Introduction
In recent years, Evidence-Based Practice (EBP) has gained significant prominence in healthcare, urging nurses to integrate it seamlessly into their daily routines to bridge the gap between evidence and practice [1]. This shift underscores a commitment to informed decision-making, optimizing patient outcomes, and advancing healthcare practices [1]. EBP is widely recognized as a problem-solving approach that critically integrates knowledge from three main domains: best available evidence, clinicians’ expertise and experience, and patient’s values and preferences [2]. A cross-cultural study involving 1,383 nursing students from various countries identified key barriers to EBP implementation, including limited influence over healthcare policies, the slow process of EBP publication, and insufficient time in clinical settings to apply evidence [1]. Furthermore, healthcare professionals, including nurses, often adhere to traditional organizational policies and procedures, neglecting the best available research evidence [3]. Recent global studies highlight both the benefits and challenges of EBP. For instance, a systematic review emphasizes that EBP leads to improved patient care, reduced healthcare costs, and enhanced clinical outcomes [4]. However, barriers to EBP implementation persist across different regions and healthcare systems. Common barriers include limited access to current research, insufficient time to review and apply evidence, and a lack of institutional support and training [4, 5]. Additionally, resistance to change among healthcare professionals and adherence to traditional practices further impede the adoption of EBP [4, 5].
Despite these challenges, research consistently shows that nursing students value EBP and maintain a positive attitude toward it. However, they encounter significant obstacles in implementing EBP principles in clinical settings [3]. For instance, a cross-sectional study conducted with 212 undergraduate nursing students in Saudi Arabia revealed that while students recognized the importance of EBP in clinical practice, more than half (56.1%) perceived it as primarily theoretical content with limited practical impact [3]. While the implementation of EBP has many benefits, integrating EBP content into the nursing curriculum requires a higher level of education than a bachelor’s degree in some countries [6]. Nursing education and practice underwent significant improvements in Saudi Arabia but are still in their infancy. Nursing education plays a vital role in achieving the necessary EBP competencies among nursing students. Undoubtedly, it is important to obtain informational background about undergraduate nursing students’ knowledge, attitudes, and skills and their implementation of EBP in a clinical setting [7]. In order to practice nursing professionally in the twenty-first century, undergraduate students need to be prepared and taught how to incorporate evidence into their work.
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The successful implementation of EBP thrives on organizational support and a culture that prioritizes EBP. Alqahtani et al. (2022) discovered that leadership support and organizational structure influence EBP and boost nurses’ participation [8]. However, it remains unclear how prepared Saudi nursing colleges are to incorporate and foster EBP competencies in their curricula. While some Saudi nursing schools have begun revising their curricula to align with the goals of Saudi Vision 2030 by offering EBP courses to all undergraduate nursing students, challenges persist. Tumala and Alshehri (2019) reported that nursing students in Saudi Arabia held highly positive attitudes toward EBP, yet they struggled to fully understand and apply it [3]. Although EBP has gained increasing attention in Saudi universities, there remains a significant gap in understanding Saudi undergraduate nursing students’ perceived knowledge, attitudes, and implementation of EBP. Therefore, the objective of this study is to assess Saudi students’ perceived knowledge, Attitude, and implementation of EBP. Furthermore, it assesses the Saudi students’ perceptions of organizational culture and readiness related to EBP in Saudi universities, with a specific focus on identifying factors that influence students’ knowledge, attitudes, and implementation of EBP.
Methods
Design and setting
The study employed a cross-sectional descriptive correlational design, recruiting subjects from three Saudi governmental universities. Taif University in Taif, Princess Noura University in Riyadh, and Jouf University in Al-Jouf. These three universities were selected because they represent diverse geographical regions of Saudi Arabia—Taif University in the western region, Princess Nourah University in the central region, and Jouf University in the northern region—providing a broader perspective on nursing education across different areas. Additionally, they were chosen due to their well-established nursing programs, which integrate research and evidence-based practice as core components of their curricula.
These universities offered four-year bachelor’s degree programs in nursing, where research and evidence-based practice courses were integrated as compulsory components in the undergraduate nursing curriculum. Notably, the nursing schools at Taif University and Princess Noura University featured a combined research and evidence-based course, while Jouf University’s nursing school offered separate compulsory courses on the research process and evidence-based practice in nursing. To ensure alignment among the three universities, the researchers reviewed and revised the course descriptions to ensure that all courses incorporated consistent intended learning outcomes (ILOs), emphasizing essential competencies such as critical appraisal, evidence retrieval, and the application of evidence-based practices in nursing care.
