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Commentary: A qualitative examination of the perceived impact of bureaucratic managerialism on evidence-based practice implementation in Nigeria: a collective case study

This paper provides useful evidence about the problems that are generated by tensions between bureaucratic imperatives concerning productivity and professional concerns about the quality of care. It also demonstrates the importance of widening nursing discourse out from the confines of North America, Europe and Australasia. The African perspective on the relationships between healthcare bureaucracy, evidence-based practice and the quality of nursing care is a fascinating one. It provides a stimulating contrast to influential Western perspectives on these relationships. The authors of this study argue that the authoritarian bureaucratic structures pertaining in the Nigerian healthcare system prevent nurses from taking professional responsibility for, and control over, their actions. They argue that this has a serious negative impact upon the quality of care because it prevents nurses from engaging in evidence-based practice, which is the mode of care that they would wish to adopt if they were given the freedom to do so. The nurses interviewed in this study are guided by a number of assumptions. First, that evidence-based practice is the optimum mode of patient care; second, that the reason it is not adopted is that it is inimical to the bureaucratic system and the cost imperatives that govern it; and third, that the arbitrary imposition of practice guidelines vitiates nurses’ capacity to generate evidence about contextually appropriate care. These assumptions stand in stark contrast to the assumptions adopted by Western critics of evidence-based practice. So, in relation to the first assumption, rather than seeing