Evidence-Based Practice among Nurses in Saudi Arabia: An ARCC© Model-Based Cross-Sectional Study of Knowledge, Beliefs, Implementation, Culture, and Readiness

Evidence-Based Practice among Nurses in Saudi Arabia: An ARCC© Model-Based Cross-Sectional Study of Knowledge, Beliefs, Implementation, Culture, and Readiness | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evidence-Based Practice among Nurses in Saudi Arabia: An ARCC© Model-Based Cross-Sectional Study of Knowledge, Beliefs, Implementation, Culture, and Readiness Faisal Alasmari¹, Ahmed Alkhaibari, Elham Al Ateeq⁴, Mohammad Paredath², and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9000988/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background : Evidence-based practice (EBP) is essential for improving nursing care quality, patient outcomes, and cost efficiency; however, its implementation remains low across healthcare settings. The ARCC model is a multilevel framework illustrating how individual and organizational factors interact to impact EBP implementation. Evidence on ARCC model use in Saudi Arabian hospitals is limited. Aim: This study investigated the relationships among registered nurses' EBP knowledge, beliefs, implementation, organizational culture, and readiness across hospitals and primary care centers in the Makkah Region, guided by the ARCC Model. Methods: A cross-sectional correlational study design was employed. A nonprobability convenience sampling technique was used. Structured, valid, and reliable questionnaires were administered to measure the study variables. Correlation analyses were conducted to examine the relationships between the study variables, whereas hierarchical multiple regression analysis was used to identify predictors of EBP implementation. Results : A total of 883 nurses responded. The mean score for EBP knowledge was 51.14 (SD = 13.22). Nurses reported a mean belief score of 55.75 (SD = 10.92). The mean score for organizational culture and readiness was 83.41 (SD = 18.70). The mean score for EBP implementation was 29.87 (SD = 15.14). Statistically significant positive correlations were observed among EBP knowledge, implementation, and organizational culture and readiness (r = 0.228–0.544, all p < .001). EBP beliefs were not significantly correlated with EBP implementation (r = 0.017, p = .617). Hierarchical regression analysis revealed that the most powerful predictor of nurses' EBP implementation was EBP knowledge (β = 0.247, p < .001), followed by organizational culture and readiness (β = 0.211, p < .001). Conclusion : The implementation of EBP among nurses is influenced by theinteractive relationship between individual knowledge and the organizational environment. Deficits in nurses' knowledge and limitations in organizational culture and readiness to implement EBP restrict the transformation of positive beliefs about EBP into daily practice. Our results support the use of the ARCC model as a comprehensive evidence-based framework to strengthen EBP knowledge, mentorship, leadership engagement, and hospital culture and infrastructure, enabling sustainable evidence integration across diverse healthcare settings. Clinical trial number: Not applicable. Evidence-based practice Organizational readiness Organizational culture ARCC© model EBP knowledge EBP implementation Saudi Arabia Figures Figure 1 Introduction Evidence-based practice (EBP) is a problem-solving approach that integrates the best available research evidence with clinical expertise and patient values to guide decisions about patient care [ 1 – 6 ]. Current studies demonstrate that EBP is associated with improved patient outcomes, including but not limited to reduced mortality, shorter hospital stays, lower infection rates, and increased patient satisfaction, while also yielding substantial economic benefits, with most studies reporting a positive return on investment [ 7 , 8 ]. EBP ensures safe, high-quality, patient-centered care by establishing standards of best practices on the basis of the most current literature and reducing variation in treatments to promote better outcomes and improved safety [ 9 – 11 ]. Despite rapid growth in healthcare research, a persistent evidence-to-practice gap remains, with estimates suggesting that it may take more than 15 years for half of evidence-based interventions to be routinely implemented in clinical practice [ 12 ]. EBP helps reduce the gap between clinical practice and the application of the results of research, thus allowing patients to benefit from new scientific developments and allowing nurses to implement new effective interventions more rapidly [ 13 ]. Consequently, EBP has become an essential concept in the development and delivery of healthcare services worldwide. As EBP rapidly replaces traditional models of authority in health care decision-making, practitioners are required to acquire knowledge, apply it to practice, and guide other practitioners in its appropriate application [ 14 , 15 ]. In the late 20th century, most Western countries, including the U.S., UK, and Australia, established EBP in nursing and have continued to support the development and dissemination of evidence-based clinical practice guidelines through international organizations specializing in evidence synthesis and guideline development [ 3 , 16 , 17 ]. The Institute of Medicine designated EBP competency as one of the five foundational competencies for all healthcare professionals, whereas the American Association of Colleges of Nursing designated EBP as one of the nine core elements of professional nursing practice [ 18 , 19 ]. While significant global advances have been made toward EBP adoption, the pace of this advancement varies worldwide; many countries, including Saudi Arabia, are still working to integrate EBP into the daily practices of their clinicians. EBPs gained recognition in Saudi Arabia in the early 2000s, with initial studies conducted among primary healthcare physicians in Riyadh focusing on awareness, attitudes, and barriers to implementation [ 20 ]. EBPs have gradually become more common across various healthcare fields, such as nursing, pharmacy, physical therapy, radiology, and allied health. This growth has been accompanied by a greater focus on education, organizational support, and the creation of national guidelines [ 21 – 25 ]. Vision 2030 initiated a comprehensive transformation of the Saudi healthcare system, focusing on patient-centered care, value-based care, and the use of EBP at all levels. Key measures included the establishment of the National Guidelines Center. This center is responsible for developing and updating evidence-based clinical guidelines to provide standardized care and improve patient outcomes throughout the country [ 26 , 27 ]. While nurses working in Saudi Arabia generally demonstrate a positive attitude toward EBP, studies consistently report barriers to EBP at both the individual and organizational levels, including limited knowledge and skills, lack of educational programs, low confidence, inadequate access to databases, insufficient staffing, lack of protected time, weak leadership engagement, and limited institutional resources [ 22 , 28 ]. Internationally, similar findings have shown that underinvestment in EBP infrastructure and leadership support has resulted in weak EBP cultures and suboptimal patient outcomes [ 29 ]. Given these persistent barriers, it is increasingly clear that individual efforts alone are insufficient and that meaningful and sustained EBP implementation will require both nurses and organizational culture and readiness to create a work environment that actively supports EBP [ 30 – 33 ]. Readiness encompasses both individual factors—such as clinicians’ knowledge, skills, and attitudes—and organizational factors, including leadership commitment, culture, and resource availability. These domains are interdependent, as neither individual nor organizational factors alone are sufficient to sustain EBP implementation [ 33 – 36 ]. Numerous studies have demonstrated considerable relationships between nurses' EBP knowledge, skills, and EBP implementation within hospital settings [ 37 – 40 ]. Additional studies have also demonstrated that EBP beliefs and organizational culture and readiness are substantial predictors of successful EBP implementation within healthcare organizations [ 41 ]. Therefore, an individual and organizational readiness assessment of EBP implementation represents the first critical step in preparing for EBP implementation to achieve a sustainable culture of inquiry [ 41 ]. Several theoretical EBP models have been developed to guide the assessment and support systematic implementation within hospitals and to structure and facilitate the translation of evidence into practice [ 42 ]. Among those models, the Advancing Research and Clinical Practice through Close Collaboration (ARCC©) model, developed by Melnyk and Fineout-Overholt (47), is among the most commonly used system-wide methods for both implementing and sustaining EBP at the organizational level. A central tenet of the ARCC© model is its emphasis on both individual- and organizational-level change through strategies such as EBP mentorship, leadership engagement, supportive culture, and targeted knowledge and competency development [ 43 – 47 ]. The first step in the ARCC© model involves assessing organizational readiness and culture and EBP implementation, as well as nurses’ beliefs toward EBP. This assessment allows organizations to identify strengths and barriers and to develop targeted interventions such as education, mentors, and environmental modifications to support and sustain the adoption of EBP [ 46 ]. Studies have consistently shown that organizations that implement the ARCC© model demonstrate increased levels of EBP beliefs, knowledge, and implementation; a stronger EBP culture; better patient outcomes; and improved job satisfaction, staff empowerment, and retention [ 44 – 49 ]. The conceptual framework for the present study was developed on the basis of the ARCC© model, guiding the selection of variables and the examination of relationships among nurses’ EBP knowledge, beliefs, implementation, organizational culture, and readiness. Although interest in EBP implementation throughout the Kingdom of Saudi Arabia is growing, several gaps remain within the existing body of evidence. No studies have investigated nurses' EBP knowledge, beliefs, implementation, organizational culture, and readiness using one conceptual framework. The lack of studies that have investigated all four of these concepts using a single conceptual framework limits our understanding of how these elements interact to influence the degree to which nurses implement EBP. Furthermore, to date, no studies have evaluated the abovementioned variables at multiple hospitals and primary health care centers in the Makkah region of Saudi Arabia. Therefore, a major geographic and system-wide gap exists in the national evidence base. These gaps underscore the need for a comprehensive, multisite evaluation to provide the information needed to develop targeted interventions and to support a system with wide development of EBP capacity-building capabilities. This study aims to evaluate clinical nurses’ EBP knowledge, beliefs, implementation, organizational culture, and readiness across eight hospitals and primary healthcare centers in the Makkah region of Saudi Arabia as the first step in implementing EBP in accordance with the ARCC© model. Specific objectives: To assess nurses’ EBP knowledge, beliefs, implementation, organizational culture, and readiness. To investigate the differences in clinical nurses' EBP knowledge, beliefs, implementation, organizational culture, and readiness according to the participants' general and research-related characteristics and to analyze the relationships among these variables. To identify predictors of EBP implementation, using multiple linear regression. Methods Study design and participants The current study employed a multicenter descriptive cross-sectional study design. Study participants were recruited via convenience sampling methods. The data were collected from eight hospitals and primary care health centers via a convenience sampling method. The target population was estimated to include more than 5,000 registered nurses. The calculations with G-Power Version 3.1 revealed that a sample size of 791 was needed to achieve the desired 80% statistical power. This was based on a fixed effects multiple linear regression model, a small effect size of f² = 0.02, a significance level (α) of 0.05, and nine predictor variables. Among 5000 nurses, 250 nurses were excluded. We distributed the survey to 4750 participants. Eventually, 883 registered nurses completed the online survey, which exceeded the minimum sample size needed for this study. The overall response rate for the study was 18.6%. The eligibility criteria for nurses in this study were (1) registered nurses in Saudi Arabia, (2) a minimum age of 18 years, and (3) willingness to participate voluntarily in the study. Intern nurses and nurses on maternity leave or sick leave or who were absent for any other reason during the inquiry were excluded from the study. Measurements The data for the study were collected by using a structured self-administered questionnaire that consisted of two primary components. The first part focuses on general and research-related characteristics. The second part included tools that measure EBP knowledge, beliefs, implementation, and organizational culture and readiness. Permission from the original author was obtained before the tools were used. General and Research-Related Characteristics The first part of the survey was created on the basis of relevant literature regarding nurses and EBP and contained nine questions that addressed the demographic and professional characteristics of the participants, such as gender, age, educational level, job role, years of clinical experience, participation in EBP-related education, and completion of research and statistics courses. EBP Knowledge Knowledge of EBP was assessed via the knowledge subscale of the Evidence-Based Practice Questionnaire (EBPQ) developed by Upton and Upton [50]. The tool comprises 14 items measuring different skill areas, including formulating clinical questions and critically evaluating the evidence. The original score is a 7-point Likert scale ranging from 1 (poor) to 7 (best). The pilot questionnaire was conducted prior to collecting all the data to test its usability, the length of time required to complete it, and clarity. The results indicated that the original numeric response options were not clearly defined. Therefore, the response format was modified to a six-point Likert scale ranging from 1 (very poor) to 6 (excellent) to provide clearer and easier-to-interpret responses for the participants. The minimum and maximum scores are 14 and 84, respectively, with higher total scores indicating a higher level of self-reported EBP knowledge. The tool originally demonstrated very high levels of reliability when used with a Cronbach’s alpha of .91. In the present study, the modified version demonstrated good internal consistency when tested, with a Cronbach’s alpha of .93. EBP Beliefs EBP beliefs were measured via the Evidence-Based Practice Beliefs (EBPB) Scale developed by Melnyk et al. [51]. The EBPB consists of 16 items. Each item uses a 5-point Likert-type scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The total scores range from 16--80, with higher scores indicating stronger beliefs in EBP. The original Cronbach's alpha for the EBPB was 0.90; in the current study, it also had high internal consistency, with a Cronbach's α = .91. EBP Implementation The Evidence-Based Practice Implementation (EBPI) Scale developed by Melnyk et al. [51] was utilized. It includes 18 items that measure how often participants have engaged in EBP-specific activities over the preceding 8 weeks, e.g., creating a PICOT question, accessing clinical guidelines, and evaluating patient outcomes. The respondents used a five-point Likert-type scale to rate their responses from 0 (0 times) to 4 (more than 8 times). The total scores range from 0-72, with higher scores representing greater EBP implementation. The reliability of the original EBPI scale was determined to be excellent (Cronbach’s alpha = .96); the reliability of the EBPI scale in this study was also found to be excellent (Cronbach’s alpha = .94). Organizational culture and readiness for EBP The degree of organizational culture and readiness for system-wide EBP implementation was assessed via the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice (OCRSIEP) Scale [52]. The OCRSIEP scale consists of 25 items that assess the extent to which EBP is supported, integrated, and prioritized within the organization. Each item uses a 5-point Likert-type scale ranging from 1 (None at All) to 5 (Very Much). Total scores range from 25 to 125, with higher scores indicating a more positive, supportive organizational culture. The original scale demonstrated excellent reliability (Cronbach’s α = 0.94), which was similarly confirmed in this study (Cronbach’s α = 0.93). Data collection procedure and ethical considerations Ethical approval was obtained from the Institutional Review Board (IRB) prior to data collection (IRB No. 20--706, approved