Sampling
The sample for this research comprised Saudi nursing students at the undergraduate level, specifically those enrolled in governmental universities. A convenience sampling method was employed due to its practicality in accessing a targeted population within a limited timeframe and resources. This approach is particularly advantageous when randomization is challenging, and the research aims to gather data from an accessible subset of the population [9]. The inclusion criteria were carefully outlined to ensure a representative group, consisting of newly graduated nursing students, senior nursing students in the 3rd or 4th year, those with research involvement demonstrated by completion of a nursing research course, and individuals with Evidence-Based Practice (EBP) training evidenced by completion of an evidence-based practice course. The exclusion criteria excluded first-year nursing students due to their limited involvement in research activities. These criteria, in line with recommendations by Polit and Beck (2016), were pivotal in shaping the study’s interpretation and enhancing the generalizability of the results [9].
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The sample size for this research was determined through power analysis utilizing G*Power 3.0.10 software [10]. For an ANOVA test, considering a medium effect size (f = 0.25) derived from the existing literature review, a significance level (α) of 0.05 to control the risk of a type I error, and a power of 80% to minimize the risk of a type II error, the researcher calculated an estimated sample size of 179 nursing students. To account for potential non-response and enhance the study’s power, additional students were recruited, resulting in a final sample of 183 nursing students. Among the participants, 53 students (29.0%) were from Princess Nourah University, 82 students (44.8%) were from Jouf University, and 48 students (26.2%) were from Taif University.
Instruments
A self-reported, three-part online survey was utilized. The first part gathered information about sample characteristics (Age, Gender, marital status, academic year, place of university, academic GPA, research involvement, and EBP training). The second part comprised the Student Evidence-Based Practice Questionnaire (S-EBPQ), a validated tool widely used to assess EBP knowledge, attitudes, and implementation among healthcare students and professionals. The S-EBPQ includes 24 items organized into three subscales: knowledge associated with EBP (14 items), attitudes toward EBP (4 items), and EBP implementation (6 items). Responses are recorded on a 7-point Likert scale, ranging from 1 (poor or negative) to 7 (excellent or positive). The tool has demonstrated robust psychometric properties, with internal consistency reliability (Cronbach’s alpha) values of 0.91 for knowledge, 0.79 for attitude, and 0.85 for EBP implementation, ensuring its reliability in assessing students’ perceptions [11]. The S-EBPQ has also been administered to Arabic-speaking undergraduate students, demonstrating satisfactory validity and good internal consistency (Cronbach’s alpha = 0.922) [12]. To enhance result interpretation, we categorized EBPQ scores for the knowledge and practice subscales as either poor (1 to < 3), satisfactory (3 to < 5), or high (5–7), while scores in the attitude subscale were grouped into two categories: negative (1 to < 3.5) or positive (3.5-7).
The last part included a scale entitled " The short version of the Organizational Culture and Readiness for System-wide Integration of Evidence-based Practice (OCRSIEP)”. This scale includes three items rated on a 5-point Likert scale, assessing organizational culture, resource availability, and mentorship support for EBP. It demonstrates strong psychometric properties, with high reliability (Cronbach’s α = 0.87), factor loadings (> 0.85), and a single-factor model explaining 80.03% of the variance, making it a concise and reliable tool for evaluating organizational readiness for EBP [13]. The permission to use all of these scales was obtained from the original authors.
Data collection
The data collection process primarily involved the administration of an online survey through the Qualtrics system, conducted at three Saudi governmental universities. The survey dissemination was facilitated through the administrative offices of these universities. Invitations, comprising an electronic survey link, were sent via email to the administrative offices, which, in turn, distributed the survey link to consenting participants. Nursing students at the selected universities were provided with an electronic link and a QR code to ensure a swift survey completion within a designated 15 to 20-minute timeframe. To maintain data integrity and prevent duplicate responses, a verification code system was implemented. Additionally, participants were encouraged to share survey invitations with their peers in other nursing departments within the university, utilizing various social media platforms to maximize response rates. Moreover, a printable poster, featuring a QR code linked to the survey, was dispatched for display on the nursing college board, offering a concise overview of the study’s purpose and objectives, outlining participation requirements for nursing staff, and providing a printable survey document for those preferring a paper-based completion option.
