Exploring the influence of power dynamics on evidence-based practice implementation in clinical nursing: a case of the Nigerian acute care setting

Background: Evidence-based practice is an important aspect of healthcare delivery as its principles are internationally recognised to have instigated quality improvement initiatives. However, available evidence suggests that complexities surrounding its implementation largely exist in healthcare settings. Aim: This study aimed to explore impact power dynamics on evidence-based practice implementation in nursing in the Nigerian acute care setting. Method: A qualitative case study approach was utilised to study two hospitals drawing on interviews. Data was generated from staff nurses (n=12), ward managers (n=21), nurse managers (n=2), and physicians (n=2). Data was inductively, iteratively and thematically analysed through cross-case synthesis. Findings: Limited decision-making power deprived nurses of their autonomy, leading to non-delivery of evidence-based practice. These findings have significant implications for policy and practice as there is imminent danger for clinical outcomes in this context. Conclusions: Power dynamics impacts implementation of evidence-based practice in nursing. However, resistance can trigger emancipatory behaviours and can enable nurses to develop agency for challenging malpractices