Hannes Karin, Vandersmissen Jo, De Blaeser Liesbeth, Peeters Gert, Goedhuys Jo, Aertgeerts Bert
Belgian Centre for Evidence-Based Medicine, Belgian Branch of the Cochrane Collaboration, Leuven, Belgium.
J Adv Nurs. 2007 Oct;60(2):162-71. doi: 10.1111/j.1365-2648.2007.04389.x.
This paper reports a study to explore the barriers to evidence-based nursing among Flemish (Belgian) nurses.
Barriers obstructing the call for an increase in evidence-based nursing have been explored in many countries, mostly through quantitative study designs. Authors report on lack of time, resources, evidence, authority, support, motivation and resistance to change. Relationships between barriers are seldom presented.
We used a grounded theory approach, and five focus groups were organized between September 2004 and April 2005 in Belgium. We used purposeful sampling to recruit 53 nurses working in different settings. A problem tree was developed to establish links between codes that emerged from the data.
The majority of the barriers were consistent with previous findings. Flemish (Belgian) nurses added a potential lack of responsibility in the uptake of evidence-based nursing, their 'guest' position in a patient's environment leading to a culture of adaptation, and a future 'two tier' nursing practice, which refers to the different education levels of nurses. The problem tree developed serves as (1) a basic model for other researchers who want to explore barriers within their own healthcare system and (2) a useful tool for orienting change management processes.
Despite the fact that the problem tree presented is context-specific for Flanders (Belgium), it gives an opportunity to develop clear objectives and targeted strategies for tackling obstacles to evidence-based nursing.
本文报告一项旨在探究弗拉芒（比利时）护士实施循证护理障碍的研究。
许多国家都对阻碍循证护理推广的障碍进行了探索，大多采用定量研究设计。作者们报告了时间、资源、证据、权威、支持、动力以及对变革的抵触等方面的缺乏。障碍之间的关系很少被呈现。
我们采用扎根理论方法，于2004年9月至2005年4月在比利时组织了五个焦点小组。我们采用目的抽样法招募了53名在不同环境中工作的护士。绘制了问题树以建立数据中出现的编码之间的联系。
大多数障碍与先前的研究结果一致。弗拉芒（比利时）护士补充了循证护理应用中可能缺乏责任感、他们在患者环境中的“访客”地位导致适应文化以及未来“两级”护理实践（这指的是护士的不同教育水平）等内容。所绘制的问题树可作为（1）其他希望在自身医疗系统中探索障碍的研究人员的基本模型，以及（2）指导变革管理过程的有用工具。
尽管所呈现的问题树是针对佛兰德（比利时）的特定情况，但它为制定明确目标和针对性策略以解决循证护理障碍提供了契机。