on September 21, 2020). Data were collected from November 2020 to February 2021. The nursing administration staff of all the participating hospitals and primary healthcare clinics located within the Makkah region of Saudi Arabia granted permission prior to data collection. The participants completed an online version of the questionnaire via "SurveyMonkey." The link for the questionnaire was provided to the nursing directors via e-mail; these links were then passed onto the head nurses of each clinical department. Following receipt of the link, the head nurses forwarded the link to the nurses working within their departments. The participants were informed of the purpose and significance of the study and that participation was entirely voluntary. A verbal explanation of the study was provided to the participants by the head nurses who distributed the questionnaires. The principal investigator's contact information was included in the information sheet at the beginning of the survey to allow participants to seek clarification if needed. During data collection, weekly reminders were sent to both the nursing directors and the head nurses to encourage participation and improve response rates. Participation was voluntary, and informed consent was obtained through the completion and submission of the questionnaire. No identifiable information was collected, thus maintaining participant anonymity and confidentiality throughout the study. All the data were stored securely and were accessible only to the research team. The study was conducted in compliance with the principles of the Declaration of Helsinki and applicable ethical guidelines. Statistical analysis The data were analyzed via the Statistical Package for the Social Sciences (SPSS), version 25.0. Descriptive statistics were used to summarize the frequency and distribution of participants’ general and research-related characteristics. Continuous variables are presented as the means and standard deviations. One-way analysis of variance (ANOVA) was performed to examine differences in EBP knowledge, beliefs, organizational readiness, and implementation according to participants’ general and research-related characteristics. Statistical significance was determined via two-tailed tests. Karl Pearson’s coefficient of correlation was used to examine the relationships among EBP knowledge, beliefs, implementation, organizational readiness, and culture. Hierarchical multiple regression analysis was conducted to identify predictors of EBP implementation. Professional variables were entered into the first model, followed by EBP knowledge, beliefs, and organizational culture and readiness in subsequent models to assess their incremental contribution to explaining variance in EBP implementation. Model fit was evaluated via R² and changes in R² (ΔR²). Statistical significance was set at p < 0.05. RESULTS Table 1: General and research-related characteristics of the participants. Variables n (%) Age Under 25 Years Old 36 (4.1) 26-30 Years Old 278 (31.5) 31-35 Years Old 362 (41) 36-40 Years Old 141 (16) Over 41 Years Old 66 (7.5) Gender Male 237 (26.8) Female 646 (73.2) Education level Diploma 217 (24.6) Bachelor 560 (63.4) Master 95 (10.8) PHD 11 (1.2) Job Title/Role Staff Nurse (RN) 399 (45.2) Charge Nurse (CN) 147 (16.6) Nursing Assistant (e.g., Nurse Aides Tech) 168 (19) Nurse Manager, Head Nurse, Assistant Manager (e.g. Administrators on the Unit) 143 (16.2) Years of experience in your role 0-5 187 (21.2) 6-10 361 (40.9) 11-15 211 (23.9) 16-20 95 (10.8) Over 20 29 (3.3) Have you ever completed nursing research course Yes 604 (68.4) No 279 (31.6) Have you ever completed a statistics course? Yes 537 (60.8) No 400 (45.3) Have you ever attended an EBP lecture? Yes 483 (54.7) No 400 (45.3) General and research-related characteristics of the participants Table 1 summarizes the main research-related characteristics of the study participants. In this sample, the majority of nurses were between 31 and 35 years of age (41%), and most of them were female (73.2%). Most participants held a bachelor’s degree (63.4%) and were working as staff nurses (45.2%). Overall, many had more than six years of nursing clinical experience. A large number of the nurses reported completing a nursing research course (68.4%) and a statistics course (60.8%). Just over half had attended an evidence-based practice lecture. Table 2: Level of EBP knowledge, beliefs, implementation, organizational culture, and readiness. Items Mean, SD Range EBP Knowledge scale 51.14, 13.22 14–84 EBP Beliefs Scale 55.75, 10.92 16 to 80 Organizational Readiness 83.41, 18.7 25–125 EBP Implementation Scale 29.87, 15.14 0–72 Levels of EBP knowledge, beliefs, implementation, organizational culture, and readiness Table 2 presents descriptive statistics across four key constructs. The EBP knowledge and beliefs scores averaged 51.14 (SD = 13.22) and 55.75 (SD = 10.92), respectively, indicating a moderate level of knowledge and generally positive beliefs. Organizational Readiness displayed a moderate mean value of 83.41 (SD = 18.7), reflecting positive and supportive organizational culture and readiness. On the other hand, EBP implementation had the lowest mean score of 29.87 (SD = 15.14), suggesting a limitation in actual EBP engagement and activities. Detailed item-level scores for each scale are presented in the S1 Appendix . Table 3: Differences in the level of EBP knowledge, beliefs, implementation, organizational culture, and readiness according to the participants' characteristics. Variables Category Organizational Readiness M, SD t/F (p) EBP Beliefs M, SD t/F (p) EBP Implementation M, SD t/F (p) EBP Knowledge M, SD t/F (p) Education level Diploma 81.1, 20.0 6.928 (P<=0.001) 52.9, 11.9 10.904 (P<=0.001) 33.0, 13.6 6.071 (P<=0.001) 49.4, 13.9 1.625 (0.182) Bachelor 85.4, 18.5 57.27, 10.49 28.42, 15.96 51.66, 13.07 Master 77.7, 15.4 54.1, 9.7 30.3, 12.8 52.0, 12.4 PHD 76.7, 11.7 49.5, 3.9 38.1, 7.2 51.2, 12.4 Gender Male 78.8, 15.1 19.901 (P<=0.001) 51.6, 9.6 50.433 (P<=0.001) 32.9, 12.4 12.854 (P<=0.001) 49.9, 10.1 2.806 (0.094) Female 85.1, 19.6 57.3, 11.0 28.8, 15.9 51.6, 14.2 Age Under 25 Years Old 81.9, 15.4 5.17 (P<=0.001) 53.5, 12.0 3.641 (0.006) 31.2, 18.2 0.458 (0.766) 50.2, 14.4 0.763 (0.55) 26-30 Years Old 84.1, 17.4 55.7, 11.0 29.9, 13.6 52.0, 12.6 31-35 Years Old 81.4, 19.1 55.0, 11.1 30.3, 15.7 50.3, 13.1 36-40 Years Old 83.3, 19.2 56.2, 10.5 28.5, 15.8 51.4, 13.9 Over 41 Years Old 92.5, 20.0 60.2, 9.1 29.7, 15.6 52.1, 14.1 Job Title/Role Staff Nurse (RN) 88.0, 21.0 11.94 (P<=0.001) 59.5, 11.2 33.461 (P<=0.001) 26.6, 17.1 13.797 (P<=0.001) 52.3, 14.8 2.842 (0.023) Charge Nurse (CN) 78.2, 16.6 51.5, 10.0 31.8, 13.3 48.8, 11.0 Nursing Assistant (e.g., Nurse Aides Tech) 81.3, 12.9 51.3, 7.7 35.2, 8.2 49.8, 10.8 Nurse Manager, Head Nurse, Assistant Manager (e.g., administrators on the Unit) 78.9, 15.5 53.5, 10.5 32.2, 14.4 51.1, 12.4 Others 81.8, 24.1 64.0, 7.9 22.0, 17.4 54.6, 14.8 Years of experience in your role 0-5 86.8, 18.7 4.706 (0.003) 59.1, 9.7 7.924 (P<=0.001) 26.2, 15.4 5.35 (0.001) 53.7, 14.1 3.017 (0.029) 6-10 83.6, 18.9 55.2, 11.8 30.5, 15.6 50.5, 12.1 11-15 79.8, 17.8 54.5, 9.6 30.6, 14.1 50.6, 12.4 16-20 83.6, 17.6 54.2, 10.6 31.9, 13.2 50.9, 13.5 Over 20 85.2, 21.9 55.2, 13.4 34.2, 16.6 47.9, 14.9 Have you ever completed nursing research course Yes 83.8, 17.5 0.639 (0.424) 55.7, 10.7 0.152 (0.696) 31.7, 14.2 29.251 (P<=0.001) 52.1, 12.8 9.157 (0.003) No 82.7, 21.0 56.0, 11.5 25.9, 16.3 49.2, 14.0 Have you ever Completed statistics course? Yes 83.7, 17.6 0.359 (0.549) 55.3, 10.8 2.879 (0.09) 32.3, 14.1 37.922 (P<=0.001) 51.9, 12.7 4.371 (0.037) No 82.9, 20.3 56.5, 11.1 26.0, 16.0 50.0, 13.9 Have you ever attendance of EBP lecture? Yes 84.1, 17.5 1.34 (0.247) 55.0, 11.1 5.529 (0.019) 33.4, 13.6 62.368 (P<=0.001) 52.1, 12.6 5.624 (0.018) No 82.6, 20.0 56.7, 10.7 25.6, 15.8 50.0, 13.9 Differences in the level of EBP knowledge, beliefs, implementation, organizational culture, and readiness according to the participants' characteristics. Differences were examined to explore factors influencing levels of EBP knowledge, beliefs, organizational readiness, and EBP implementation among nurses (Table 3). Significant differences in EBP knowledge were found according to job title/role (p = .023), years of experience (p = .029), completion of nursing research courses (p = .003), completion of statistics courses (p = .037), and attendance at EBP lectures (p = .018). EBP beliefs differed significantly by education level (p < .001), gender (p < .001), job title/role (p < .001), years of experience (p < .001), and attendance at EBP lectures (p = .019), with male nurses and those in leadership roles showing more favorable beliefs. Organizational readiness differed significantly by education level (p < .001), gender (p < .001), job title/role (p < .001), and years of experience (p = .003), with bachelor-prepared, female, and staff nurses reporting higher readiness. EBP implementation was significantly associated with education level, gender, job title/role, years of experience, completion of research and statistics courses, and attendance at EBP lectures (all p < .001), with nurses in leadership roles and those with research training demonstrating greater implementation (Table 3) . Table 4: Correlations between EBP knowledge, beliefs, implementation, organizational culture, and readiness. Variables Organizational Culture & Readiness EBP Beliefs EBP Implementation EBP Knowledge Organizational Culture & Readiness 1 EBP Beliefs 0.544 *** 1 EBP Implementation 0.228 *** 0.017 1 EBP Knowledge 0.409 *** 0.330 *** 0.298 *** 1 Note. The values are Pearson’s correlation coefficients (r). *** p < .001. Correlations between EBP knowledge, beliefs, implementation, organizational culture, and readiness Table 4 presents the correlations between EBP knowledge, beliefs, implementation, organizational culture, and organizational readiness. The findings reveal positive and statistically significant associations among most study variables. Organizational readiness demonstrated a moderate correlation with EBP beliefs (r = 0.544, p < 0.001) and a weak-to-moderate correlation with EBP knowledge (r = 0.409, p < 0.001) but a weak yet significant correlation with EBP implementation (r = 0.228, p < 0.001). EBP knowledge showed a weak-to-moderate association with beliefs (r = 0.330, p < 0.001) and a weak yet significant association with implementation (r = 0.298, p < 0.001). Conversely, the relationship between EBP beliefs and implementation was negligible and nonsignificant (r = 0.017, p = 0.617), indicating that positive beliefs alone may not necessarily translate into practice implementation. All significant correlations were at the 0.01 level (2-tailed). Table 5: Factors affecting EBP implementation. Variables Model 1 Model 2 Model 3 Model 4 b β P B β P b β P b β P (Constant) 21.026 P<=0.001 4.855 0.068 6.940 0.040 2.829 0.406 Education level: -1.416 -0.058 0.072 -1.872 -0.077 0.013 -1.829 -0.076 0.015 -1.618 -0.067 0.029 Job Title/Role: 0.807 0.066 0.069 0.895 0.073 0.034 0.832 0.068 0.052 1.114 0.091 0.009 years of experience in your role: 1.585 0.108 0.003 1.819 0.124 P<=0.001 1.801 0.123 P<=0.001 1.651 0.112 0.001 Have you ever completed a nursing research course: 2.636 0.081 0.057 1.944 0.060 0.141 1.940 0.060 0.142 2.144 0.066 0.099 Have you ever completed a statistics course? 2.027 0.065 0.138 2.075 0.067 0.112 2.040 0.066 0.118 1.856 0.060 0.148 Have you ever attendance of EBP lecture? 5.555 0.183 P<=0.001 5.045 0.166 P<=0.001 4.981 0.164 P<=0.001 4.547 0.150 P<=0.001 EBP Knowledge 0.333 0.290 P<=0.001 0.345 0.301 P<=0.001 0.283 0.247 P<=0.001 EBP Beliefs -0.046 -0.033 0.318 -0.178 -0.129 0.001 Organizational culture and Readiness 0.171 0.211 P<=0.001 R 2 (∆R 2 ) 0.100 (0.100) 0.182 (0.083) 0.183 (0.001) 0.211 (0.028) F (P) 16.167 (P<=0.001) 27.871 (P<=0.001) 24.512 (P<=0.001) 25.966 (P<=0.001) Note. N = 883. Dependent variable EBP Implementation (EBPI) total score (range 0–72). Bold P values and β indicate statistical significance (P ≤ 0.05). Model 1: demographic and research-related characteristics; Model 2: + EBP Knowledge; Model 3: + EBP Beliefs; Model 4: + Organizational Culture and Readiness (OCRSIEP). Factors affecting EBP implementation Hierarchical multiple regression analysis identified significant predictors of EBP implementation (Table 5). In the final model (Model 4), EBP knowledge was the strongest predictor (β = 0.247, p < .001), followed by organizational culture and readiness (β = 0.211, p < .001), attendance at EBP lectures (β = 0.150, p < .001), years of experience (β = 0.112, p = .001), and job title/role (β = 0.091, p = .009). EBP beliefs showed a significant negative association (β = -0.129, p = .001). The model explained 21.1% of the variance in EBP implementation (R² = .211, F = 25.966, p < .001). Age and gender were excluded because of nonsignificant effects in preliminary regression analyses, whereas hospital site was excluded because of substantially unequal sample sizes across sites (ranging from n = 3 to n = 358), which precluded reliable estimation of site-level effects. The results of the multicollinearity tests were acceptable (VIF range: 1.037–1.893; tolerance range: .528–.964), and the Durbin‒Watson statistic (1.925) indicated no autocorrelation in the residuals. Discussion This study examined the relationships among nurses' EBP knowledge, beliefs, implementation, organizational culture, and readiness across multiple hospitals and primary healthcare centers in the Makkah region, guided by the ARCC© model. The discussion is structured around this framework to clarify how individual and organizational factors jointly influence EBP implementation. The level of EBP implementation In the present study, EBP implementation was found to be low to moderate relative to the scale range (M = 29.9, SD = 15.14 out of 0–72), indicating limited engagement in EBP activities despite generally positive EBP beliefs and moderate knowledge, organizational culture, and readiness. The item-level results revealed gaps in advanced EBP behaviors—such as generating a PICO question about one’s practice (M = 1.57, SD = 1.18) and sharing evidence from a study or studies in the form of a report or presentation to more than two colleagues (M = 1.56, SD = 1.17)—indicating limited engagement in higher-level EBP activities. Given that PICOT question formulation is considered a foundational step in the EBP process, this gap in competency raises important concerns regarding the depth and quality of reported EBP implementation, as the inability to clearly formulate clinical questions undermines subsequent evidence searching, appraisal, and application. This finding suggests that EBP implementation may be overestimated when core methodological steps are not consistently performed. This pattern is consistent with Saudi literature, which consistently reports lower implementation scores than EBP knowledge and attitudes [23,53]. These findings are further supported by Mohamed [54], who reported that nurses perceived EBP as complex due to their limited ability to formulate research questions and integrate evidence into clinical decision-making, with EBP steps rarely articulated in practice. Similar implementation gaps have been consistently reported internationally, with studies across high- and low-resource settings showing that despite favorable attitudes toward EBP, nurses demonstrate limited engagement in higher-level implementation behaviors, particularly PICO question formulation and dissemination of research evidence [34, 55]. Evidence from both low- and middle-income countries and well-resourced health systems further confirms that EBP implementation remains suboptimal and is constrained less by beliefs and more by deficits in knowledge and skills and organizational support [56, 57]. The findings from these international studies also strongly support our findings that EBP implementation is less influenced by nurses’ overall beliefs and more influenced by deficits in foundational EBP knowledge and skills and organizational support, a relationship reflected in the present study by the alignment between low belief scores related to the clarity of EBP steps and perceived difficulty of EBP, low knowledge scores in converting information needs into researchable questions, and low engagement in core implementation behaviors such as PICOT formulation—indicating that limitations in essential methodological skills, rather than unfavorable beliefs, primarily constrain high-quality EBP implementation. The disconnect identified here creates a 'rhetoric-reality gap', which indicates that, at present, the professional ideals of EBP have not yet been met by the realities of clinical practice. Our nurses have expressed positive belief in EBP; however, this enthusiasm has been hindered from actually being executed. Low PICOT formulation scores serve as an alert, indicating that without the technical 'how-to,' these beliefs are simply theoretical. Additionally, the hierarchical nature of health care may cause nurses to believe that they do not have the organizational 'permissions' or mentorship required to challenge long-standing routines. Thus, they have the map (beliefs), but their vehicle (skills and support) is presently underpowered. EBP Knowledge as a Predictor of EBP Implementation In the present study, we found that EBP knowledge was the strongest predictor of EBP implementation (β = 0.247, p < .001), indicating the important role of an individual's knowledge in EBP implementation. The average EBP knowledge score was moderate (M = 51.14, SD = 13.22, out of 14–84), indicating a moderate level of perceived knowledge. Although participants scored their general research skills at a higher level, they also reported lower scores on their ability to convert information needs into a research question (M = 3.49; SD = 1.26) and information technology skills (M = 3.48; SD = 1.29). This pattern suggests that nurses are aware of EBP principles but do not have the core methodological skills needed to put EBP into daily practice, which include formulating a question and searching for evidence. This may help explain the gap between EBP knowledge and actual implementation. Notably, attendance at EBP lectures was also a significant predictor of EBP implementation (β = 0.150, p < .001), further reinforcing that structured educational exposure plays a direct role in bridging the gap between knowledge acquisition and clinical application. Additionally, years of experience in one’s current position were a modest but significant predictor of EBP implementation (β = 0.112, p = .001), possibly because more experienced nurses are more confident in their practice and have better knowledge of institutional processes. However, the relatively small effect size suggests that experience alone is insufficient without structured EBP knowledge and supportive organizational environments. Our results are also supported by studies from Saudi Arabia, where it has been demonstrated that EBP knowledge is a major determinant of EBP implementation—while at the same time demonstrating that there are significant gaps in essential technical EBP skills. One Saudi study revealed that EBP knowledge was a significant predictor of EBP use (β = .452, p < .001) [23], a result that was subsequently replicated by another study that demonstrated that knowledge continued to contribute significantly to implementation even when accounting for organizational factors [53]. While the overall level of knowledge among Saudi nurses has been deemed adequate, many have expressed difficulty in translating EBP into action. Qualitative evidence supports the notion that Saudi nurses perceive the process of EBP to be difficult because they possess limited skills in developing clinical questions and retrieving evidence and limited skills in utilizing information technology and accessing research databases [54]. More importantly, the authors found no relationship between these deficits and interest in EBP; rather, the deficits were associated with limited practical skill development—a finding that is consistent with the findings of the current study that the weakest link in the pathway of knowledge to implementation is represented by foundational competencies rather than general awareness. International studies have similarly demonstrated a commonality with this pattern—with nurses reporting moderate EBP knowledge across different healthcare systems—but have consistently cited foundational competency deficits, particularly in converting clinical problems into researchable questions and effectively using information technology for evidence retrieval [41, 56, 58]. Collectively, the abovementioned findings support the conclusion that conceptual EBP knowledge alone is not sufficient—as deficits in developing clinical questions and utilizing information technology to retrieve evidence reduce the rigors of the evidence search, appraisal, and implementation process. Given that converting information needs into structured clinical questions represents a foundational step in the EBP process, targeted, skill-based educational strategies that focus on developing these foundational competencies are needed to improve the translation of knowledge into effective practice [59] . Organizational culture and Readiness for EBP Implementation In our study, we found that organizational culture and readiness were predictors of EBP implementation (beta = 0.211, p < .001). These findings suggest that the organizational system and structure are important factors for EBP implementation. The average organizational culture and readiness score was found to be moderate (mean = 83.4; SD = 18.7) on a scale of 25-125. The item-level data revealed that the lowest scores were for the following items: overall institutional readiness for EBP (m = 3.16, SD = 1.15); availability of nurse scientists to assist in generating evidence when evidence does not exist (m = 3.17, SD = 1.15); extent to which EBP is practiced within the organization (m = 3.19, SD = 1.30); and availability of advanced practice nurses to serve as EBP mentors (m = 3.23, SD = 1.22). These findings further strengthen our interpretation that EBP implementation is influenced less by nurses' overall beliefs and more by gaps in foundational EBP knowledge and skills and limited organizational support, including a lack of access to EBP mentors and nurse scientists, which collectively restrict the development, guidance, and execution of the core methodological steps required for high-quality and sustainable EBP. Consistent with previous studies conducted in Saudi Arabia, organizational readiness for EBP has been described as generally moderate, transitional, and not well established to be able to sustain routine implementation [33]. Using the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Scale, a study of Saudi postgraduate nurses reported a mean readiness score of 76.58 three months after completing an educational intervention, which the authors described as reflecting 'a moderate movement toward a culture of EBP' that was not yet sustainable. Notably, this score improved to 92.10 twelve months later, indicating a positive shift in nurses' perceptions of their organizational environment following sustained EBP practice [33]. Thus, the findings of the present study, with a mean readiness score of 83.4, support the findings from Saudi Arabia and indicate that the organizational culture and readiness for EBP in Saudi Arabia could be transitional. Qualitative evidence also supports this observation, with one study showing that the workplace climate was "not encouraging and not supportive" due to inadequate organizational commitment, infrastructure, and accessibility to EBP resources [54]. In addition, several studies conducted in Saudi Arabia support the predictive role of organizational readiness and culture for EBP implementation. For example, both organizational support and leadership commitment have been found to be significant predictors of EBP implementation, whereas resource limitations have resulted in less willingness for nurses to implement EBP in daily practice [60]. Furthermore, the findings of the present study at the item level are consistent with those of the Saudi literature in terms of deficits in structural and human capacity, including shortages of doctor-prepared nurses, EBP mentors, and role models [33]. The above findings are supported by qualitative evidence that describes a "rhetoric-reality gap," wherein EBP is advocated for at the policy or accreditation level but is limited in its implementation in the clinical setting owing to hierarchical structures, inconsistent messages from leaders, and the absence of protected positions for EBP champions [28]. Internationally, studies have shown that organizational culture and readiness significantly impact the level of EBP implementation, with several studies showing that leadership support, resource availability, and the necessary infrastructure are important enablers across various healthcare systems [61–63]. Furthermore, the moderate level of organizational readiness observed in our study is consistent with international findings [61, 63]. Consequently, this suggests a transitional EBP culture. In this culture, limited leadership support, inadequate mentorship, and insufficient infrastructure hinder the consistent implementation of EBP in both resource-rich and resource-poor settings [34,64]. The ARCC© Model as a Unifying Framework for System-Wide Evidence-Based Practice Implementation Our results, supported by national and international data, indicate that gaps in implementing EBP are caused by an interplay between the individual's and the organization's factors rather than being solely due to one of these factors. While the nurses in this study showed positive beliefs toward EBP and reasonable levels of baseline knowledge, they were unable to implement it consistently without essential elements such as mentorship, leadership engagement, knowledge and skills in core EBP steps, and a supportive environment for EBP. These patterns align closely with the conceptual underpinnings of the ARCC model, supporting its use as a comprehensive framework for addressing the multiple barriers to EBP implementation identified in this study. The ARCC© model operationalizes EBP implementation through integrated, system-level strategies that directly correspond to the observed deficits [41, 46]. A critical component of the ARCC model is the formal, organizational assessment of EBP readiness utilizing the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice (OCRSIEP). The use of OCRSIEP allows leaders to assess their organization's readiness gaps and develop specific plans for implementation on the basis of the organization's needs [46, 52, 65]. Equally important is the development of EBP mentors—clinical staff with a higher level of competency who provide ongoing direct support for the translation of evidence into practice while increasing the confidence of clinicians in their ability to apply evidence in their practices [44,46,48,66]. Additionally, the ARCC emphasizes the interactive education of nurses, which focuses on the development of core EBP competencies, specifically, EBP processes such as PICOT question development, evidence appraisal, and EBP implementation planning [46,59,65]. Research consistently shows that interventions based on the ARCC model improve EBP use within organizations, strengthen the organizational culture, and enhance nurse mentoring, thereby encouraging participation in EBP activities, with organizational readiness and EBP knowledge emerging as key predictors of sustained practice change [41,46,65,67]. Conclusion This study demonstrated that nurses across the studied hospitals and primary healthcare centers in the Makkah region have positive beliefs toward EBP; however, the actual level of EBP implementation remains modest. The strongest predictors of EBP implementation were EBP knowledge and organizational culture and readiness, indicating that both a supportive organizational environment and individual knowledge play important roles in successful EBP implementation. Furthermore, attendance at EBP lectures and years of professional experience also contributed significantly to implementation but less than the previously mentioned factors did. In addition, gaps in core EBP skills, mentorship, and institutional support limit the translation of evidence into practice. Overall, our results indicate that successful EBP implementation requires a combination of two types of interventions: enhancing nurses’ EBP knowledge through evidence-based education, specifically skills-based education programs, and creating an environment that supports EBP, including ongoing nurse leadership engagement, mentoring, sufficient time for EBP integration, and appropriate infrastructure to facilitate the use of EBP in everyday clinical practice. Strengths and limitations of the study This study is characterized by several important strengths. This is one of the few multisite studies conducted in Saudi Arabia investigating nurses’ EBP knowledge, beliefs, implementation, organizational culture, and readiness simultaneously. Compared with earlier Saudi studies, this multisite design allows for a more representative assessment of EBP implementation across care settings and organizational contexts. The investigation included nurses working in both hospitals and primary healthcare centers throughout the Makkah region, providing a broader representation of various clinical environments and a comprehensive picture of EBP implementation in the region. The use of validated instruments, coupled with the alignment of the study variables with the ARCC model, provides a robust basis for the reliability and precision of the findings. Furthermore, the substantial sample size supports robust statistical analysis, strengthening the reliability of the observed relationships among the key EBP variables. Although there are numerous strengths to this study, it is important to acknowledge its limitations. The use of convenience sampling from hospitals and primary healthcare centers within a specific geographic area limits the generalizability of the results to other regions or healthcare systems. Additionally, the cross-sectional design precludes the determination of causal relationships between the study variables. Furthermore, the reliance on self-report surveys introduces the potential for social desirability and recall biases. Although the EBP knowledge subscale was revised to allow for a new response format after pilot testing to assist in improving clarity, the revision did not change the conceptualization of the EBP knowledge subscale items or constructs. For this reason, comparisons with studies using the original response format should be made cautiously. Relevance to Clinical Practice Our findings indicate that healthcare organizations must strengthen both individual competencies and the organizational culture to foster the adoption of EBP. Guided by the ARCC© model, clinical leaders should ensure that their hospitals provide system-wide support, as well as mentorship and a structured education program for nurses that is designed to develop their EBP knowledge skills and core EBP competencies, while also promoting an EBP culture within their organization that fosters inquiry and provides opportunities for shared governance and leader engagement [ 44 , 46 ]. Strategies that can be used to apply these recommendations include following a clear model such as the ARCC©, which integrates need assessment and EBP mentors and provides nurses with resources, such as protected time, education, and journal clubs, as well as providing nurses with the access to evidence-based resources needed to support their practice and including the expectation of implementing EBP in all aspects of nursing practice, such as policy and role expectations [ 47 , 52 ]. These strategies allow clinical leaders to create a systematic process. This process helps nurses consistently and sustainably use evidence in their practice [ 41 , 67 ]. As a result, this will improve the quality and safety of patient care. Additionally, several studies have demonstrated the positive impact of the successful implementation of EBP on patient outcomes, the well-being of nurses, and the generation of significant cost savings and returns on investment for health care organizations [ 7 , 29 ]. These findings reinforce EBP as a critical strategy for both clinical and fiscal success. Recommendations for future research To improve the generalizability of the findings and investigate intraorganizational variations, it is recommended that multicenter research be conducted across various geographic regions and healthcare sectors in Saudi Arabia. The existing evidence base would benefit from experimental or quasi experimental designs to assess the efficacy of structured, theory-driven intervention frameworks, such as the ARCC Model. Abbreviations EBP – Evidence-Based Practice ARCC© – Advancing Research and Clinical Practice through Close Collaboration OCRSIEP —Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice EBPB – Evidence-Based Practice Beliefs PICOT – Patient/Population, Intervention, Comparison, Outcome, Time PHC —Primary Healthcare Center Declarations Acknowledgments The researchers thank all the nurses who participated in this study. The authors also extend their appreciation to Taif University for its support. Author contributions Faisal Alasmari contributed to the conceptualization, methodology, data analysis, and writing of the original draft. Elham Al Ateeq contributed to conceptualization, supervision, and writing, review and editing. Mohammad Paredath contributed to the data analysis and writing of the original draft. Ahmed Alkhaibari, Hawazin Alhawsaw, Fahad M. Althobaiti, Husam Aburub, Yahya Malem, Reham Alrwaitey, Mohummud Ramjan, and Ali Alahmadi contributed to the writing of the original draft. All the authors have read and approved the final version of the manuscript. Funding The study was not funded. Data availability The datasets generated and analyzed during this study are not publicly available due to institutional data governance policies but are available from the corresponding author upon reasonable request. Ethics approval Permission to conduct this study was obtained from the Institutional Review Board of King Abdullah Medical City in Holy Capital, Ministry of Health, Saudi Arabia prior to data collection (IRB No. 20-706; approved on September 21, 2020). Approval to collect data was also granted by the nursing administrations of all participating hospitals and primary healthcare centers in the Makkah region of Saudi Arabia. Data were collected between November 2020 and February 2021. All methods followed the STROBE guidelines and were conducted in accordance with the Declaration of Helsinki. Consent to participate All participants received an online participant information sheet detailing the purpose of the study, the voluntary nature of participation, procedures for data handling, and their right to withdraw prior to survey submission. Explicit electronic informed consent was obtained from all participants before access to the questionnaire was granted. Consent for publication Not applicable. No identifiable personal data are presented in this manuscript. Competing interests The authors declare that they have no competing interests. Author details 1Nursing Professional Practice and Research Department, Executive Nursing Administration King Faisal Hospital Specialist and Research Center, Madinah 42522 Saudi Arabia 2 Nursing Research and Evidence-Based Practice Department, King Abdullah Medical City, Makkah 24246, Saudi Arabia 3 Nursing Leadership and Education Department, College of Nursing, Taif University, Taif 21974, Saudi Arabia 4 Group Chief Quality and Nursing, Almeswak Medical Group, Riyadh 11461, Saudi Arabia 5 Nursing Adult Services, Executive Nursing Administration King Faisal Hospital Specialist and Research Center, Madinah 42522 Saudi Arabia 6 Nursing Quality Department, King Abdullah Medical City, Makkah 24246, Saudi Arabia References Cheng Y, Zou C, Liu C, Jia Y, Yang R, Zhang Y, et al. Evidence-based general practice: a scoping review. BMC Prim Care. 2025 May 14;26(1):161. Melkamu Y, Asemahagn MA, Walle AA, Tsega Y. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9000988","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607362832,"identity":"703e7dee-e70e-43fa-8a39-4d8610a77229","order_by":0,"name":"Faisal Alasmari¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIie3OMUvDQBTA8RcOzuWFbBII0q/wSkApUvJVUgK6CDp2CgdCOrln6JeQgvMdb/UDCOdgKTh1UARxuMGkuumFujncfzje8H7cAwiF/mEHCiK9m4RgmMPXnA4R7Ha+iazg/m8EMN+THPKT/nB3o5MFvpF2j5eJEsYi1CMvyc7I3DR2vOR4VZrmedJqWZ0i8Fh5SJGVpGNlo1bEK35VTAR4nCHoyEcwO38xztmiFbjR2vUkee9IXfjJBTFKO+uIKLXc/SI7ImYD5IqPGlu1QuZkGqaUZT5ZElcDh92ut85O24Q3aX9YsrheP2zn9dRHfkn0D+2/HwqFQqGffQIId1s2EZFPlwAAAABJRU5ErkJggg==","orcid":"","institution":"King Faisal Specialist Hospital \u0026 Research Centre","correspondingAuthor":true,"prefix":"","firstName":"Faisal","middleName":"","lastName":"Alasmari¹","suffix":""},{"id":607362835,"identity":"4c36bc0b-8297-4b11-9c6e-d9d1f24c6e2c","order_by":1,"name":"Ahmed Alkhaibari","email":"","orcid":"","institution":"King Faisal Specialist Hospital \u0026 Research 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City","correspondingAuthor":false,"prefix":"","firstName":"Hawazin","middleName":"","lastName":"Alhawsaw⁶","suffix":""},{"id":607362840,"identity":"0c536b06-83d1-400c-a91e-195036dc6eae","order_by":5,"name":"Fahad M Althobaiti³","email":"","orcid":"","institution":"Taif University","correspondingAuthor":false,"prefix":"","firstName":"Fahad","middleName":"M","lastName":"Althobaiti³","suffix":""},{"id":607362841,"identity":"6d398ab3-ef5b-47be-a674-926993aaf886","order_by":6,"name":"Husam Aburub¹","email":"","orcid":"","institution":"King Faisal Specialist Hospital \u0026 Research Centre","correspondingAuthor":false,"prefix":"","firstName":"Husam","middleName":"","lastName":"Aburub¹","suffix":""},{"id":607362842,"identity":"65b799dd-f743-40c9-8934-a20750f9c3a7","order_by":7,"name":"Yahya Malem⁵","email":"","orcid":"","institution":"King Faisal Specialist Hospital \u0026 Research 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Centre","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Alahmadi⁵","suffix":""}],"badges":[],"createdAt":"2026-03-01 11:08:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9000988/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9000988/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104994290,"identity":"8d25d2d2-60e4-4830-beed-ca210f0718f2","added_by":"auto","created_at":"2026-03-19 15:59:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":879157,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdvancing Research and Clinical Practice through the Close Collaboration (ARCC©) Model\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9000988/v1/4a827f6118686e618485e202.png"},{"id":105035680,"identity":"0f6088f5-0870-4d60-b54b-bb5491d778d9","added_by":"auto","created_at":"2026-03-20 07:26:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2904224,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9000988/v1/4ca9af38-3ef7-4513-b72b-d33820197621.pdf"},{"id":104994286,"identity":"04a7c993-af31-4252-ac0e-b5a716594687","added_by":"auto","created_at":"2026-03-19 15:59:41","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18841,"visible":true,"origin":"","legend":"","description":"","filename":"S1Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-9000988/v1/1966231cfb404ac47c27ac9e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEvidence-Based Practice among Nurses in Saudi Arabia: An ARCC© Model-Based Cross-Sectional Study of Knowledge, Beliefs, Implementation, Culture, and Readiness\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEvidence-based practice (EBP) is a problem-solving approach that integrates the best available research evidence with clinical expertise and patient values to guide decisions about patient care [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. Current studies demonstrate that EBP is associated with improved patient outcomes, including but not limited to reduced mortality, shorter hospital stays, lower infection rates, and increased patient satisfaction, while also yielding substantial economic benefits, with most studies reporting a positive return on investment [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. EBP ensures safe, high-quality, patient-centered care by establishing standards of best practices on the basis of the most current literature and reducing variation in treatments to promote better outcomes and improved safety [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Despite rapid growth in healthcare research, a persistent evidence-to-practice gap remains, with estimates suggesting that it may take more than 15 years for half of evidence-based interventions to be routinely implemented in clinical practice [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. EBP helps reduce the gap between clinical practice and the application of the results of research, thus allowing patients to benefit from new scientific developments and allowing nurses to implement new effective interventions more rapidly [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eConsequently, EBP has become an essential concept in the development and delivery of healthcare services worldwide. As EBP rapidly replaces traditional models of authority in health care decision-making, practitioners are required to acquire knowledge, apply it to practice, and guide other practitioners in its appropriate application [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the late 20th century, most Western countries, including the U.S., UK, and Australia, established EBP in nursing and have continued to support the development and dissemination of evidence-based clinical practice guidelines through international organizations specializing in evidence synthesis and guideline development [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. The Institute of Medicine designated EBP competency as one of the five foundational competencies for all healthcare professionals, whereas the American Association of Colleges of Nursing designated EBP as one of the nine core elements of professional nursing practice [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eWhile significant global advances have been made toward EBP adoption, the pace of this advancement varies worldwide; many countries, including Saudi Arabia, are still working to integrate EBP into the daily practices of their clinicians. EBPs gained recognition in Saudi Arabia in the early 2000s, with initial studies conducted among primary healthcare physicians in Riyadh focusing on awareness, attitudes, and barriers to implementation [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. EBPs have gradually become more common across various healthcare fields, such as nursing, pharmacy, physical therapy, radiology, and allied health. This growth has been accompanied by a greater focus on education, organizational support, and the creation of national guidelines [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Vision 2030 initiated a comprehensive transformation of the Saudi healthcare system, focusing on patient-centered care, value-based care, and the use of EBP at all levels. Key measures included the establishment of the National Guidelines Center. This center is responsible for developing and updating evidence-based clinical guidelines to provide standardized care and improve patient outcomes throughout the country [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eWhile nurses working in Saudi Arabia generally demonstrate a positive attitude toward EBP, studies consistently report barriers to EBP at both the individual and organizational levels, including limited knowledge and skills, lack of educational programs, low confidence, inadequate access to databases, insufficient staffing, lack of protected time, weak leadership engagement, and limited institutional resources [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. Internationally, similar findings have shown that underinvestment in EBP infrastructure and leadership support has resulted in weak EBP cultures and suboptimal patient outcomes [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eGiven these persistent barriers, it is increasingly clear that individual efforts alone are insufficient and that meaningful and sustained EBP implementation will require both nurses and organizational culture and readiness to create a work environment that actively supports EBP [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]. Readiness encompasses both individual factors\u0026mdash;such as clinicians\u0026rsquo; knowledge, skills, and attitudes\u0026mdash;and organizational factors, including leadership commitment, culture, and resource availability. These domains are interdependent, as neither individual nor organizational factors alone are sufficient to sustain EBP implementation [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eNumerous studies have demonstrated considerable relationships between nurses\u0026apos; EBP knowledge, skills, and EBP implementation within hospital settings [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e]. Additional studies have also demonstrated that EBP beliefs and organizational culture and readiness are substantial predictors of successful EBP implementation within healthcare organizations [\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e]. Therefore, an individual and organizational readiness assessment of EBP implementation represents the first critical step in preparing for EBP implementation to achieve a sustainable culture of inquiry [\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e]. Several theoretical EBP models have been developed to guide the assessment and support systematic implementation within hospitals and to structure and facilitate the translation of evidence into practice [\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e]. Among those models, the Advancing Research and Clinical Practice through Close Collaboration (ARCC\u0026copy;) model, developed by Melnyk and Fineout-Overholt (47), is among the most commonly used system-wide methods for both implementing and sustaining EBP at the organizational level. A central tenet of the ARCC\u0026copy; model is its emphasis on both individual- and organizational-level change through strategies such as EBP mentorship, leadership engagement, supportive culture, and targeted knowledge and competency development [\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe first step in the ARCC\u0026copy; model involves assessing organizational readiness and culture and EBP implementation, as well as nurses\u0026rsquo; beliefs toward EBP. This assessment allows organizations to identify strengths and barriers and to develop targeted interventions such as education, mentors, and environmental modifications to support and sustain the adoption of EBP [\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e]. Studies have consistently shown that organizations that implement the ARCC\u0026copy; model demonstrate increased levels of EBP beliefs, knowledge, and implementation; a stronger EBP culture; better patient outcomes; and improved job satisfaction, staff empowerment, and retention [\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e]. The conceptual framework for the present study was developed on the basis of the ARCC\u0026copy; model, guiding the selection of variables and the examination of relationships among nurses\u0026rsquo; EBP knowledge, beliefs, implementation, organizational culture, and readiness.\u003c/p\u003e\n\u003cp\u003eAlthough interest in EBP implementation throughout the Kingdom of Saudi Arabia is growing, several gaps remain within the existing body of evidence. No studies have investigated nurses\u0026apos; EBP knowledge, beliefs, implementation, organizational culture, and readiness using one conceptual framework. The lack of studies that have investigated all four of these concepts using a single conceptual framework limits our understanding of how these elements interact to influence the degree to which nurses implement EBP. Furthermore, to date, no studies have evaluated the abovementioned variables at multiple hospitals and primary health care centers in the Makkah region of Saudi Arabia. Therefore, a major geographic and system-wide gap exists in the national evidence base.\u003c/p\u003e\n\u003cp\u003eThese gaps underscore the need for a comprehensive, multisite evaluation to provide the information needed to develop targeted interventions and to support a system with wide development of EBP capacity-building capabilities. This study aims to evaluate clinical nurses\u0026rsquo; EBP knowledge, beliefs, implementation, organizational culture, and readiness across eight hospitals and primary healthcare centers in the Makkah region of Saudi Arabia as the first step in implementing EBP in accordance with the ARCC\u0026copy; model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSpecific objectives:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eTo assess nurses\u0026rsquo; EBP knowledge, beliefs, implementation, organizational culture, and readiness.\u003c/li\u003e\n \u003cli\u003eTo investigate the differences in clinical nurses\u0026apos; EBP knowledge, beliefs, implementation, organizational culture, and readiness according to the participants\u0026apos; general and research-related characteristics and to analyze the relationships among these variables.\u003c/li\u003e\n \u003cli\u003eTo identify predictors of EBP implementation, using multiple linear regression.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study employed a multicenter descriptive cross-sectional study design.\u003cbr\u003e\u0026nbsp; Study participants were recruited via convenience sampling methods. The data were collected from eight hospitals and primary care health centers via a convenience sampling method. The target population was estimated to include more than 5,000 registered nurses. The calculations with G-Power Version 3.1 revealed that a sample size of 791 was needed to achieve the desired 80% statistical power. This was based on a fixed effects multiple linear regression model, a small effect size of f\u0026sup2; = 0.02, a significance level (\u0026alpha;) of 0.05, and nine predictor variables.\u003cbr\u003e\u0026nbsp; Among 5000 nurses, 250 nurses were excluded. We distributed the survey to 4750 participants. Eventually, 883 registered nurses completed the online survey, which exceeded the minimum sample size needed for this study. The overall response rate for the study was 18.6%. The eligibility criteria for nurses in this study were (1) registered nurses in Saudi Arabia, (2) a minimum age of 18 years, and (3) willingness to participate voluntarily in the study. Intern nurses and nurses on maternity leave or sick leave or who were absent for any other reason during the inquiry were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data for the study were collected\u0026nbsp;by using a structured self-administered questionnaire that consisted of two primary components. The first part focuses on general and research-related characteristics. The second part included tools that measure EBP knowledge, beliefs, implementation, and organizational culture and readiness. Permission from the original author was obtained before the tools were used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral and Research-Related Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first part of the survey was created on the basis of relevant literature regarding nurses and EBP and contained nine questions that addressed the demographic and professional characteristics of the participants, such as gender, age, educational level, job role, years of clinical experience, participation in EBP-related education, and completion of research and statistics courses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEBP Knowledge\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKnowledge of EBP was assessed via the knowledge subscale of the Evidence-Based Practice Questionnaire (EBPQ) developed by Upton and Upton [50]. The tool comprises 14 items measuring different skill areas, including formulating clinical questions and critically evaluating the evidence. The original score is a 7-point Likert scale ranging from 1 (poor) to 7 (best). The pilot questionnaire was conducted prior to collecting all the data to test its usability, the length of time required to complete it, and clarity. The results indicated that the original numeric response options were not clearly defined. Therefore, the response format was modified to a six-point Likert scale ranging from 1 (very poor) to 6 (excellent) to provide clearer and easier-to-interpret responses for the participants. The minimum and maximum scores are 14 and 84, respectively, with higher total scores indicating a higher level of self-reported EBP knowledge. The tool originally demonstrated very high levels of reliability when used with a Cronbach\u0026rsquo;s alpha of .91. In the present study, the modified version demonstrated good internal consistency when tested, with a Cronbach\u0026rsquo;s alpha of .93.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEBP Beliefs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEBP beliefs were measured via the Evidence-Based Practice Beliefs (EBPB) Scale developed by Melnyk et al. [51]. The EBPB consists of 16 items. Each item uses a 5-point Likert-type scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The total scores range from 16--80, with higher scores indicating stronger beliefs in EBP. The original Cronbach\u0026apos;s alpha for the EBPB was 0.90; in the current study, it also had high internal consistency, with a Cronbach\u0026apos;s \u0026alpha; = .91.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEBP Implementation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Evidence-Based Practice Implementation (EBPI) Scale developed by Melnyk et al. [51] was utilized. It includes 18 items that measure how often participants have engaged in EBP-specific activities over the preceding 8 weeks, e.g., creating a PICOT question, accessing clinical guidelines, and evaluating patient outcomes. The respondents used a five-point Likert-type scale to rate their responses from 0 (0 times) to 4 (more than 8 times). The total scores range from 0-72, with higher scores representing greater EBP implementation. The reliability of the original EBPI scale was determined to be excellent (Cronbach\u0026rsquo;s alpha = .96); the reliability of the EBPI scale in this study was also found to be excellent (Cronbach\u0026rsquo;s alpha = .94).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOrganizational culture and readiness\u0026nbsp;for EBP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe degree of organizational culture and readiness for system-wide EBP implementation was assessed via the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice (OCRSIEP) Scale [52]. The OCRSIEP scale consists of 25 items that assess the extent to which EBP is supported, integrated, and prioritized within the organization. Each item uses a 5-point Likert-type scale ranging from 1 (None at All) to 5 (Very Much). Total scores range from 25 to 125, with higher scores indicating a more positive, supportive organizational culture. The original scale demonstrated excellent reliability (Cronbach\u0026rsquo;s \u0026alpha; = 0.94), which was similarly confirmed in this study (Cronbach\u0026rsquo;s \u0026alpha; = 0.93).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedure and ethical\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econsiderations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB) prior to data collection (IRB No. 20--706, approved on September 21, 2020). Data were collected from November 2020 to February 2021. The nursing administration staff of all the participating hospitals and primary healthcare clinics located within the Makkah region of Saudi Arabia granted permission prior to data collection. The participants completed an online version of the questionnaire via \u0026quot;SurveyMonkey.\u0026quot; The link for the questionnaire was provided to the nursing directors via e-mail; these links were then passed onto the head nurses of each clinical department. Following receipt of the link, the head nurses forwarded the link to the nurses working within their departments. The participants were informed of the purpose and significance of the study and that participation was entirely voluntary. A verbal explanation of the study was provided to the participants by the head nurses who distributed the questionnaires. The principal investigator\u0026apos;s contact information was included in the information sheet at the beginning of the survey to allow participants to seek clarification if needed.\u003c/p\u003e\n\u003cp\u003eDuring data collection, weekly reminders were sent to both the nursing directors and the head nurses to encourage participation and improve response rates. Participation was voluntary, and informed consent was obtained through the completion and submission of the questionnaire. No identifiable information was collected, thus maintaining participant anonymity and confidentiality throughout the study. All the data were stored securely and were accessible only to the research team. The study was conducted in compliance with the principles of the Declaration of Helsinki and applicable ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed via the Statistical Package for the Social Sciences (SPSS), version 25.0. Descriptive statistics were used to summarize the frequency and distribution of participants\u0026rsquo; general and research-related characteristics. Continuous variables are presented as the means and standard deviations.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eOne-way analysis of variance (ANOVA) was performed to examine differences in EBP knowledge, beliefs, organizational readiness, and implementation according to participants\u0026rsquo; general and research-related characteristics. Statistical significance was determined via two-tailed tests.\u003c/p\u003e\n\u003cp\u003eKarl Pearson\u0026rsquo;s coefficient of correlation was used to examine the relationships among EBP knowledge, beliefs, implementation, organizational readiness, and culture.\u003c/p\u003e\n\u003cp\u003eHierarchical multiple regression analysis was conducted to identify predictors of EBP implementation. Professional variables were entered into the first model, followed by EBP knowledge, beliefs, and organizational culture and readiness in subsequent models to assess their incremental contribution to explaining variance in EBP implementation. Model fit was evaluated via R\u0026sup2; and changes in R\u0026sup2; (\u0026Delta;R\u0026sup2;). Statistical significance was set at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eTable 1: General and research-related characteristics of the participants.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eUnder 25 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e36 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e26-30 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e278 (31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e31-35 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e362 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e36-40 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e141 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eOver 41 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e66 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e237 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e646 (73.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e217 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Bachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e560 (63.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Master\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e95 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; PHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e11 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob Title/Role\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Staff Nurse (RN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e399 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Charge Nurse (CN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e147 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Nursing Assistant (e.g., Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Aides Tech)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e168 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Nurse Manager, Head Nurse, Assistant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Manager (e.g. Administrators on the Unit)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e143 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of experience in your role\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; 0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e187 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; 6-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e361 (40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; 11-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e211 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; 16-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e95\u0026nbsp;(10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eOver 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e29 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever completed nursing research course\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e604 (68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e279 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever completed a statistics course?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e537 (60.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e400 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever attended an EBP lecture?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e483 (54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e400 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral and research-related characteristics of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eparticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 summarizes the main research-related characteristics of the study participants. In this sample, the majority of nurses were between 31 and 35 years of age (41%), and most of them were female (73.2%). Most participants held a bachelor\u0026rsquo;s degree (63.4%) and were working as staff nurses (45.2%). Overall, many had more than six years of nursing clinical experience. A large number of the nurses reported completing a nursing research course (68.4%) and a statistics course (60.8%). Just over half had attended an evidence-based practice lecture.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e2: Level of EBP knowledge, beliefs, implementation, organizational culture, and readiness.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"599\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean, SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eEBP Knowledge scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e51.14, 13.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e14\u0026ndash;84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eEBP Beliefs Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e55.75, 10.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e16 to 80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eOrganizational Readiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e83.41, 18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e25\u0026ndash;125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eEBP Implementation Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e29.87, 15.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0\u0026ndash;72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eLevels\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of EBP knowledge, beliefs, implementation, organizational culture, and readiness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents descriptive statistics across four key constructs. The EBP knowledge and beliefs scores averaged 51.14 (SD = 13.22) and 55.75 (SD = 10.92), respectively, indicating a moderate level of knowledge and generally positive beliefs. Organizational Readiness displayed a moderate mean value of 83.41 (SD = 18.7), reflecting positive and supportive organizational culture and readiness. On the other hand, EBP implementation had the lowest mean score of 29.87 (SD = 15.14), suggesting a limitation in actual EBP engagement and activities. Detailed item-level scores for each scale are presented in the \u003cstrong\u003eS1 Appendix\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Differences in the level of EBP knowledge, beliefs, implementation, organizational culture, and readiness according to the participants\u0026apos; characteristics.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"733\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrganizational Readiness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eM, SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et/F\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(p)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBP\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBeliefs\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eM, SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et/F\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(p)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBP\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eImplementation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eM, SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et/F\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(p)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBP\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eM, SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et/F (p)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003elevel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e81.1,\u003c/p\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.928\u003c/p\u003e\n \u003cp\u003e(P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e52.9,\u003c/p\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10.904 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e33.0,\u003c/p\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.071 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e49.4,\u003c/p\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1.625 (0.182)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e85.4,\u003c/p\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e57.27,\u003c/p\u003e\n \u003cp\u003e10.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e28.42,\u003c/p\u003e\n \u003cp\u003e15.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e51.66,\u003c/p\u003e\n \u003cp\u003e13.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e77.7,\u003c/p\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e54.1,\u003c/p\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e30.3,\u003c/p\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e52.0,\u003c/p\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003ePHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e76.7,\u003c/p\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e49.5,\u003c/p\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e38.1,\u003c/p\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e51.2,\u003c/p\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e78.8,\u003c/p\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e19.901\u003c/p\u003e\n \u003cp\u003e(P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e51.6,\u003c/p\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e50.433 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e32.9,\u003c/p\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e12.854 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e49.9,\u003c/p\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003e2.806 (0.094)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e85.1,\u003c/p\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e57.3,\u003c/p\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e28.8,\u003c/p\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e51.6,\u003c/p\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eUnder 25 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e81.9,\u003c/p\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.17\u003c/p\u003e\n \u003cp\u003e(P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e53.5,\u003c/p\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.641 (0.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e31.2,\u003c/p\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.458 (0.766)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e50.2,\u003c/p\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.763 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e26-30 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e84.1,\u003c/p\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e55.7,\u003c/p\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e29.9,\u003c/p\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e52.0,\u003c/p\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e31-35 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e81.4,\u003c/p\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e55.0,\u003c/p\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e30.3,\u003c/p\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e50.3,\u003c/p\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e36-40 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e83.3,\u003c/p\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e56.2,\u003c/p\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e28.5,\u003c/p\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e51.4,\u003c/p\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eOver 41 Years Old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e92.5,\u003c/p\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60.2,\u003c/p\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e29.7,\u003c/p\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e52.1,\u003c/p\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob Title/Role\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eStaff Nurse (RN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e88.0,\u003c/p\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11.94\u003c/p\u003e\n \u003cp\u003e(P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e59.5,\u003c/p\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 76px;\"\u003e\n \u003cp\u003e33.461 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e26.6,\u003c/p\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e13.797 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e52.3,\u003c/p\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 56px;\"\u003e\n \u003cp\u003e2.842 (0.023)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eCharge Nurse (CN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e78.2,\u003c/p\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e51.5,\u003c/p\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e31.8,\u003c/p\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e48.8,\u003c/p\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eNursing Assistant\u003c/p\u003e\n \u003cp\u003e(e.g., Nurse Aides Tech)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e81.3,\u003c/p\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e51.3,\u003c/p\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e35.2,\u003c/p\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e49.8,\u003c/p\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eNurse Manager, Head\u003c/p\u003e\n \u003cp\u003eNurse, Assistant\u003c/p\u003e\n \u003cp\u003eManager\u003c/p\u003e\n \u003cp\u003e(e.g., administrators\u003c/p\u003e\n \u003cp\u003eon the Unit)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e78.9,\u003c/p\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e53.5,\u003c/p\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e32.2,\u003c/p\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e51.1,\u003c/p\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e81.8,\u003c/p\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e64.0,\u003c/p\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e22.0,\u003c/p\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e54.6,\u003c/p\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eexperience\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ein your role\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e86.8, 18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.706\u003c/p\u003e\n \u003cp\u003e(0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e59.1,\u003c/p\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.924 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e26.2,\u003c/p\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.35\u003c/p\u003e\n \u003cp\u003e(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e53.7,\u003c/p\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 56px;\"\u003e\n \u003cp\u003e3.017 (0.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e6-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e83.6, 18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e55.2,\u003c/p\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e30.5,\u003c/p\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e50.5,\u003c/p\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e11-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e79.8, 17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e54.5,\u003c/p\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e30.6,\u003c/p\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e50.6,\u003c/p\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e16-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e83.6, 17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e54.2,\u003c/p\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e31.9,\u003c/p\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e50.9,\u003c/p\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eOver 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e85.2, 21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e55.2,\u003c/p\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e34.2,\u003c/p\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e47.9,\u003c/p\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ecompleted nursing\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eresearch course\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e83.8, 17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003cp\u003e(0.424)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e55.7,\u003c/p\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003cp\u003e(0.696)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e31.7,\u003c/p\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e29.251 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e52.1,\u003c/p\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003e9.157 (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e82.7, 21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e56.0,\u003c/p\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e25.9,\u003c/p\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e49.2,\u003c/p\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCompleted\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003estatistics course?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e83.7, 17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003cp\u003e(0.549)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e55.3,\u003c/p\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.879\u003c/p\u003e\n \u003cp\u003e(0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e32.3,\u003c/p\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e37.922 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e51.9,\u003c/p\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003e4.371 (0.037)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e82.9, 20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e56.5,\u003c/p\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e26.0,\u003c/p\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e50.0,\u003c/p\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eattendance of\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEBP lecture?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e84.1,\u003c/p\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003cp\u003e(0.247)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e55.0,\u003c/p\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5.529\u003c/p\u003e\n \u003cp\u003e(0.019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e33.4,\u003c/p\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e62.368 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e52.1,\u003c/p\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003e5.624 (0.018)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e82.6, 20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e56.7,\u003c/p\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e25.6,\u003c/p\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e50.0,\u003c/p\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDifferences in the level of EBP knowledge, beliefs, implementation, organizational culture, and readiness according to the participants\u0026apos; characteristics.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDifferences were examined to explore factors influencing levels of EBP knowledge, beliefs, organizational readiness, and EBP implementation among nurses (Table 3).\u003c/p\u003e\n\u003cp\u003eSignificant differences in EBP knowledge were found according to job title/role (p = .023), years of experience (p = .029), completion of nursing research courses (p = .003), completion of statistics courses (p = .037), and attendance at EBP lectures (p = .018). EBP beliefs differed significantly by education level (p \u0026lt; .001), gender (p \u0026lt; .001), job title/role (p \u0026lt; .001), years of experience (p \u0026lt; .001), and attendance at EBP lectures (p = .019), with male nurses and those in leadership roles showing more favorable beliefs. Organizational readiness differed significantly by education level (p \u0026lt; .001), gender (p \u0026lt; .001), job title/role (p \u0026lt; .001), and years of experience (p = .003), with bachelor-prepared, female, and staff nurses reporting higher readiness. EBP implementation was significantly associated with education level, gender, job title/role, years of experience, completion of research and statistics courses, and attendance at EBP lectures (all p \u0026lt; .001), with nurses in leadership roles and those with research training demonstrating greater implementation\u0026nbsp;\u003cstrong\u003e(Table 3)\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCorrelations\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;between EBP knowledge, beliefs, implementation, organizational culture, and readiness.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrganizational Culture \u0026amp; Readiness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBP Beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBP Implementation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBP Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOrganizational Culture \u0026amp; Readiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEBP Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.544\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEBP Implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.228\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEBP Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.409\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.330\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.298\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe values are Pearson\u0026rsquo;s correlation coefficients (r). \u003csup\u003e***\u003c/sup\u003ep \u0026lt; .001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelations\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;between EBP knowledge, beliefs, implementation, organizational culture, and readiness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 presents the correlations between EBP knowledge, beliefs, implementation, organizational culture, and organizational readiness. The findings reveal positive and statistically significant associations among most study variables. Organizational readiness demonstrated a moderate correlation with EBP beliefs (r = 0.544, p \u0026lt; 0.001) and a weak-to-moderate correlation with EBP knowledge (r = 0.409, p \u0026lt; 0.001) but a weak yet significant correlation with EBP implementation (r = 0.228, p \u0026lt; 0.001). EBP knowledge showed a weak-to-moderate association with beliefs (r = 0.330, p \u0026lt; 0.001) and a weak yet significant association with implementation (r = 0.298, p \u0026lt; 0.001). Conversely, the relationship between EBP beliefs and implementation was negligible and nonsignificant (r = 0.017, p = 0.617), indicating that positive beliefs alone may not necessarily translate into practice implementation. All significant correlations were at the 0.01 level (2-tailed).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Factors affecting EBP implementation.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"762\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 154px;\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 169px;\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 156px;\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 162px;\"\u003e\n \u003cp\u003eModel 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003eb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003eb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e21.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.068\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e6.940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.040\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eEducation level:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e-1.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-1.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.077\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-1.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-1.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eJob Title/Role:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eyears of experience in your role:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e1.585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.108\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.124\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1.801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.123\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.112\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eHave you ever completed a nursing research course:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e2.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1.940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eHave you ever completed a statistics course?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e2.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eHave you ever attendance of EBP lecture?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e5.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.183\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e5.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.166\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e4.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.164\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e4.547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.150\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eEBP Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.290\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.301\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.247\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eEBP Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e-0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.129\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eOrganizational culture and Readiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.211\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e (∆R\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.100 (0.100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.182 (0.083)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.183 (0.001)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.211 (0.028)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eF (P)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e16.167 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e27.871 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e24.512 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e25.966 (P\u0026lt;=0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eN = 883. Dependent variable EBP Implementation (EBPI) total score (range 0\u0026ndash;72). Bold P values and \u0026beta; indicate statistical significance (P \u0026le; 0.05). Model 1: demographic and research-related characteristics; Model 2: + EBP Knowledge; Model 3: + EBP Beliefs; Model 4: + Organizational Culture and Readiness (OCRSIEP).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors affecting EBP implementation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHierarchical multiple regression analysis identified significant predictors of EBP implementation (Table 5). In the final model (Model 4), EBP knowledge was the strongest predictor (\u0026beta; = 0.247, p \u0026lt; .001), followed by organizational culture and readiness (\u0026beta; = 0.211, p \u0026lt; .001), attendance at EBP lectures (\u0026beta; = 0.150, p \u0026lt; .001), years of experience (\u0026beta; = 0.112, p = .001), and job title/role (\u0026beta; = 0.091, p = .009). EBP beliefs showed a significant negative association (\u0026beta; = -0.129, p = .001). The model explained 21.1% of the variance in EBP implementation (R\u0026sup2; = .211, F = 25.966, p \u0026lt; .001). Age and gender were excluded because of nonsignificant effects in preliminary regression analyses, whereas hospital site was excluded because of substantially unequal sample sizes across sites (ranging from n = 3 to n = 358), which precluded reliable estimation of site-level effects. The results of the multicollinearity tests were acceptable (VIF range: 1.037\u0026ndash;1.893; tolerance range: .528\u0026ndash;.964), and the Durbin‒Watson statistic (1.925) indicated no autocorrelation in the residuals.