Ethical considerations
The study obtained approval from the Ethical Committee of Bioethics at Jouf University. (Approval no: 7-08-44, Date: 19 June 2023) and it was performed in accordance with the Helsinki Declaration [14]. Transparent communication of the study’s purpose and details was provided on the opening page of the electronic questionnaire, with participants signaling their consent through questionnaire completion. Respecting participants’ autonomy, individuals had the freedom to decide their participation. The researcher diligently followed ethical principles in nursing research, emphasizing the utmost privacy protection. To guarantee confidentiality, all questionnaire responses were securely stored on the researcher’s personal computer, ensuring restricted access and maintaining the anonymity of participants.
Data analysis
All returned online surveys were handled only by the researcher who conducted data entry and checked the surveys for completeness and eligibility for analysis. In this study, SPSS Version 26 was employed to perform data analysis. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize the sociodemographic and contextual characteristics of the study sample, as well as their responses to items on the evidence-based practice (EBP) scales. Categorical variables, such as age, gender, marital status, current GPA, and university affiliation, were reported using frequencies and percentages. For continuous variables, including the subscales of knowledge, attitudes, and application of EBP, mean scores were computed by summing the total scores for all items within each subscale and dividing by the number of items in that subscale. The data underwent a thorough screening and cleaning process before analysis.
Analysis of variance (ANOVA) and independent-sample t-tests were employed to assess differences in knowledge, attitude, and practice related to Evidence-Based Practice (EBP) in accordance with students’ sociodemographic and contextual characteristics. In addition, post hoc analyses were performed to identify significant pairwise differences between groups, and the results were presented in detail within the text. The Student Evidence-Based Practice Questionnaire (S-EBPQ) in this study exhibited strong internal consistency. The Cronbach’s Alpha coefficients for the knowledge, attitudes, EBP retrieving and reviewing, and sharing and applying EBP subscales were 0.89, 0.75, 0.94, and 0.93, respectively. These results confirm the reliability of the questionnaire in assessing students’ EBP-related knowledge, attitudes, and practices.
Results
Sociodemographic and contextual characteristics of students
The survey was sent to a total of 281 nursing students. Out of these, 183 students (which represents 65.1% of the total number of invited students) from three governmental universities responded to the survey by completing and returning it. Table 1 presents a breakdown of the sociodemographic and contextual characteristics of the 183 nursing students. Regarding age, the majority of students fell within the 18–22 age group, comprising 66.1% of the sample, while 30.1% were in the 23–27 age range, and a smaller percentage, 3.8%, were aged 28–32. In terms of gender distribution, the sample displayed a female predominance, with 71.6% being female, compared to 28.4% of male students. Marital status indicated that the vast majority were single (97.3%), with a minority being Married (2.7%).
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The student’s academic performance, as indicated by their current GPA, exhibited variation. Only 3.8% of students had a GPA between 2 and 2.75, while a significant proportion, 48.6%, achieved a GPA in the range of 3.76 to 4.5. Additionally, 28.4% had a GPA between 2.76 and 3.75, and 19.1% boasted a GPA above 4.5. Among the participants, 53 students (29.0%) were from Princess Nourah University, 82 students (44.8%) were from Jouf University, and 48 students (26.2%) were from Taif University. Lastly, research involvement was found in 72.1% of students, while 27.9% reported no previous involvement in research. Additionally, 62.8% of students had received evidence-based practice training, while 37.2% had not.
Table 1
Descriptive statistics (Frequencies and Percentages) of students’ sociodemographic and contextual characteristics (N = 183)
Variables | N | % |
|---|---|---|
Age (Years) | ||
18–22 | 121 | 66.1 |
23–27 | 55 | 30.1 |
28–32 | 7 | 3.8 |
Gender | ||
Male | 52 | 28.4 |
Female | 131 | 71.6 |
Marital Status | ||
Single | 178 | 97.3 |
Married | 5 | 2.7 |
Current GPA | ||
2–2.75 | 7 | 3.8 |
2.76–3.75 | 52 | 28.4 |
3.76–4.5 | 89 | 48.6 |
Above 4.5 | 35 | 19.1 |
University Affiliation | ||
Jouf University | 82 | 44.8 |
Princess Nourah | 53 | 29.0 |
Taif University | 48 | 26.2 |
Research Involvement | ||
Yes | 132 | 72.1 |
No | 51 | 27.9 |
EBP Training | ||
Yes | 115 | 62.8 |
No | 68 | 37.2 |
Saudi students’ perceived knowledge associated with EBP, attitude toward EBP, and application of EBP
Saudi students’ perceived attitude toward EBP
Table 2 provides a comprehensive overview of Saudi nursing students’ perceived knowledge, attitude, and application of Evidence-Based Practice (EBP). Starting with the “Knowledge Associated with EBP” category, the data indicates that a majority of students perceive their EBP knowledge positively. Specifically, 54.6% of students rate their knowledge as “Satisfactory,” while an additional 31.7% perceive their knowledge as “High. However, it’s important to address the 13.7% of students who consider their knowledge “Poor.” Moving to “EBP Retrieving and Reviewing,” the data reveals that 48.1% of students perceive their skills in this aspect as “Satisfactory,” while 32.2% rate their skills as “High.” However, 19.7% of students still perceive their skills as “Poor.” This underscores the importance of enhancing training and educational programs in this specific area to bridge this gap.
In terms of “EBP Sharing and Application,” the table indicates that a significant proportion of students feel positive about their abilities in this domain. Specifically, 41.0% of students rate their skills as “High,” and an additional 36.1% perceive their skills as “Satisfactory. However, 23.0% of students still perceive their skills as “Poor.” Addressing this group’s needs through targeted training and practical experiences may further boost their confidence and competence in applying EBP. Finally, the data on “Attitude Toward EBP” is promising, with 64.5% of students displaying a “Positive” attitude. A positive attitude is a crucial driver for successful EBP implementation. Nonetheless, it’s notable that 35.5% of students still hold a “Negative” attitude.
Table 2
Frequencies, percentages, and mean scores of Saudi students’ perception across EBP subscales: knowledge, retrieval, sharing, application, and attitudes (N = 183)
Subscales | Level | N | % | M | SD |
|---|---|---|---|---|---|
knowledge associated with EBP | Poor | 25 | 13.7% | 2.29 | 0.49 |
Satisfactory | 100 | 54.6% | 3.98 | 0.98 | |
High | 58 | 31.7% | 5.54 | 1.14 | |
EBP Retrieving and reviewing | Poor | 36 | 19.7% | 2.43 | 0.84 |
Satisfactory | 88 | 48.1% | 3.99 | 1.20 | |
High | 59 | 32.2% | 5.58 | 1.01 | |
EBP Sharing and application | Poor | 42 | 23.0% | 2.36 | 1.20 |
Satisfactory | 66 | 36.1% | 4.10 | 0.53 | |
High | 75 | 41.0% | 5.87 | 0.76 | |
Attitude toward EBP | Negative | 65 | 35.5% | 2.58 | 0.63 |
Positive | 118 | 64.5% | 4.98 | 0.99 |
Table 3 presents the results of item analysis for each subscale related to Saudi students’ perceived knowledge, attitude, and application of Evidence-Based Practice (EBP). In the “Knowledge associated with EBP” subscale, students generally held a positive perception, with the highest-rated item being “Shared this information with colleagues” (mean 4.76), indicating a frequency of sharing EBP-related information. In contrast, “My practice has changed because of evidence I have found” had the lowest mean (mean 4.01), suggesting a less frequent inclination to change practice based on evidence. Within the “EBP Retrieving and reviewing” subscale, students displayed confidence, with the highest-rated items being “Awareness of major information types and sources” and “Ability to determine clinical applicability” (both mean 4.39). However, “Ability to critically analyze evidence” had the lowest mean (mean 4.04), indicating a less frequent critical appraisal of evidence.
In the “EBP Sharing and Application” subscale, students expressed a positive perception. “Ability to review your own practice” was the highest-rated item (mean 4.43), suggesting moderate self-review. Conversely, “Ability to identify gaps in your professional practice” received the lowest mean (mean 4.08). Regarding the “Attitude toward EBP” subscale, students generally demonstrated a positive attitude, with the highest mean for “I welcome questions on my practice” (mean 4.31) and the lowest for “My practice has changed because of evidence I have found” (mean 4.01). These findings highlight areas of strength and potential areas for improvement in EBP education for nursing students.
Table 3
Item analysis of Saudi students’ perceived knowledge, attitude, retrieval, sharing, and application of EBP (N = 183)
Subscale | Items | M | SD | Rank by Highest |
|---|---|---|---|---|
knowledge associated with EBP | Total subscale | 4.41 | 1.31 | |
Shared this information with colleagues | 4.76 | 1.72 | 1 | |
Evaluated the outcomes of your practice | 4.56 | 1.69 | 2 | |
Formulated a clearly answerable question | 4.33 | 1.64 | 3 | |
Critically appraised, against set criteria | 4.32 | 1.62 | 4 | |
Integrated the evidence you have found with your expertise | 4.26 | 1.64 | 5 | |
Tracked relevant evidence after formulating the question | 4.25 | 1.48 | 6 | |
Attitude toward EBP | Total subscale | 4.13 | 1.45 | |
I welcome questions on my practice | 4.31 | 1.76 | 1 | |
Evidence-based practice is fundamental to professional practice | 4.06 | 1.84 | 2 | |
My practice has changed because of evidence I have found | 4.01 | 1.71 | 3 | |
EBP retrieving and reviewing | Total subscale | 4.27 | 1.43 | |
Awareness of major information types and sources | 4.39 | 1.68 | 1 | |
Ability to determine how useful (clinically applicable) the material is | 4.39 | 1.69 | 2 | |
Converting your information needs into a research question | 4.34 | 1.65 | 3 | |
Ability to determine how valid (close to the truth) the material is | 4.37 | 1.72 | 4 | |
Research skills | 4.19 | 1.66 | 5 | |
Knowledge of how to retrieve evidence | 4.17 | 1.67 | 6 | |
Ability to analyze critically evidence against set standards | 4.04 | 1.66 | 7 | |
EBP sharing and application | EBP sharing and application | 4.27 | 1.55 | |
Ability to review your own practice | 4.43 | 1.88 | 1 | |
Sharing of ideas and information with colleagues | 4.38 | 1.80 | 2 | |
Dissemination of new ideas about care to colleagues | 4.31 | 1.76 | 3 | |
Ability to apply information to individual cases | 4.18 | 1.64 | 4 | |
Ability to identify gaps in your professional practice | 4.08 | 1.58 | 5 |
Differences in Saudi students’ perceived knowledge, attitude, and application of EBP in governmental universities by selected sociodemographic and contextual characteristics
The marital status variable was excluded due to its minimal variability, with 97.3% of participants being single, making it statistically insignificant for the analysis. As shown in Table 4, the analysis of Saudi students’ perceived knowledge, attitudes, and application associated with EBP across age groups revealed no statistically significant differences. The mean knowledge scores for students aged 18–22, 23–27, and 28–32 were 4.42, 4.46, and 3.86, respectively, and the ANOVA (F-statistic) for this comparison was 0.673 (p = 0.511). Similar non-significant findings were observed for attitudes (F = 0.127, p = 0.881), EBP retrieving and reviewing (F = 0.589, p = 0.556), and EBP sharing (F = 0.245, p = 0.783), reinforcing that age does not significantly impact these variables among the students in the sample. In the assessment of perceived knowledge, attitudes, and EBP application in governmental universities, significant gender-based differences were observed. For the “knowledge subscale,” females (M = 4.61) scored significantly higher than males (M = 3.90) (t = -3.410, p = 0.001). In terms of the “attitude subscale,” no significant difference was noted despite slightly lower scores for males (M = 3.83) compared to females (M = 4.25) (t = -1.783, p = 0.076). Similarly, the “EBP retrieving and reviewing” subscale showed no significant difference (t = -1.771, p = 0.078). However, for “EBP sharing,” a significant gender difference was observed, with females (M = 4.42) scoring higher than males (M = 3.90) (t = -2.107, p = 0.038). These findings suggest that gender influences perceptions of EBP, with variations depending on the specific aspect examined.
In the examination of perceived knowledge, attitudes, “EBP retrieving and reviewing”, and “EBP sharing and application” among Saudi students with respect to their GPAs, the EBP sharing and application subscale exhibited a significant difference (F = 2.700, p = 0.040), while the other subscales did not reveal such significance. Post hoc Tukey HSD tests identified one statistically significant pairwise difference: students with a GPA “Above 4.5” scored significantly higher than those in the “2–2.75” GPA group (mean difference = 1.389, p = 0.04). No significant differences were found among the other GPA groups.
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When comparing universities, Princess Nourah University had the highest mean knowledge score (M = 4.87), followed by Jouf University (M = 4.33), and Taif University (M = 4.05). ANOVA results indicated a statistically significant difference among the universities (F = 5.512, p = 0.005) for the “knowledge subscale.” Post hoc Tukey HSD tests showed that students from Princess Nourah University scored significantly higher than those from Jouf University (mean difference = 0.54, p = 0.04) and Taif University (mean difference = 0.82, p = 0.004). No significant difference was observed between Jouf University and Taif University students (mean difference = 0.28, p = 0.46). Similarly, for EBP sharing and application, there were statistically significant differences among the universities, Post hoc Tukey HSD tests revealed that students from Princess Nourah University scored significantly higher than those from Taif University (mean difference = 0.91, p = 0.009). However, no significant differences were found between Princess Nourah University and Jouf University (mean difference = 0.30, p = 0.51), nor between Jouf University and Taif University (mean difference = 0.61, p = 0.07).
Students who reported being involved in research demonstrated higher mean scores for knowledge (M = 4.54) compared to those not involved (M = 4.08), with a statistically significant t-test (t = 2.104, p = 0.037). Similarly, the EBP sharing subscale showed a significant difference, with higher scores for students involved in research (M = 4.43) than those not involved (M = 3.88) (t = 2.150, p = 0.033). In contrast, no significant differences were found in attitudes (t = 1.585, p = 0.115) and EBP retrieving and reviewing (t = 1.399, p = 0.164) based on research involvement. Even though students who received EBP training exhibited a slightly higher mean score in perceived knowledge, no statistically significant differences were found in this regard (t = 0.863, p = 0.389). Similarly, for attitudes (t = 0.882, p = 0.379), EBP retrieving and reviewing (t = 1.127, p = 0.261), and EBP sharing (t = 0.934, p = 0.352), there were no statistically significant differences between students who received EBP training and those who did not.
Table 4
Differences in Saudi students’ perceived knowledge, attitude, and application of EBP by selected sociodemographic and contextual characteristics
Variables | Knowledge associated with EBP | Attitude toward EBP | EBP retrieving and reviewing | EBP sharing and application |
|---|---|---|---|---|
M (SD) | M (SD) | M (SD) | M (SD) | |
Age (Years) | ||||
18–22 | 4.42 (1.25) | 4.14 (1.35) | 4.34 (1.38) | 4.32 (1.47) |
23–27 | 4.46 (1.38) | 4.13 (1.66) | 4.16 (1.55) | 4.22 (1.72) |
28–32 | 3.86 (1.70) | 3.86 (1.44) | 3.88 (1.42) | 3.94 (1.63) |
ANOVA (F) | 0.67 | 0.13 | 0.59 | 0.25 |
Gender | ||||
Male | 3.90 (1.13) | 3.83 (1.23) | 3.97 (1.28) | 3.90 (1.48) |
Female | 4.62 (1.32) | 4.25 (1.51) | 4.39 (1.48) | 4.42 (1.56) |
t-test (2-tailed) | -3.41b | -1.73 | -1.77 | -2.1a |
Current GPA | ||||
2–2.75 | 3.81 (0.72) | 3.62 (1.34) | 3.57 (1.16) | 3.46 (1.67) |
2.76–3.75 | 4.34 (1.28) | 4.01 (1.39) | 4.34 (1.38) | 4.08 (1.49) |
3.76–4.5 | 4.43 (1.18) | 4.12 (1.43) | 4.15 (1.38) | 4.23 (1.43) |
Above 4.5 | 4.59 (1.70) | 4.43 (1.59) | 4.63 (1.63) | 4.85 (1.78) |
ANOVA (F) | 0.77 | 0.91 | 1.56 | 2.7 a |
Affiliation | ||||
Princess Nourah | 4.87 (1.14) | 4.33 (1.38) | 4.58 (1.29) | 4.65 (1.35) |
Jouf University | 4.33 (1.34) | 4.17 (1.51) | 4.19 (1.53) | 4.35 (1.59) |
Taif University | 4.05 (1.31) | 3.83 (1.39) | 4.06 (1.38) | 3.74 (1.56) |
ANOVA (F) | 5.51 b | 1.57 | 1.88 | 4.67 a |
Research Involvement | ||||
Yes | 4.54 (1.26) | 4.23 (1.42) | 4.36 (1.32) | 4.43 (1.42) |
No | 4.09 (1.39) | 3.86 (1.50) | 4.03 (1.68) | 3.88 (1.79) |
t-test (2-tailed) | 2.10 a | 1.56 | 1.40 | 2.15 a |
EBP Training | ||||
Yes | 4.48 (1.34) | 4.20(1.47) | 4.36 (1.44) | 4.36 (1.59) |
No | 4.30 (1.25) | 4.01(1.40) | 4.11 (1.43) | 4.14 (1.47) |
t-test (2-tailed) | 0.86 | 0.88 | 1.13 | 0.93 |
Organizations’ support and resources for EBP implementation
Table 5 provides insights into the perceptions of nursing students regarding the organizational support and readiness for EBP within their educational institutions, along with the mean scores and the distribution of responses. The availability of resources to support EBP teaching received the highest mean score (M = 3.59), indicating that students perceive access to learning materials and institutional support as relatively favorable. This suggests that well-equipped institutions can enhance students’ ability to integrate EBP into their practice. However, the provision of EBP mentors had the lowest mean score (M = 3.47), reflecting less favorable perceptions regarding mentorship availability. Since mentorship is a key factor in guiding students through critical appraisal and evidence integration, its perceived lack may hinder students’ confidence and ability to apply EBP effectively. The organizational culture supporting EBP teaching received a mean score of 3.49, indicating a moderately favorable perception among students. While this suggests that institutions promote an environment conducive to EBP integration, it also highlights room for improvement in fully embedding EBP principles into the academic and clinical culture.
