Results – Phase Two
Eight of the nine focus group participants attended the sessions regularly. All were
female, and identified as either Quechua (n = 6) or Aymara (n = 3) descendants. Their mean age was 50 years, and, on average, had worked in nursing for 25 years. Five had worked in medical-surgical specialties, two in ambulatory and public health settings, one as a university educator, and another as a hospital administrator. Of the nine, six held management positions, four had graduate-level education, and seven had been involved in research for one or two years. After analyzing the discussion, four themes emerged, as discussed below.
Limited definition of EBP. While the participants did not offer clear statements
defining EBP, they expressed that EBP is a “responsible care” and “guarantees quality of
care” and is “baked up scientifically” and “documented.” Similarly, participants’ answers
on how they identify EBP interventions were imprecise descriptions and oriented toward applying current protocols, “procedures.” These nurses were also limited in providing clear answers when asked about their values and beliefs regarding EBP. As one participant stated, “I think it’s unfortunate, but what I see is that a large majority… do not know what EBP is. Because of the overwork… the nurse tends to do a job of compliance and not of logical reasoning…or of doing research.” However, in further sessions, participants mentioned that EBP was highly regarded because of what they ”heard” or ”it is the [current] talk.” They also mentioned that there is a “lack of socialization of what nursing based on evidence is” and “of knowing what the advantages [of it] are.” The nurses agreed that “inculcating” this knowledge should start in the “undergraduate years, as at this level, if nurses have a bad training, [they] cannot succeed, rise, in the graduate level.” “Motivation” was cited as a key factor for socializing EBP as well as “self-criticism,” “commitment,” “collaboration,” “passion for what you do,” and “empathy” to gain “recognition among the care team.” Moreover, the nurses felt that learning about EBP would assist in their typically “heavy workload,” as one voiced, EBP “helps you optimize your time and also feel supported…you feel more secure, you do your job better, more efficient, and obviously there is an internal customer satisfaction.”
Absence of support to implement EBP. The “lack of support from administrative authorities” was indicated as the prime barrier to engaging in EBP. One participant stated, “we still do not have [EBP] as a National Policy and less at the level of health ministry… [it] is an urgent need that every professional, in our case, in the field of nursing, should be managing [EBP].” Another participant mused hypothetically about the impact of EBP policies on nursing: “Now, if we gain research positions…from the Ministry of Health, we would reach those positions in each hospital, …[and] advance a lot, but the vision of our authorities is very different.” Similarly, the nurses also expressed their frustration about politically-appointment management positions, designated “a dedo ” (arbitrarily), or those given by seniority. A participant stated that “older generations have greater difficulty in being able to engage in EBP, as they are often limited by technological skill.” Overall, the nurses identified a broad spectrum of barriers to EBP; their quotes, categorized as personal and organizational barriers, are found in Table 3.
Unsustainable EBP initiatives. When participants were queried about facilitators
necessary to embark on EBP, they described the reverse of nearly all the barriers found in Table 3. For instance, instead of “noncontinuity of nursing initiatives from previous authorities,” they proposed “continuity of nursing initiatives…” While these nurses described initiatives previously launched to enhance EBP, they stated that those initiatives were short-lived and administratively under-supported. For example, in one hospital, a survey was conducted by a freshman group of volunteer nurses to assess the level of “knowledge nurses have about phlebitis care,” as high prevalence of phlebitis was a concern. However, the respondent stated that some of the nurses did not complete the survey. This apathy was attributed to the fact that the nurses did not understand “that filling out a questionnaire is also contributing in producing evidence.” Despite this barrier, “50 nurses…out of the 150 nurses [employed] in the hospital” were surveyed. The results showed that “70% had good, 25% regular, and 5% deficient knowledge” of phlebitis care. Based on these findings, the surveyors organized: (a) a refresher education program on phlebitis care (this was provided freely in order to motivate attendance, and it also contributed “points” toward the nurses’ performance evaluations); and (b) a sub-committee “to sensitize the staff on the topic…for instance, on the frequency of washing [one’s] hands.” The results of this project “made possible…the installation of hand sanitizer [dispensers] between patients’ rooms by the hospital.” One participant portrays the general sentiment felt by the volunteer nurses regarding this project in this way: “Although the work we’ve done was not recognized—as complaints reached the management office, because some nurses used hours of their shifts to complete the project—the [fact is that it] has already taken place and has been very beneficial for us…even though we do not know if we will continue doing [research].”
Feelings of disenfranchisement limiting EBP initiatives.Sentiments of being undervalued and experiences of frustration emerged throughout the participants’ dialogues. For instance one respondent states that a particular nurse “occupies an administrative planning position in a hospital, but they do not want to recognize her as such; they recognize that she knows how to do the job well, but not as [a] nurse administrator within the establishment, so…our work is not valued.” Another participant who worked at a hospital said, “the medical part thinks that they have to direct us in everything, that they have to tell us how many we have to be in a unit and what we have to do.” However, nurses agreed that undervaluing of their work also comes from the nurses themselves. “We are selfish; when one person does changes, others [give] criticism: “Why is she doing it in that way? That is wrong. We do not even get paid for it.” While almost all participants expressed frustration, some reflected on how “nurses’ energy should be channeled” to “be the best,” vs. “rivalry” between colleagues. Further, regarding support among the nurses, they stated that learning skills or revisiting “teamwork,” looking for strategies to access and “use technology to make work more agile,” and being “committed to bettering [ourselves]…and being mentors to students” were “key to transform nursing.” Moreover, some felt that the BNA should advocate for “incentives—monetary or not—to support research in nursing.” The personal values that the participants emphasized for themselves were to be “aguerrida ” (fierce) and to “jerarquizar ” (hierarchize) the nursing profession “within the multidisciplinary team.”