Barriers to evidence-based nursing: a focus group study

Aim. This paper reports a study to explore the barriers to evidence-based nursing among Flemish (Belgian) nurses. Background. 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. Methods. 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. Findings. 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. Conclusion. 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.