Who is missing from the evidence? Decolonising pharmacology in nursing education for more inclusive evidence-informed care

How do we teach pharmacology in a way that prepares nurses to deliver safe, person-centred care for all patients, not only those who look like the “average” person in the evidence base? In this blog post, Dr Kinan Mokbel, and Dr Iveren Winifred Nyinoh reflect on their workshop “Decolonising Pharmacology: Equity and Nursing Practice”, which aimed to highlight a topic that is often overlooked and rarely discussed in nursing: pharmacology evidence and prescribing guidance do not automatically apply equally to everyone.

Strengthening equity within evidence-informed prescribing

Most pharmacology teaching and many guidelines imply that evidence travels well, and that drug response is more or less universal. But in reality, the research base behind medicines is often underrepresented in many populations, and the consequences show up later as unequal benefit, preventable harm and avoidable trial-and-error prescribing. Nurses are right at the centre of this; they notice side effects early on, support adherence and advocate when a “standard pathway” does not appear to best fit the patient under their care. In our workshop we helped students to explore this important topic whilst understanding and respecting guidelines. Through our discussions with students, the workshop focused on applying medicines evidence with an equity and patient-safety lens, and being honest about the limitations of the evidence when we teach it.

How we delivered the workshop

In July 2025, Dr Kinan Mokbel and Dr Iveren Winifred Nyinoh developed and delivered an interactive workshop for MSci (integrated Master’s) Nursing students at the University of Exeter on Decolonising Pharmacology. We opened by setting out the intended learning outcomes, then used a short warm-up prompt using Mentimeter asking students what they thought “decolonising pharmacology” might involve. This worked well because it quickly showed that 88% (7/8) were unfamiliar with the term or unsure how it links to day-to-day practice.

From there, the session introduced decolonising pharmacology as a way of questioning how historical power structures and underrepresentation have shaped drug development, clinical trials and prescribing guidance. Our discussions circled around two practical questions that nursing students can relate to and can meaningfully apply in their practice:

• Who was represented in the evidence behind this recommendation?
• What does that mean for the patient in front of me, today?

This was followed by facilitated case-based discussion. Pharmacogenomics was then used as an accessible entry point, because it helps students see how biological variation can matter, while also keeping attention on wider issues of representation and structural inequity. In brief, pharmacogenomics means that small differences in a person’s DNA can affect how their body responds to a medicine. It helps explain why the same drug and dose can work well for one person but cause side effects, or does not work, for another..​

Takeaways from the group exercise

One key case study anchored the discussion: hypertension and how guideline categories are applied in practice. Students considered a scenario involving first-line antihypertensive treatment where guidance refers to ethnicity. We explored why broad categories can appear in prescribing algorithms, but also why these categories can become risky if they are treated as biological facts. The discussion focused on applying guidance with clinical “humility” and recognising that “race” or ethnicity can act as a proxy for a mix of variables (including ancestry, environment and access to care). Importantly, the nursing role stayed central: monitoring response, noticing adverse effects and advocating for review when the pathway does not fit the patient.

Student Reflection on the workshop

We used a brief pre- and post-session Mentimeter check-in. Before the workshop, 88% (7/8) of pre-session respondents reported limited familiarity with decolonising pharmacology, with uncertainty about what it means in a clinical context. After the workshop, 100% of respondents (11/11) reported at least one specific takeaway that surprised them. Confidence also shifted: 100% (7/7) of respondents said they felt more confident in their understanding of pharmacological equity and how it applies in practice.

This does not, on its own, demonstrate long-term change, but it does suggest that a short, structured intervention can shift students from uncertainty towards critical engagement.

Conclusions

Decolonising pharmacology belongs in nursing education because it strengthens evidence-informed care. It equips students to apply pharmacological knowledge more safely by making two things visible: the limits of generalisability, and the way structural inequity can sit inside “standard” practice. If we want graduates who can deliver inclusive care, we need to teach them not only what the guideline says, but also how to interpret it responsibly when evidence is incomplete. For nurses, that also means being confident in advocacy: noticing mismatch, escalating appropriately and supporting safer decisions for the patient in front of them.

References

• Nursing and Midwifery Council (NMC). Future nurse: Standards of proficiency for registered nurses (2018): https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/
• Abimbola S, Pai M. Will global health survive its decolonisation? The Lancet (2020).
• Vyas DA, Eisenstein LG, Jones DS. Hidden in Plain Sight – Reconsidering the Use of Race Correction in Clinical Algorithms. New England Journal of Medicine (2020).
• Cheek DJ, Walker T. Pharmacogenomics for Nurses. Nursing Clinics. 2025 Jun 1;60(2):283-92.

For more information please contact: