Skip to main content
NCBI home page
Wiley Open Access Collection logoLink to Wiley Open Access Collection
. 2024 Oct 23;72(2):e13054. doi: 10.1111/inr.13054

Organizational evidence‐based practice culture, implementation leadership, and nurses: A bidirectional mediation model

Shuang Hu 1, Siying Liu 2, Xianfeng Li 3, Junqiang Zhao 4,5, Jia Chen 1, Wenjun Chen 1,✉, Jiale Hu 6,✉
PMCID: PMC11969321  PMID: 39440962

Abstract

Aim

This study aimed to explore 1) factors that influenced the evidence‐based practice competencies and behaviors of clinical nurses and 2) the interaction between the organizational evidence‐based practice culture, head nurses' implementation leadership, and nurses' evidence‐based practice competencies and behaviors.

Background

The significance of organizational evidence‐based practice culture and head nurses' implementation leadership in enhancing nurses' evidence‐based practice competencies and behavior is widely recognized in healthcare settings. However, there is limited knowledge of how these factors influence nurses' evidence‐based practice competencies and behavior.

Methods

A cross‐sectional survey was conducted at 10 hospitals in China. Data were collected via online questionnaires from October to December 2020, utilizing social characteristic questionnaires, the Evidence‐Based Practice Questionnaire, the Organizational Culture and Readiness Scale for System‐wide Implementation of Evidence‐Based Practice, and the Implementation Leadership Scale. All data were imported into the IBM Statistical Program for the Social Sciences (SPSS) 27.0 and PROCESS version 4.1 macro on SPSS for statistical analysis. The design and reporting of our study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist.

Results

We received 1047 (99.15%) valid questionnaires. The multiple linear regression analysis showed that significant factors were organizational evidence‐based practice culture, implementation leadership, and years of experience in nursing. After controlling for the impact of the covariate (years of experience in nursing), it was found that organizational evidence‐based practice culture partially mediated the relationship between head nurses' implementation leadership and nurses' evidence‐based practice competencies and behaviors. Additionally, head nurses' implementation leadership partially mediated the relationship between organizational evidence‐based practice culture and nurses' evidence‐based practice competencies and behaviors.

Conclusion

Organizational evidence‐based practice culture, head nurses' implementation leadership, and years of experience in nursing significantly predict nurses' evidence‐based practice competencies and behaviors. Organizational evidence‐based practice culture and head nurses' implementation leadership mutually mediated their influence on nurses' implementation of evidence‐based practice.

Implications for nursing and policy

Head nurses should proactively seek opportunities to enhance their implementation leadership, such as participating in training programs (e.g., mentoring and coaching programs) and attending conferences, workshops, or seminars on implementation leadership. Policymakers should also consider providing more policy support for implementing leadership development and cultivating a positive evidence‐based practice culture.

Keywords: evidence‐based practice, head nurse, implementation leadership, nursing, organizational culture

INTRODUCTION

Numerous studies have explored evidence‐based practice (EBP) implementation factors and identified common aspects hindering or facilitating the implementation process. These include the quality and accessibility of evidence being implemented (Finch et al., 2020), the characteristics of the implementation context (e.g., systems, organizations, leadership) (Nilsen & Bernhardsson et al., 2019), clinical practitioners (e.g., nurses) (Bach‐Mortensen et al., 2018), and clients (e.g., patients) (Juckett et al., 2020). There is a considerable need to explore the influence mechanism among multiple key determinants of EBP implementation and how they collectively impact implementation (Williams et al., 2020). Such a study could further enrich the current determinant frameworks for EBP implementation (Nilsen et al., 2015), develop more effective strategies and interventions to address the intricate interactions (Damschroder et al., 2022), and allocate resources more efficiently, focusing on areas that have the greatest influence on EBP implementation (Mathieson et al., 2018).

Leadership is a major factor in promoting nurses’ EBP implementation (Castiglione et al., 2020). It is described as “a multidimensional process of influence that enables clinical staff to use evidence in their clinical decision‐making and includes activities and behaviors of unit‐level managers and supervisors that influence staff, their environment, and organizational factors that influence implementation” (Gifford et al., 2017, p. 16). Unit‐level nurse managers, also called head nurses in China, oversee nursing staff and operations within a specific unit or department (Gifford et al., 2018). Studies conducted globally have revealed that unit‐level nurse managers play a crucial role in initiating and facilitating EBP implementation (Bianchi et al., 2020; Gifford et al., 2018). They could directly influence clinical nurses' implementation of EBP and other key stakeholders involved in the process, such as physicians and executive leaders (Birken et al., 2018). Studies revealed that unit‐level managers could influence clinical nurses' EBP competencies (knowledge, skills, and attitude) toward EBP implementation (Guerrero et al., 2020) and lead nurses' EBP implementation through frequent interactions with them (Bianchi et al., 2018), significant involvement in supervising and guiding nursing care (Gifford, Squires, et al., 2018), and pursue necessary resources and training opportunities from senior leaders (e.g., hospital administrators, and nursing directors) or external entities (e.g., nursing associations) (Shuman et al., 2017; Williams et al., 2020).

Organizational EBP culture comprises specific organizational features, such as personnel engagement in EBP, resource accessibility, and promoting EBP among key stakeholders (Melnyk et al., 2022). These elements and identified strengths and opportunities enhance consistent EBP implementation (Melnyk et al., 2022). Organizational EBP culture is often regarded as the predominant factor influencing an organization's success in achieving its vision and strategic goals in EBP implementation (Cleary‐Holdforth et al., 2022). Researchers have suggested that organizational EBP culture could shape EBP implementation by creating a context where certain ideas, activities, or events related to EBP are highly valued (Li et al., 2018). Melnyk et al. (2021) and Furuki et al. (2023) found that organizations that foster a culture of openness and embrace EBP implementation can directly enhance clinical nurses' EBP competency, beliefs, and implementation, leading to sustained use of EBP and ultimately contributing to improved patient outcomes.

Moreover, the head nurse's implementation leadership mutually influences organizational EBP culture (Aarons et al., 2017). On the one hand, Birken et al. (2018) and Shuman et al. (2018) found that head nurses hold a unique position that connects hospital senior leaders with clinical nurses and mediates organizational goals with day‐to‐day activities. Studies have shown that by directly advocating EBP implementation programs among senior leaders and showing visible support for employees' health, head nurses can create an organizational culture that encourages EBP implementation (Guerrero et al., 2016). For example, Farahnak et al. (2020) found that managers who communicate the importance of EBP and its potential benefits for patients and the organization help to create a culture of continuous improvement and innovation.

On the other hand, a positive EBP culture also promotes managers to develop themselves as leaders in the implementation process. Osei et al. (2017) found that strong shared cultural values are associated with commitment, self‐confidence, and ethical behavior. As a result, these values can significantly shape managers' development of implementation leadership behavior (Metwally et al., 2019).

However, despite the valuable contribution of previous research, the precise relationships between organizational EBP culture, head nurses' implementation leadership, and nurses' EBP competencies and behaviors remain unclear. To our knowledge, only one study in China found that the EBP work environment can mediate the relationship between head nurses' implementation leadership and nurses' EBP beliefs (Zhang et al., 2023). While the work environment focuses on the physical and social aspects of the workplace, organizational culture is more about the values, beliefs, and behaviors that shape an organization's overall identity and how work is carried out (Shuman et al., 2018). Focusing on organizational culture is important for developing EBP competencies and behavior because it can encourage individuals to embrace and integrate EBP into their daily work (Melnyk et al., 2022).

Globally, a cross‐sectional study by Shuman et al. (2018) revealed that head nurses' implementation leadership behaviors and EBP competencies correlated to unit implementation climate. Williams et al. (2020) conducted a 5‐year study to test a theory of implementation leadership, implementation climate, and clinicians' use of EBP. They found that leaders can influence the achievement of better implementation outcomes, both directly and through the implementation climate (Williams et al., 2020). Implementation climate refers to the extent to which employees share perceptions that the adoption and implementation of EBP are expected, supported, and rewarded within their organization (Ehrhart et al., 2014). It is more closely related to the short‐term aspects of an implementation effort than the culture that addresses the long‐term and foundational aspects of an organization's approach to change (Powell et al., 2021). EBP culture should be studied because it has the potential to exert a lasting and more profound influence on EBP implementation.

