The first thing they teach you about evidence-based practice is to find the best available evidence. The thing they often do not teach you is what to do when the best available evidence requires resources you do not have.
Most EBP models were developed in well-resourced healthcare settings. They assume access to the latest equipment, adequate staffing ratios, reliable supply chains, and electronic health records. In many clinical settings across sub-Saharan Africa — and in under-resourced settings globally — none of these can be taken for granted.
The question is not 'what does the evidence say?' alone. It is 'what does the evidence say, given what we actually have to work with?'
Evidence-based practice in resource-constrained settings requires an additional layer of clinical reasoning: adaptation. This means identifying the core mechanism behind an evidence-based intervention — why it works — and finding contextually appropriate ways to achieve the same outcome with available resources.
It also means being honest with patients and families about constraints, documenting adaptations carefully, and advocating persistently for the resources that would allow full evidence-based care.
Practising well in constrained settings is not a compromise. It is a form of clinical excellence that demands more — not less — from the nurse who does it.
Written by
Ada Nwosa
PhD Candidate, Registered Nurse, and University Lecturer — writing at the intersection of nursing evidence, education, and faith.
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