint Andrés (UMSA) Nursing School of La Paz, the
Bolivian Nurses Association (BNA) and the University College of Nursing
(SUCON). This collaborative work has led to the present study. Although
similar academic investigations in Western and Eastern countries
investigated perceived challenges and barriers of EBP implementation
were found;13-16 there
are differences between those studies and the present work. Here, we
endeavored to understand factors preventing the transfer of evidence
into practice by including Bolivian nurses’ involvement and examine how
organizational systems in local contexts affect the nurses’ engagement
in using evidence to offer quality care. This study used an explanatory,
sequential mixed-method design to survey Bolivian nurses about their
EBP-associated perceptions and barriers. In phase one, we distributed a
survey to 177 nurses. In phase two, nine participants explored the
survey findings and discussed factors about the fit between structural
systems’ context and EBP engagement and implementation.