By identifying the interaction among organizational EBP culture, head nurses' implementation leadership, and nurses' EBP competencies and behaviors, we can better develop interventions to enhance care and promote effective EBP implementation within the nursing context. Therefore, we conducted the study to explore 1) the factors that influence the EBP competencies and behaviors of clinical nurses and 2) the relationship among organizational EBP culture, head nurses' implementation leadership, and nurses' EBP competencies and behaviors in China.

Conceptual model

In this study, we developed a conceptual model (Figure 1) using the integrated Promoting Action on Research Implementation in Health Services (i‐PARIHS) framework to guide our research. The i‐PARIHS framework defines successful EBP implementation as achieving implementation/project goals through facilitators' effective introduction of innovations into recipients' contexts, encompassing the local, organizational, and health system levels (Harvey & Kitson et al., 2016). Our study focused on the interaction between the context (e.g., organizational EBP culture, implementation leadership, and structure characteristics) and the recipients (EBP competencies and behaviors, characteristics). Based on previous studies and the conceptual model, the following hypotheses have been considered:

FIGURE 1.

FIGURE 1

Open in a new tab

Conceptual model. EBP, evidence‐based practice.

Hypothesis 1

Organizational EBP culture, head nurses' implementation leadership, and other structural and individual characteristics (e.g., hospital level, working experience) significantly predict nurses' competencies and behaviors.

Hypothesis 2

Organizational EBP culture and head nurses' implementation leadership mutually mediate their influence on nurses' implementation of EBP.

The conceptual model designed for this study depicts the interrelationships among these three crucial concepts, clarifying the dynamics that support effective EBP implementation.

METHODS

Study design

This study used a multisite cross‐sectional design. We conducted the study following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist (Elm et al., 2007).

Settings and participants

This study was conducted in tertiary and secondary acute care hospitals in Hunan province in south‐central China. Tertiary and secondary acute care hospitals are responsible for providing specialized health services, medical education, and research at the regional or provincial level (Chen et al., 2021). We applied stratified convenience sampling to identify one tertiary and one secondary hospital from each of the five geographic regions of Hunan province (center, south, east, west, and north). The eligible criteria for hospitals were any secondary or tertiary hospital, according to the Chinese Hospital Classification Management Standards (Li et al., 2008). The study recruited five tertiary and five secondary hospitals, all of which consented to participate. Ten nursing units were randomly selected from each hospital, resulting in 100 units being recruited.

We recruited clinical nurses from 100 nursing units to participate in the study. A clinical nurse is a licensed registered nurse who provides direct patient care in a nursing unit (Shuman et al., 2018). A nurse was eligible if he or she held a registered nurse license, was employed full‐time during the investigation, and had direct patient care responsibilities.

In China, nurses can attain five levels of education: 1) Secondary school education, which typically lasts 2–3 years, is designed to cultivate practical skills and basic nursing knowledge suitable for grassroots medical care; 2) Associate degree programs, also 3 years in length, further deepen specialized knowledge and skills, preparing graduates for mid‐level nursing positions across various medical institutions; 3) Bachelor's education, a 4‐year program, aims to comprehensively enhance clinical managerial and research skills, enabling graduates to assume roles in hospital management, advanced clinical nursing, or public health; 4) Master's level education, typically 3 years in length, emphasizes advanced professional practice and scientific research, making it suitable for careers in higher education institutions, large hospitals, or research organizations; 5) Doctoral education, usually 4 years in length, is designed to cultivate nursing experts, with graduates often assuming senior leadership positions in universities, research institutions, or policy‐making departments.

There are five different job titles for nurses: 1) Junior nurses, who serve as the entry point for nursing professionals and typically need to pass the National Qualifying Examination for Nurses; 2) Senior nurses, who must have worked the field for a certain number of years (e.g., one year for bachelor nurses), demonstrating professional skills and the ability to work independently; 3) Nurse‐in‐charge, who possess a specified number of years of work experience and have achieved notable accomplishments in clinical work, teaching, and scientific research; 4) Co‐chief superintendent nurses, who were required to have richer clinical experience, as well as certain management capabilities; and 5) Chief superintendent nurses, who are senior experts in the field of nursing. They are expected to contribute significantly to nursing practice, scientific research, and teaching. Before obtaining a title job, nurses must pass the corresponding national examinations.