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the relationships among nurses\u0026apos; EBP knowledge, beliefs, implementation, organizational culture, and readiness across multiple hospitals and primary healthcare centers in the Makkah region, guided by the ARCC\u0026copy; model. The discussion is structured around this framework to clarify how individual and organizational factors jointly influence EBP implementation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe level of EBP\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eimplementation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the present study, EBP implementation was found to be low to moderate relative to the scale range (M = 29.9, SD = 15.14 out of 0\u0026ndash;72), indicating limited engagement in EBP activities despite generally positive EBP beliefs and moderate knowledge, organizational culture, and readiness. The item-level results revealed gaps in advanced EBP behaviors\u0026mdash;such as generating a PICO question about one\u0026rsquo;s practice (M = 1.57, SD = 1.18) and sharing evidence from a study or studies in the form of a report or presentation to more than two colleagues (M = 1.56, SD = 1.17)\u0026mdash;indicating limited engagement in higher-level EBP activities. Given that PICOT question formulation is considered a foundational step in the EBP process, this gap in competency raises important concerns regarding the depth and quality of reported EBP implementation, as the inability to clearly formulate clinical questions undermines subsequent evidence searching, appraisal, and application. This finding suggests that EBP implementation may be overestimated when core methodological steps are not consistently performed.\u003c/p\u003e\n\u003cp\u003eThis pattern is consistent with Saudi literature, which consistently reports lower implementation scores than EBP knowledge and attitudes [23,53]. These findings are further supported by Mohamed [54], who reported that nurses perceived EBP as complex due to their limited ability to formulate research questions and integrate evidence into clinical decision-making, with EBP steps rarely articulated in practice.\u003c/p\u003e\n\u003cp\u003eSimilar implementation gaps have been consistently reported internationally, with studies across high- and low-resource settings showing that despite favorable attitudes toward EBP, nurses demonstrate limited engagement in higher-level implementation behaviors, particularly PICO question formulation and dissemination of research evidence [34, 55]. Evidence from both low- and middle-income countries and well-resourced health systems further confirms that EBP implementation remains suboptimal and is constrained less by beliefs and more by deficits in knowledge and skills and organizational support [56, 57].\u003c/p\u003e\n\u003cp\u003eThe findings from these international studies also strongly support our findings that EBP implementation is less influenced by nurses\u0026rsquo; overall beliefs and more influenced by deficits in foundational EBP knowledge and skills and organizational support, a relationship reflected in the present study by the alignment between low belief scores related to the clarity of EBP steps and perceived difficulty of EBP, low knowledge scores in converting information needs into researchable questions, and low engagement in core implementation behaviors such as PICOT formulation\u0026mdash;indicating that limitations in essential methodological skills, rather than unfavorable beliefs, primarily constrain high-quality EBP implementation. The disconnect identified here creates a \u0026apos;rhetoric-reality gap\u0026apos;, which indicates that, at present, the professional ideals of EBP have not yet been met by the realities of clinical practice. Our nurses have expressed positive belief in EBP; however, this enthusiasm has been hindered from actually being executed. Low PICOT formulation scores serve as an alert, indicating that without the technical \u0026apos;how-to,\u0026apos; these beliefs are simply theoretical. Additionally, the hierarchical nature of health care may cause nurses to believe that they do not have the organizational \u0026apos;permissions\u0026apos; or mentorship required to challenge long-standing routines. Thus, they have the map (beliefs), but their vehicle (skills and support) is presently underpowered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEBP Knowledge as\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ea\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePredictor of EBP Implementation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the present study, we found that EBP knowledge was the strongest predictor of EBP implementation (\u0026beta; = 0.247, p \u0026lt; .001), indicating the important role of an individual\u0026apos;s knowledge\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ein EBP implementation. The average EBP knowledge score was moderate (M = 51.14, SD = 13.22, out of 14\u0026ndash;84), indicating a moderate level of perceived knowledge. Although participants scored their general research skills at a higher level, they also reported lower scores on their ability to convert information needs into a research question (M = 3.49; SD = 1.26) and information technology skills (M = 3.48; SD = 1.29). This pattern suggests that nurses are aware of EBP principles but do not have the core methodological skills needed to put EBP into daily practice, which include formulating a question and searching for evidence. This may help explain the gap between EBP knowledge and actual implementation.\u0026nbsp;Notably, attendance at EBP lectures was also a significant predictor of EBP implementation (\u0026beta; = 0.150, p \u0026lt; .001), further reinforcing that structured educational exposure plays a direct role in bridging the gap between knowledge acquisition and clinical application.\u003c/p\u003e\n\u003cp\u003eAdditionally, years of experience in one\u0026rsquo;s current position were a modest but significant predictor of EBP implementation (\u0026beta; = 0.112, p = .001), possibly because more experienced nurses are more confident in their practice and have better knowledge of institutional processes. However, the relatively small effect size suggests that experience alone is insufficient without structured EBP knowledge and supportive organizational environments.\u003c/p\u003e\n\u003cp\u003eOur results are also supported by studies from Saudi Arabia, where it has been demonstrated that EBP knowledge is a major determinant of EBP implementation\u0026mdash;while at the same time demonstrating that there are significant gaps in essential technical EBP skills. One Saudi study revealed that EBP knowledge was a significant predictor of EBP use (\u0026beta; = .452, p \u0026lt; .001) [23], a result that was subsequently replicated by another study that demonstrated that knowledge continued to contribute significantly to implementation even when accounting for organizational factors [53]. While the overall level of knowledge among Saudi nurses has been deemed adequate, many have expressed difficulty in translating EBP into action. Qualitative evidence supports the notion that Saudi nurses perceive the process of EBP to be difficult because they possess limited skills in developing clinical questions and retrieving evidence and limited skills in utilizing information technology and accessing research databases [54]. More importantly, the authors found no relationship between these deficits and interest in EBP; rather, the deficits were associated with limited practical skill development\u0026mdash;a finding that is consistent with the findings of the current study that the weakest link in the pathway of knowledge to implementation is represented by foundational competencies rather than general awareness.\u003c/p\u003e\n\u003cp\u003eInternational studies have similarly demonstrated a commonality with this pattern\u0026mdash;with nurses reporting moderate EBP knowledge across different healthcare systems\u0026mdash;but have consistently cited foundational competency deficits, particularly in converting clinical problems into researchable questions and effectively using information technology for evidence retrieval [41, 56, 58]. Collectively, the abovementioned findings support the conclusion that conceptual EBP knowledge alone is not sufficient\u0026mdash;as deficits in developing clinical questions and utilizing information technology to retrieve evidence reduce the rigors of the evidence search, appraisal, and implementation process. Given that converting information needs into structured clinical questions represents a foundational step in the EBP process, targeted, skill-based educational strategies that focus on developing these foundational competencies are needed to improve the translation of knowledge into effective practice [59]\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOrganizational culture and Readiness for EBP Implementation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, we found that organizational culture and readiness were predictors of EBP implementation (beta = 0.211, p \u0026lt; .001). These findings suggest that the organizational system and structure are important factors for EBP implementation. The average organizational culture and readiness score was found to be moderate (mean = 83.4; SD = 18.7) on a scale of 25-125. The item-level data revealed that the lowest scores were for the following items: overall institutional readiness for EBP (m = 3.16, SD = 1.15); availability of nurse scientists to assist in generating evidence when evidence does not exist (m = 3.17, SD = 1.15); extent to which EBP is practiced within the organization (m = 3.19, SD = 1.30); and availability of advanced practice nurses to serve as EBP mentors (m = 3.23, SD = 1.22). These findings further strengthen our interpretation that EBP implementation is influenced less by nurses\u0026apos; overall beliefs and more by gaps in foundational EBP knowledge and skills and limited organizational support, including a lack of access to EBP mentors and nurse scientists, which collectively restrict the development, guidance, and execution of the core methodological steps required for high-quality and sustainable EBP.\u003c/p\u003e\n\u003cp\u003eConsistent with previous studies conducted in Saudi Arabia, organizational readiness for EBP has been described as generally moderate, transitional, and not well established to be able to sustain routine implementation [33]. Using the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Scale, a study of Saudi postgraduate nurses reported a mean readiness score of 76.58 three months after completing an educational intervention, which the authors described as reflecting \u0026apos;a moderate movement toward a culture of EBP\u0026apos; that was not yet sustainable. Notably, this score improved to 92.10 twelve months later, indicating a positive shift in nurses\u0026apos; perceptions of their organizational environment following sustained EBP practice [33]. Thus, the findings of the present study, with a mean readiness score of 83.4, support the findings from Saudi Arabia and indicate that the organizational culture and readiness for EBP in Saudi Arabia could be transitional.\u003c/p\u003e\n\u003cp\u003eQualitative evidence also supports this observation, with one study showing that the workplace climate was \u0026quot;not encouraging and not supportive\u0026quot; due to inadequate organizational commitment, infrastructure, and accessibility to EBP resources [54]. In addition, several studies conducted in Saudi Arabia support the predictive role of organizational readiness and culture for EBP implementation. For example, both organizational support and leadership commitment have been found to be significant predictors of EBP implementation, whereas resource limitations have resulted in less willingness for nurses to implement EBP in daily practice [60].\u003c/p\u003e\n\u003cp\u003eFurthermore, the findings of the present study at the item level are consistent with those of the Saudi literature in terms of deficits in structural and human capacity, including shortages of doctor-prepared nurses, EBP mentors, and role models [33]. The above findings are supported by qualitative evidence that describes a \u0026quot;rhetoric-reality gap,\u0026quot; wherein EBP is advocated for at the policy or accreditation level but is limited in its implementation in the clinical setting owing to hierarchical structures, inconsistent messages from leaders, and the absence of protected positions for EBP champions [28].\u003c/p\u003e\n\u003cp\u003eInternationally, studies have shown that organizational culture and readiness significantly impact the level of EBP implementation, with several studies showing that leadership support, resource availability, and the necessary infrastructure are important enablers across various healthcare systems [61\u0026ndash;63]. Furthermore, the moderate level of organizational readiness observed in our study is consistent with international findings [61, 63]. Consequently, this suggests a transitional EBP culture. In this culture, limited leadership support, inadequate mentorship, and insufficient infrastructure hinder the consistent implementation of EBP in both resource-rich and resource-poor settings [34,64].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe ARCC\u0026copy; Model as a Unifying Framework for System-Wide Evidence-Based Practice Implementation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur results, supported by national and international data, indicate that gaps in implementing EBP are caused by an interplay between the individual\u0026apos;s and the organization\u0026apos;s factors rather than being solely due to one of these factors. While the nurses in this study showed positive beliefs toward EBP and reasonable levels of baseline knowledge, they were unable to implement it consistently without essential elements such as mentorship, leadership engagement, knowledge and skills in core EBP steps, and a supportive environment for EBP. These patterns align closely with the conceptual underpinnings of the ARCC model, supporting its use as a comprehensive framework for addressing the multiple barriers to EBP implementation identified in this study.\u003c/p\u003e\n\u003cp\u003eThe ARCC\u0026copy; model operationalizes EBP implementation through integrated, system-level strategies that directly correspond to the observed deficits [41, 46]. A critical component of the ARCC model is the formal, organizational assessment of EBP readiness utilizing the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice (OCRSIEP). The use of OCRSIEP allows leaders to assess their organization\u0026apos;s readiness gaps and develop specific plans for implementation on the basis of the organization\u0026apos;s needs [46, 52, 65]. Equally important is the development of EBP mentors\u0026mdash;clinical staff with a higher level of competency who provide ongoing direct support for the translation of evidence into practice while increasing the confidence of clinicians in their ability to apply evidence in their practices [44,46,48,66]. Additionally, the ARCC emphasizes the interactive education of nurses, which focuses on the development of core EBP competencies, specifically, EBP processes such as PICOT question development, evidence appraisal, and EBP implementation planning [46,59,65]. Research consistently shows that interventions based on the ARCC model improve EBP use within organizations, strengthen the organizational culture, and enhance nurse mentoring, thereby encouraging participation in EBP activities, with organizational readiness and EBP knowledge emerging as key predictors of sustained practice change [41,46,65,67].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that nurses across the studied hospitals and primary healthcare centers in the Makkah region have positive beliefs toward EBP; however, the actual level of EBP implementation remains modest. The strongest predictors of EBP implementation were EBP knowledge and organizational culture and readiness, indicating that both a supportive organizational environment and individual knowledge play important roles in successful EBP implementation. Furthermore, attendance at EBP lectures and years of professional experience also contributed significantly to implementation but less than the previously mentioned factors did. In addition, gaps in core EBP skills, mentorship, and institutional support limit the translation of evidence into practice. Overall, our results indicate that successful EBP implementation requires a combination of two types of interventions: enhancing nurses\u0026rsquo; EBP knowledge through evidence-based education, specifically skills-based education programs, and creating an environment that supports EBP, including ongoing nurse leadership engagement, mentoring, sufficient time for EBP integration, and appropriate infrastructure to facilitate the use of EBP in everyday clinical practice.