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Table 5
Perceptions of nursing students regarding the organizational support and readiness for EBP
M | Strongly Disagree | Disagree | Neither Agree nor Disagree | Agree | Strongly Agree | |
|---|---|---|---|---|---|---|
My organization has a culture that supports faculty to teach EBP | 3.49 | 10.9% | 13.7% | 18.0% | 30.6% | 26.8% |
My organization has readily available resources to enhance the teaching of EBP | 3.59 | 9.3% | 8.2% | 20.8% | 37.7% | 24.0% |
My organization provides EBP mentors to enhance the integration of EBP across educational programs | 3.47 | 12.0% | 10.4% | 24.6% | 24.6% | 28.4% |
Discussion
The study aimed to assess Saudi nursing students’ perceived knowledge, attitudes, and application of Evidence-Based Practice (EBP), as well as their perceptions of organizational culture and readiness supporting EBP implementation. The results reveal that while the majority of students demonstrated satisfactory knowledge and positive attitudes toward EBP, notable gaps persist in critical appraisal skills and practical application. Over 10% of students reported poor knowledge levels, a concerning gap that, given EBP’s benefits [15, 16], indicates an urgent need to re-evaluate curricular models using innovative active learning approaches [2, 17]. While positive attitudes facilitate EBP adoption, negative mindsets among over a third of students could pose barriers [18, 19]. Qualitative inquiry through focus groups may provide contextual insights to guide enhancements in curricula and faculty development tailored to the Saudi nursing education context [6, 20]. Students expressed confidence in determining the clinical relevance of evidence. However, critical appraisal represented a relative weakness, aligning with regional research [21, 22]. Developing critical appraisal abilities early and reinforcing application clinically could strengthen this core competency [23, 24].
An intriguing finding was female students demonstrated significantly higher EBP knowledge than males, contrasting with other regional studies [7, 25]. Qualitative exploration would help elucidate potential sociocultural influences driving this gender difference in the Saudi context. Surprisingly, academic performance (GPA) did not impact EBP knowledge or attitudes, diverging from some studies [8, 24, 26]. Examining potential mediators like practical exposure and faculty mentoring that could moderate GPA’s influence merits investigation [27]. Surprisingly, academic performance (GPA) did not impact EBP knowledge or attitudes, diverging from some studies correlating higher GPAs with greater EBP confidence [28]. This finding suggests that factors beyond academic achievement, such as hands-on clinical experience, exposure to research, and institutional support, may play a more significant role in shaping EBP competencies [29, 30]. Additionally, students with lower GPAs might still develop strong EBP skills through structured training, mentorship, or active participation in research activities. These findings warrant examining potential mediating factors like practical exposure and faculty mentorship that could moderate the relationship between GPA and EBP perceptions, as academic performance alone does not fully predict capabilities [29, 30]. Future studies should explore whether active engagement in research, clinical decision-making exercises, and mentorship programs contribute more to EBP readiness than academic grades alone.
The lack of GPA influence underscores that the drivers of EBP knowledge are complex, multifactorial, and require deeper investigation [31]. It cannot be presumed that students with higher academic grades necessarily have superior EBP competencies. Holistic assessment mechanisms incorporating both knowledge and applied clinical skills may provide better insight compared to reliance on GPA alone [29, 30, 32]. Overall, these demographic variations reveal intriguing areas needing further exploration through qualitative and mixed methods approaches to unravel the contextual nuances shaping EBP perspectives among Saudi nursing students.
The variability in organizational readiness across universities highlights the pivotal role of institutional processes in cultivating EBP cultures [33‐35]. This aligns with literature emphasizing the significance of organizational context in shaping successful EBP integration in academia and practice. Addressing the identified mentorship gaps through faculty development and practice partnerships is important and warrants prioritization. Potential initiatives could include EBP mentorship programs, communities of practice, and integration with clinical sites [32, 36].
