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Despite the globalization trend of establishing evidence-based practice in the healthcare system, midwives in the Gambia encounter limited access to academic databases and usually practice based on what was taught in schools. Most of them have never heard of evidence-based practice. Facing the shortages of medical resources and nurses, with an overwhelming amount of patients every day, least attention is paid to the scientific evidence.
To understand how the Gambia midwives perceive evidence-based practice and learn the subject, this qualitative study explored their reflections of their first evidence-based course. Naturalistic inquiry served the methodology for this study. 24 Gambia midwives from a government sponsored training program participated the evidence-based practice course. The 18-week, 36 hours, evidence-based course provided the nature setting for this study. At the end of the course, midwives were asked to write reflection journals to describe their learning and the meaning of the course to their personal and professional life. The constant comparative method and establishment of trustworthiness suggested by Lincoln and Guba were used to analyze reflection journals and ensure study quality.
Themes emerged were (1) the nature and impact of the evidence-based practice course, (2) open the door of evidence-based practice, (3) the learning promoting instructor, (4) effective strategies, (5) interesting contents, (6) achievement, (7) difficulties in learning evidence-based practice. At the beginning of the course, midwives did not know anything about evidence-based practice and academic databases. They considered this course was difficult to learn. Before they entered the course, they did not attempt to challenge textbooks or research before. With the assistance of the course instructor and participation of class activities, the midwives became well acquainted with academic databases, the Endnote program, and techniques used to validate evidence. They became critical thinkers and had confidence in themselves. Many of them had expressed the wish to use evidence-based practice to promote healthcare quality in their country. In conclusion, there is no boundary for evidence-based practice. Getting to know research design and statistics might be difficult for nurses, but the change brought by the evidence-based practice might arouse nurses' enthusiasm and bring a sense of achievement to them.