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e \u003cp\u003eThis study is characterized by several important strengths. This is one of the few multisite studies conducted in Saudi Arabia investigating nurses\u0026rsquo; EBP knowledge, beliefs, implementation, organizational culture, and readiness simultaneously. Compared with earlier Saudi studies, this multisite design allows for a more representative assessment of EBP implementation across care settings and organizational contexts. The investigation included nurses working in both hospitals and primary healthcare centers throughout the Makkah region, providing a broader representation of various clinical environments and a comprehensive picture of EBP implementation in the region. The use of validated instruments, coupled with the alignment of the study variables with the ARCC model, provides a robust basis for the reliability and precision of the findings. Furthermore, the substantial sample size supports robust statistical analysis, strengthening the reliability of the observed relationships among the key EBP variables.\u003c/p\u003e \u003cp\u003eAlthough there are numerous strengths to this study, it is important to acknowledge its limitations. The use of convenience sampling from hospitals and primary healthcare centers within a specific geographic area limits the generalizability of the results to other regions or healthcare systems. Additionally, the cross-sectional design precludes the determination of causal relationships between the study variables. Furthermore, the reliance on self-report surveys introduces the potential for social desirability and recall biases. Although the EBP knowledge subscale was revised to allow for a new response format after pilot testing to assist in improving clarity, the revision did not change the conceptualization of the EBP knowledge subscale items or constructs. For this reason, comparisons with studies using the original response format should be made cautiously.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eRelevance to Clinical Practice\u003c/h2\u003e \u003cp\u003eOur findings indicate that healthcare organizations must strengthen both individual competencies and the organizational culture to foster the adoption of EBP. Guided by the ARCC\u0026copy; model, clinical leaders should ensure that their hospitals provide system-wide support, as well as mentorship and a structured education program for nurses that is designed to develop their EBP knowledge skills and core EBP competencies, while also promoting an EBP culture within their organization that fosters inquiry and provides opportunities for shared governance and leader engagement [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Strategies that can be used to apply these recommendations include following a clear model such as the ARCC\u0026copy;, which integrates need assessment and EBP mentors and provides nurses with resources, such as protected time, education, and journal clubs, as well as providing nurses with the access to evidence-based resources needed to support their practice and including the expectation of implementing EBP in all aspects of nursing practice, such as policy and role expectations [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. These strategies allow clinical leaders to create a systematic process. This process helps nurses consistently and sustainably use evidence in their practice [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. As a result, this will improve the quality and safety of patient care.\u003c/p\u003e \u003cp\u003eAdditionally, several studies have demonstrated the positive impact of the successful implementation of EBP on patient outcomes, the well-being of nurses, and the generation of significant cost savings and returns on investment for health care organizations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These findings reinforce EBP as a critical strategy for both clinical and fiscal success.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eRecommendations for future research\u003c/h2\u003e \u003cp\u003eTo improve the generalizability of the findings and investigate intraorganizational variations, it is recommended that multicenter research be conducted across various geographic regions and healthcare sectors in Saudi Arabia. The existing evidence base would benefit from experimental or quasi experimental designs to assess the efficacy of structured, theory-driven intervention frameworks, such as the ARCC Model.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eEBP\u003c/strong\u003e \u0026ndash; Evidence-Based Practice\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eARCC\u0026copy;\u003c/strong\u003e \u0026ndash; Advancing Research and Clinical Practice through Close Collaboration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOCRSIEP\u003c/strong\u003e\u0026mdash;Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEBPB\u003c/strong\u003e \u0026ndash; Evidence-Based Practice Beliefs\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePICOT\u003c/strong\u003e \u0026ndash; Patient/Population, Intervention, Comparison, Outcome, Time\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePHC\u003c/strong\u003e\u0026mdash;Primary Healthcare Center\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers thank all the nurses who participated in this study. The authors also extend their appreciation to Taif University for its support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFaisal Alasmari contributed to the conceptualization, methodology, data analysis, and writing of the original draft. Elham Al Ateeq contributed to conceptualization, supervision, and writing, review and editing. Mohammad Paredath contributed to the data analysis and writing of the original draft. Ahmed Alkhaibari, Hawazin Alhawsaw, Fahad M. Althobaiti, Husam Aburub, Yahya Malem, Reham Alrwaitey, Mohummud Ramjan, and Ali Alahmadi contributed to the writing of the original draft. All the authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during this study are not publicly available due to institutional data governance policies but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission to conduct this study was obtained from the \u003cstrong\u003eInstitutional Review Board of King Abdullah Medical City in Holy Capital, Ministry of Health, Saudi Arabia\u003c/strong\u003e prior to data collection (IRB No. 20-706; approved on September 21, 2020). Approval to collect data was also granted by the nursing administrations of all participating hospitals and primary healthcare centers in the Makkah region of Saudi Arabia. Data were collected between November 2020 and February 2021. All methods followed the STROBE guidelines and were conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants received an online participant information sheet detailing the purpose of the study, the voluntary nature of participation, procedures for data handling, and their right to withdraw prior to survey submission. Explicit electronic informed consent was obtained from all participants before access to the questionnaire was granted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No identifiable personal data are presented in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1Nursing Professional Practice and Research Department, Executive Nursing Administration King Faisal Hospital Specialist and Research Center, Madinah 42522 Saudi Arabia\u003c/p\u003e\n\u003cp\u003e2 Nursing Research and Evidence-Based Practice Department, King Abdullah Medical City, Makkah 24246, Saudi Arabia\u003c/p\u003e\n\u003cp\u003e3 Nursing Leadership and Education Department, College of Nursing, Taif University, Taif 21974, Saudi Arabia\u003c/p\u003e\n\u003cp\u003e4 Group Chief Quality and Nursing, Almeswak Medical Group, Riyadh 11461, Saudi Arabia\u003c/p\u003e\n\u003cp\u003e5 Nursing Adult Services, Executive Nursing Administration King Faisal Hospital Specialist and Research Center, Madinah 42522 Saudi Arabia\u003c/p\u003e\n\u003cp\u003e6 Nursing Quality Department, King Abdullah Medical City, Makkah 24246, Saudi Arabia\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCheng Y, Zou C, Liu C, Jia Y, Yang R, Zhang Y, et al. 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Factors associated with beliefs and implementation of evidence-based practice among nurses: a cross-sectional study. \u003cem\u003eBMC nursing\u003c/em\u003e 24.1 (2025): 929.\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eYeheyis T, Hoyiso D, Borie YA, Tagesse N. Implementation of evidence-based clinical practice and its associated factors among health care workers at public hospitals in Sidama regional state, southern Ethiopia. Landenmark H, editor. PLoS ONE. 2024 Mar 21;19(3):e0299452.\u003c/li\u003e\n\u003cli\u003eKaseka PU, Mbakaya BC. Knowledge, attitude and use of evidence-based practice (EBP) among registered nurse-midwives practicing in central hospitals in Malawi: a cross-sectional survey. BMC Nurs. 2022 Dec;21(1):144.\u003c/li\u003e\n\u003cli\u003eYoo JY, Kim JH, Kim JS, Kim HL, Ki JS. Clinical nurses\u0026rsquo; beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. Schultz T, editor. PLoS ONE. 2019 Dec 26;14(12):e0226742.\u003c/li\u003e\n\u003cli\u003eDusin J, Melanson A, Mische-Lawson L. Evidence-based practice models and frameworks in the healthcare setting: a scoping review. BMJ Open. 2023 May;13(5):e071188.\u003c/li\u003e\n\u003cli\u003eMelnyk BM, Fineout-Overholt E, Gallagher-Ford L, Stillwell SB. Evidence-Based Practice, Step by Step: Sustaining Evidence-Based Practice Through Organizational Policies and an Innovative Model. AJN The American Journal of Nursing. 2011 Sep;111(9):57.\u003c/li\u003e\n\u003cli\u003eMelnyk BM, Tan A, Hsieh AP, Gallagher-Ford L. Evidence-Based Practice Culture and Mentorship Predict EBP Implementation, Nurse Job Satisfaction, and Intent to Stay: Support for the ARCC\u0026copy; Model. Worldviews Evid Based Nurs. 2021 Aug;18(4):272\u0026ndash;81.\u003c/li\u003e\n\u003cli\u003eKim SC, Ecoff L, Brown CE, Gallo AM, Stichler JF, Davidson JE. Benefits of a Regional Evidence-Based Practice Fellowship Program: A Test of the ARCC Model. Worldviews Evid Based Nurs. 2017 Apr;14(2):90\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eMelnyk BM, Fineout-Overholt E, Giggleman M, Choy K. A Test of the ARCC\u0026copy; Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes. Worldviews Evid Based Nurs. 2017 Feb;14(1):5\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eGorsuch CRPF, Gallagher Ford L, Koshy Thomas B, Melnyk BM, Connor L. Impact of a Formal Educational Skill-Building Program Based on the ARCC Model to Enhance Evidence-Based Practice Competency in Nurse Teams. Worldviews Evid Based Nurs. 2020 Aug;17(4):258\u0026ndash;68.\u003c/li\u003e\n\u003cli\u003eMelnyk BM. 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Beliefs and implementation of evidence-based practice among community health nurses: a cross-sectional descriptive study. \u003cem\u003eJournal of clinical nursing\u003c/em\u003e 27.9-10 (2018): 2052-2061.\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eAdombire S, Baiden D, Puts M, Puchalski Ritchie LM, Ani-Amponsah M, Cranley L. Knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses in low- and middle-income countries: A scoping review. Worldviews on Evidence-Based Nursing. 2024;21(5):542\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eStokke K, Olsen NR, Espehaug B, Nortvedt MW. Evidence-based practice beliefs and implementation among nurses: a cross-sectional study. BMC Nurs. 2014 Dec;13(1):8.\u003c/li\u003e\n\u003cli\u003eUbbink DT, Hamid A, Shifaza F. 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Implementation of evidence-based practice: the experience of nurses and midwives. \u003cem\u003ePlos one\u003c/em\u003e 16.8 (2021): e0256600.\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eKo\u0026ccedil;ak V, Arslan S, Aldem Budak M. Effectiveness of Evidence-Based Practice-Based Mentor Nurse Training Program: A Quasi-Experimental Controlled Study Design. Worldviews on Evidence-Based Nursing. 2025;22(4):e70069.\u003c/li\u003e\n\u003cli\u003eChays-Amania A, Schwingrouber J, Colson S. Using Implementation Science to Implement Evidence-Based Practice: A Discursive Paper. J Adv Nurs. 2024 Oct 21;\u003c/li\u003e\n\u003cli\u003eCrawford CL, Rondinelli J, Zuniga S, Valdez RM, Tze‐Polo L, Titler MG. Barriers and facilitators influencing EBP readiness: Building organizational and nurse capacity. Worldviews Ev Based Nurs. 2023 Feb;20(1):27\u0026ndash;36.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Evidence-based practice, Organizational readiness, Organizational culture, ARCC© model, EBP knowledge, EBP implementation, Saudi Arabia","lastPublishedDoi":"10.21203/rs.3.rs-9000988/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9000988/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Evidence-based practice (EBP) is essential for improving nursing care quality, patient outcomes, and cost efficiency; however, its implementation remains low across healthcare settings. The ARCC model is a multilevel framework illustrating how individual and organizational factors interact to impact EBP implementation. Evidence on ARCC model use in Saudi Arabian hospitals is limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e This study investigated the relationships among registered nurses' EBP knowledge, beliefs, implementation, organizational culture, and readiness across hospitals and primary care centers in the Makkah Region, guided by the ARCC Model.\u003cbr\u003e\n \u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional correlational study design was employed. A nonprobability convenience sampling technique was used. Structured, valid, and reliable questionnaires were administered to measure the study variables. Correlation analyses were conducted to examine the relationships between the study variables, whereas hierarchical multiple regression analysis was used to identify predictors of EBP implementation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 883 nurses responded. The mean score for EBP knowledge was 51.14 (SD = 13.22). Nurses reported a mean belief score of 55.75 (SD = 10.92). The mean score for organizational culture and readiness was 83.41 (SD = 18.70). The mean score for EBP implementation was 29.87 (SD = 15.14). Statistically significant positive correlations were observed among EBP knowledge, implementation, and organizational culture and readiness (r = 0.228–0.544, all p \u0026lt; .001). EBP beliefs were not significantly correlated with EBP implementation (r = 0.017, p = .617). Hierarchical regression analysis revealed that the most powerful predictor of nurses' EBP implementation was EBP knowledge (β = 0.247, p \u0026lt; .001), followed by organizational culture and readiness (β = 0.211, p \u0026lt; .001).\u003cbr\u003e\n \u0026nbsp;\u003cstrong\u003eConclusion\u003c/strong\u003e: The implementation of EBP among nurses is influenced by theinteractive relationship between individual knowledge and the organizational environment. Deficits in nurses' knowledge and limitations in organizational culture and readiness to implement EBP restrict the transformation of positive beliefs about EBP into daily practice. Our results support the use of the ARCC model as a comprehensive evidence-based framework to strengthen EBP knowledge, mentorship, leadership engagement, and hospital culture and infrastructure, enabling sustainable evidence integration across diverse healthcare settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u003cbr\u003e\nNot applicable.\u003c/p\u003e","manuscriptTitle":"Evidence-Based Practice among Nurses in Saudi Arabia: An ARCC© Model-Based Cross-Sectional Study of Knowledge, Beliefs, Implementation, Culture, and Readiness","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 15:59:23","doi":"10.21203/rs.3.rs-9000988/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-10T12:25:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T20:29:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T05:31:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39366980294564514509401876742867664314","date":"2026-03-18T10:06:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155932375915870344599794199704007050555","date":"2026-03-18T09:14:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159214024965523102318764115402922006377","date":"2026-03-16T18:58:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-16T08:01:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-10T09:55:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-09T19:49:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-03-04T16:56:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"798e9bab-795c-4cfc-b27d-27d0f323b79d","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-10T12:41:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 15:59:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9000988","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9000988","identity":"rs-9000988","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}