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.