We used G*Power software to determine the sample size. The sample size was calculated to be at least 384 based on the total number of nurses in Hunan province (n = 237, 0.42) in 2020. The calculation was conducted with a confidence level (CI) of 95% and a margin of error of ± 5%.

Study variables and measures

Dependent variable

Clinical nurses' self‐reported EBP competencies and behaviors were measured using the Evidence‐Based Practice Questionnaire (EBPQ) developed by Upton et al. (2006) and translated into Chinese by Yang et al. (2010). EBP competencies refer to the level at which nurses are expected to use evidence to enhance care intentionally (Shuman et al., 2018). This expectation comes from combining their knowledge, skills, and attitudes toward EBP (Shuman et al., 2018). The questionnaire included 24 items that measured EBP knowledge and skills (n = 14 items), attitude (n = 4 items), and behaviors (n = 6 items). Participants were asked to indicate their level of agreement with each item on a 7‐point Likert scale. The scale's total score ranges from 0 to 168 points, with higher scores indicating more positive knowledge, skills, attitudes, and behaviors. The Chinese version showed high internal consistency, with a Cronbach alpha value of 0.94 and the subscales' values of 0.79 to 0.94 (Yang et al., 2010).

Independent variable

Characteristics of participants and healthcare settings: Characteristics of participants included gender, age, job title, education level, and years of experience in nursing. Setting Characteristics involved the hospital level they worked in (i.e., tertiary, secondary), the type of unit they worked in (e.g., surgical, internal medicine, critical care), and the bed–nurse ratio in nursing units.

Organizational EBP culture: We applied organizational culture and readiness for system‐wide implementation of the EBP scale (OCRSIEP) to identify organizational characteristics that are strengths and opportunities for promoting EBP within a healthcare system (Melnyk & Fineout‐Overholt et al., 2022). The scale comprises 25 questions assessed on a 5‐point Likert scale, with responses ranging from “not at all” to “very much.” Higher scores indicate a more positive organizational EBP culture. Mao et al. (2014) translated the OCRSIEP into Chinese. They deleted one item from the original version (i.e., compared to the past 6 months, how much movement in your organization has been toward EBP culture). Mao et al. (2014) divided the scale into two domains: 1) the extent of personnel involvement in EBP, their skills, and resource reserves (n = 15 items) and 2) the extent to which various professional groups promote EBP (n = 9 items). The overall Cronbach's α of the Chinese version was 0.966.

Implementation leadership of head nurses: The perception of head nurses' implementation leadership by clinical nurses is measured by the 12‐item Implementation Leadership Scale (ILS) (Aarons et al., 2014). The scale scores were based on a 5‐point Likert scale, with responses ranging from 0 (“not at all”) to 4 (“very great extent”). A higher score indicated more favorable implementation leadership. Hu et al. (2021) translated the original English version of ILS into Chinese. They demonstrated excellent internal consistency, with Cronbach's α of 0.93 for the total score and 0.86–0.95 for the subscale scores. Psychometric testing also indicated good convergent validity and acceptable aggregation (Hu et al., 2021).

Data collection and ethical consideration

Ethical approval was obtained from the Institutional Review Board of the Xiangya Nursing School, Central South University (No. E202095). The data were collected over 3 months, from October to December 2020. After obtaining authorization from the hospital administrators, the research team posted a recruitment letter (including the study introduction and invitation to participate) in the participating hospitals. Clinical nurses interested in participating in the study contacted the research team and provided their contact information (WeChat number).

Survey data were collected online using Sojump (www.sojump.com), an online data collection website that is popularly used in questionnaire surveys in China (Wang et al., 2022). One of the research team members sent a questionnaire (a survey link generated by Sojump) to nurses through WeChat, the most commonly used social networking application in China (Peng & Ye et al., 2018). Participants could access the informed consent form by clicking on the survey link. If participants wished to take part in the study, they could click the “Agree to Participate” button and proceed to complete and submit the survey.

Each internet protocol address was limited to one questionnaire submission. Data were automatically collected upon submission. The data collection was anonymous, with no collection of personally identifiable information.

