Nursing Students’ Self‐Perceived Competence and Barriers to Evidence-Based Practice (5)

28 April, 2019

The 'barriers and resistance to Evidence Based Practice' is multidisciplinary, cutting across the many cadres of health workers.

When I read the section that you said, 'Having no authority to change patient care policies' is reported to be a key barrier to evidence-based practice. It would be interesting to know more about this. How much of this is due to senior clinicians being resistant to change? How much is due to professional hierarchies where nurses are not given a voice?', I remembered that in most of the multidisciplinary Evidence Based Practice workshops that we have run in Nigeria (and Ghana) since 2000, the same questions come up and it is not only nurses that ask these questions. Junior Consultants, General practitioners/family physicians, Resident Post graduate doctors, and medical students ask the same questions. Our solution is to spread the skills and knowledge of evidence based practice to cover the spectrum of health workers from clinicians to community health practitioners, nurses and midwifes, pharmacists and physiotherapists, medical laboratory technicians, nutritionists and dietitians, others such that seniors in every cadre are receptive to and accept when juniors observe areas that need improvement and come forward to say so. That they are not victimised for 'correcting a senior' but rather they are encouraged and rewarded for acting in the interest of best practice for the benefit of patients. 

It is not easy, change never comes easily, so that even though we noticed resistance initially, gradually even the seniors are leading the necessary change of culture and attitude, as the benefits of evidence based practice become more understood. 

Joseph Ana

Africa Centre for Clinical Governance Research & Patient Safety

at HealthResources International (HRI) WA

National Implementing Organisation: 12-Pillar Clinical Governance

National Implementing Organisation: PACKNigeria Programme for PHC

HIFA Profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007.

Website: Joseph is a member of the HIFA Steering Group:

Email: jneana AT