Elucidating frontline nurses’ perspectives in clinical settings could provide equally vital insights to inform multifaceted strategies for enhancing organizational readiness among future employers [37, 38]. A collaborative academic-practice approach would be beneficial to create aligned visions and programs easing the transition of EBP competencies from the classroom into clinical environments. Overall, the study results underscore the need for greater attention to organizational facets across the educational and professional spectrum to provide optimal enabling environments for students to learn EBP foundations and subsequently apply them in practice [39, 40].
Regarding factors influencing EBP perceptions, the superior performance of female students warrants further research to decipher the reasons behind this gender difference. While age and GPA showed no significant impact, university affiliation did, underscoring the role of institutional factors in shaping EBP experiences [41, 42]. Additionally, research engagement correlated positively with EBP knowledge and application, likely due to enhanced skills in finding and applying evidence. However, the lack of difference between trained and untrained students implies that the quality and depth of EBP exposure may be more critical than mere incorporation into curricula. This highlights that effective EBP teaching requires more than just superficial coverage in the classroom; experiential learning, role modeling, clinical integration, and reflective exercises are pivotal for competencies to develop [41‐43].
The reliance on self-reported data may have introduced response bias, as students might have overestimated or underestimated their EBP competencies. Future research should incorporate objective assessments to validate these perceptions. Additionally, the study’s cross-sectional design limits causal inferences, making it difficult to determine whether EBP training directly improves knowledge and application over time. A longitudinal approach would provide more insight into knowledge progression and skill retention.
Implications and recommendations
The study’s findings suggest crucial improvements in Evidence-Based Practice (EBP) education and integration. Addressing knowledge gaps calls for a reevaluation of teaching techniques through active learning, while enhancing critical appraisal skills requires collaborative workshops and experiential learning. Organizational support for EBP achieved through mentorship, faculty development, and academic-practice partnerships, needs greater emphasis, with consistent institutional cultures prioritizing EBP as a vital goal.
To bridge EBP gaps, specific active learning techniques and innovative curricular approaches can be implemented. Active learning strategies like flipped classrooms (students review EBP-related materials before class and engage in problem-solving discussions during sessions), case-based learning, simulation-based training (using virtual or high-fidelity patient scenarios), and peer-led journal clubs can be integrated. Beyond nursing education, these findings can inform institutional policies by promoting evidence-based decision-making, structured mentorship, and interdisciplinary collaboration to enhance learning and policy effectiveness.
Looking ahead, there is a need for longitudinal tracking of knowledge progression and qualitative exploration of attitudinal barriers and gender differences. Comparative studies on pedagogical approaches, investigations into clinical transition challenges, and exploration of interprofessional education strategies can provide additional insights. These research avenues are key to bridging existing gaps and propelling the strategic shift towards evidence-based nursing practices, highlighting the influence of organizational culture on EBP readiness.
Study limitations
Several limitations were identified in this study. The cross-sectional design employed restricts the ability to establish causality and introduces the potential for social desirability response biases. Additionally, the study’s sample was confined to three universities, diminishing the generalizability of the findings. The quantitative approach, while providing valuable data, offered limited insight into experiential and attitudinal factors. Moreover, the reliance solely on self-reported data, without incorporating objective knowledge assessments, adds a layer of potential bias to the study’s outcomes.
Conclusion
This cross-sectional study offered valuable insights into Saudi nursing students’ knowledge, attitudes, and application of evidence-based practice (EBP). The findings reveal a reasonably positive EBP outlook among students but also some persisting gaps in knowledge, critical appraisal skills, and organizational support requiring addressable. While students generally have satisfactory foundations, targeted interventions are warranted to further strengthen competencies and actualize the strategic paradigm shift toward evidence-based nursing. Future longitudinal studies should track knowledge progression, while qualitative analyses can explore attitudinal barriers, gender differences, and institutional influences, alongside comparative research on pedagogical approaches and clinical transition challenges to enhance EBP readiness and integration.
Acknowledgements
We would like to extend our most sincere appreciation to the Deanship of Graduate Studies and Scientific Research at Jouf University for funding this project.
Declarations
Ethics approval and consent to participate
“This study was approved by the bioethics institutional review board of Jouf University and was performed in accordance with the Helsinki Declaration [14]. The study received the approval number (7-08-44). Invitations, comprising an electronic survey link, were sent via email to the administrative offices, which, in turn, distributed the survey link to consenting participants. Therefore, the informed consent was obtained from all the participants by the return of the completed questionnaire as implying consent”. To ensure confidentiality, which is paramount in protecting the participants’ identities, anonymity was maintained as the highest security standard.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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