Data analysis

All data were imported into the IBM Statistical Program for the Social Sciences (SPSS) 27.0 and PROCESS version 4.1 macro on SPSS for statistical analysis (IBM Corp. et al., 2017). Descriptive statistics were employed to analyze continuous and categorical data, utilizing proportions, frequency, mean, and standard deviation measures. We used a radar chart to demonstrate the mean scores of the items in the EBPQ. T‐test, Kruskal‐Wallis H test, and analysis of variance (ANOVA) were performed to identify variations in EBP competency across different nurse characteristics. The correlation analysis explored whether organizational EBP culture and head nurses' implementation leadership were related to clinical nurses' EBP competencies and behaviors. We employed multiple linear regression analysis to ascertain the factors associated with EBP competency and behaviors, utilizing variables that showed statistical significance in both univariate and correlation analyses as independent variables.

Hayes et al.’s (2022) PROCESS macro version 4.1 (Model 4) was employed to test the mediating role of organizational EBP culture between head nurses' implementation leadership and nurses' EBP competency and behaviors (Appendix 1A) or to test the mediating role of head nurses' implementation leadership between organizational EBP culture and nurses' EBP competency and behaviors (Appendix 1B). Based on the multiple linear regression analysis results, significant participants and healthcare setting characteristics were set as covariates when performing the mediating effect analysis (Hayes et al., 2022). A p‐value of less than 0.05 was regarded as significant.

RESULTS

Characteristics of participants and settings

We received 1056 survey questionnaires. After filtering out invalid responses (e.g., incomplete questionnaires), we retained 1047 (99.15%) of the questionnaires. Appendix 2 summarizes the characteristics of the nurses, revealing that most of the 1047 respondents were female nurses (n = 1029, 98.3%) aged between 20 and 40 years old (n = 971, 92.7%). Approximately two‐thirds had bachelor's degrees (n = 679, 64.8%) and had been licensed as a registered nurse for under 10 years (n = 729, 70%). Nearly three‐fifths of the participants (n = 601, 59.1%) were from tertiary hospitals, and 546 (35.4%) were from secondary hospitals. More than 80% of participants reported that the bed–nurse ratio in their nursing unit was less than 0.4.

Nurses' level of EBP competency and behaviors

Appendix 3 shows that nurses' self‐perceived EBPQ scores averaged (5.48 ± 1.49) points. Among the three dimensions of the EBPQ, the attitude dimension obtained the highest average score (5.79 ± 1.31) points, followed by behaviors (5.67 ± 1.52). Nurses' knowledge and skills (5.30 ± 1.49) received the lowest average score. As presented in Appendix 4, the three lowest‐scoring items were from the knowledge and skills dimension. They included “research skills” (4.94 ± 1.72), “skills to convert information needs into a research question” (5.17 ± 1.53), and “ability to analyze critical evidence against set standards” (5.20 ± 1.55). The three highest‐scoring items were related to nurses' attitudes toward EBP and relevant behaviors. These items were “Evidence‐based practice is fundamental to professional practice” (5.89 ± 1.29), “My practice has changed because of evidence I have found” (5.89 ± 1.26), and “Formulated a clearly answerable question at the beginning of the process toward filling this gap” (5.84 ± 1.39).

Factors affecting nurses' EBP competencies and behaviors

Bivariate correlations are shown in Appendix 5. Nurses' EBP competencies and behaviors were positively related to organizational EBP culture (r = 0.80, p <.001) and head nurses' implementation leadership (r = 0.76, p <.001). Head nurses' implementation leadership was also positively related to organizational EBP culture (r = 0.79, p <.001). We employed a multiple linear regression using head nurses' implementation leadership, organizational EBP culture, and independent variables (age, education level, job title, years of experience in nursing) that significantly impacted nurses' EBP competency in the univariate analyses (refer to Table 1). We found that significant factors included organizational EBP culture (β = 0.55, p <.001), implementation leadership (β = 0.33, p <.001), and years of experience in nursing (β = 0.08, p = .027) (See Appendix 6). The regression model demonstrated significance (F = 381.41, p <.001) and explained 69% of the variance. Therefore, Hypothesis 1 is supported.

TABLE 1.

Multiple linear regression analysis of nurses' EBP competencies and behaviors (n = 1047).

Variables B (95% CI) β t p
Organizational culture 0.73 (0.66, 0.80) 0.55 19.27 <.001
MM implementation leadership 0.90 (0.75, 1.06) 0.33 11.62 <.001
Years of experience in nursing 2.24 (0.26, 4.22) 0.08 2.22 0.027
R 2 0.69
F 381.41
p <.001
Open in a new tab

Abbreviations: CI, confidence interval; MM, middle‐level manager; EBP, evidence‐based practice.

Association among organizational EBP culture, head nurses' implementation leadership, and EBP competencies and behaviors of clinical nurses

The mediation model is shown in Table 2. The values for total, effect, and indirect effect in two parts of Table 2 were all significant (p <.001). This result suggests that, while controlling for the covariate (years of experience in nursing), organizational EBP culture was a mediator in the link between head nurses' implementation leadership and nurses' EBP competencies and behaviors. Furthermore, head nurses' implementation leadership mediated the relationship between organizational EBP culture and nurses' EBP competencies and behaviors. Therefore, Hypothesis 2 is supported.

TABLE 2.

Results of the mediation effect (n = 1047).

Model Outcome variable Predictor variable R2 F β t
A EBP competencies and behaviors 0.57 698.97
Implementation leadership 2.09 36.84 **
Years of experience in nursing −0.41 −0.74
Organizational culture 0.63 872.58
Implementation leadership 1.61 40.19 **
Years of experience in nursing −2.06 −5.20 **
EBP competencies and behaviors 0.69 763.01
Implementation leadership 0.91 11.74 **
Organizational culture 0.73 19.53 **
Years of experience in nursing 1.09 2.25 *
B EBP competencies and behaviors 0.66 950.91
Organizational culture 1.08 43.04 **
Years of experience in nursing 1.27 2.46 *
Implementation leadership 0.62 838.59
Organizational culture 0.38 40.19 **
Years of experience in nursing 0.19 0.99
EBP competencies and behaviors 0.65 950.91
Organizational culture 0.73 19.53 **
Implementation leadership 0.91 11.74 **
Years of experience in nursing 1.09 2.25 *
Open in a new tab

Abbreviations: MM, middle‐level manager; EBP, evidence‐based practice.

*

p < 0.05.

**

p < 0.01.

The model's total, direct, and mediating effects are summarized in Table 3.

TABLE 3.

Decomposition table of total effect, direct effect, and mediating effect (n = 1047).

Model Effect type Effect (Boot) SE 95% Boot LLCI 95% Boot ULCI Relative effect (%)
A Total effect 2.09 ** 0.06 1.98 2.20
Direct effect 0.91 ** 0.08 0.76 1.06 43.5%
Indirect effect 1.18 ** 0.08 1.01 1.35 56.5%
B Total effect 1.07 ** 0.03 1.03 1.13
Direct effect 0.73 ** 0.04 0.66 0.81 68.2%
Indirect effect 0.34 ** 0.04 0.26 0.43 31.8%
Open in a new tab

Abbreviations: LLCI, lower limit confidence interval; ULCI, upper limit confidence interval.

**

p < 0.01.

DISCUSSION

We conducted a cross‐sectional study to explore the determinants of clinical nurses' EBP competencies and behaviors in acute care hospitals. Our findings corroborated Hypothesis 1 that the years of experience in nursing, organizational EBP culture, and head nurses' implementation leadership were major predictors for nurses' EBP competencies and behaviors. Furthermore, our results confirmed Hypothesis 2, indicating that organizational EBP culture and head nurses' implementation leadership mutually influenced each other's impact on nurses' EBP competencies and behaviors.

Chinese nurses' EBP competencies and behaviors have increased over the last decade. The average score of nurses' EBP competencies and behaviors is (5.48 ± 1.49) points, higher than those reported by other studies conducted in China over the last 10 years that applied the same scale (Li et al., 2019; Liu et al., 2016). When compared with studies in other countries, such as the USA (Williamson et al., 2015), Finland (Lunden et al., 2021), Saudi Arabia (Alqahtani et al., 2020), and Oman (Al‐Busaidi et al., 2019), the nurses in this study demonstrated higher levels of EBP competencies and behaviors. The rapid advancement of EBP in recent years has improved nurses' EBP competencies and behaviors in China (Chen et al., 2020). Zhao et al. (2022) conducted a scoping review of EBP implementation research progress in healthcare in China, and their search yielded 309 papers. They found that the first study on EBP implementation in China was conducted in 2005, and 94.8% of the studies were published after 2013 (Zhao et al., 2022).

In addition, in the last 15 years, China has had the highest number of nursing trainees participating in the JBI Evidence‐based Clinical Fellowship program outside of Australia (McArthur et al., 2020). Notably, nurses' attitudes toward EBP received the highest score among the three dimensions, which aligns with the findings of previous studies by Li et al. (2019), Liu et al. (2016), and Alqahtani et al. (2020). The large number of EBP training and studies conducted over the last 10–15 years have increased nurses' optimism toward using EBP in clinical nursing practice and their recognition of the importance of EBP (Lai et al., 2023). Our study showed that the highest‐scoring item was “Evidence‐based practice is fundamental to professional practice,” suggesting that nurses do not perceive EBP as a waste of time but rather acknowledge its value in nursing practice (Alqahtani et al., 2022).

Furthermore, our study showed that senior nurses have better EBP competencies and behaviors than junior nurses, consistent with previous studies (Al‐Busaidi et al., 2019; Chen et al., 2020; Yoo et al., 2019). A scoping review by Furuki et al. (2023) showed that years of experience consistently emerged as one of the most frequently reported factors influencing nurses' knowledge and skills of EBP. Previous studies have indicated that nurses with extensive nursing experience tend to exhibit greater confidence in the execution of EBP. Chen et al. (2020) argued that this confidence came from their rich experience conducting daily nursing work and dealing with emergencies. Moreover, as described above, many EBP training programs have been conducted in China over the last 10–15 years (Zhou et al., 2020). Senior nurses can access EBP methods and training more easily through continuous professional education (Al‐Busaidi et al., 2019). This underscores the importance of providing more EBP training resources for junior nurses. Moreover, it suggests that pre‐training evaluation should be conducted to develop individualized EBP training plans based on nurses' EBP competency levels and personal needs (Rodríguez‐Pérez et al., 2022).

Consistent with previous studies and the i‐PARIHS framework, we found that organizational EBP culture and head nurses' implementation leadership were major predictors of nurses' EBP competencies and behaviors. Our study further contributes to the existing evidence by demonstrating that head nurses' implementation leadership and organizational EBP culture synergistically mediate their impact on developing nurses' EBP competencies and behaviors. The head nurses in our study demonstrated strong proactivity and supportive leadership behaviors. Specifically, nurses perceived that their managers could establish roadmaps and plans for EBP implementation and were dedicated to supporting nurses' adoption of EBP.

Similarly, previous studies revealed that head nurses could provide a supportive environment for nurses' acquisition of EBP knowledge, fostering a positive attitude toward EBP and their implementation of EBP (Birken et al., 2018; Shuman et al., 2020). In addition, stronger knowledgeable and persistent leadership behaviors in head nurses indicate their better grasp of EBP knowledge and commitment to overcoming challenges related to EBP (Bianchi et al., 2018). Aaron et al. (2017) claimed that managers with sufficient EBP knowledge and persistence could help create a sustained and positive atmosphere that boosts nurses' EBP competencies, especially in the knowledge dimension of EBP.

On the other hand, organizational EBP culture also shapes nurses' EBP competencies and behaviors by influencing head nurses' implementation leadership. One potential explanation for this mechanism is that the organizational culture influences nurses' EBP competencies and behaviors by enhancing the proactive role of head nurses in facilitating EBP implementation. As highlighted by Birken et al. (2015), a supportive EBP culture could enhance head nurses' commitment to change via prioritizing EBP implementation within the organization, establishing implementation policies and practices (such as those related to human resources, training, and funding), and encouraging head nurses to utilize performance reviews and human resources to drive EBP implementation (Osei et al., 2017). Gifford et al. (2018) further demonstrated that managers' commitment to change could increase nurses' willingness to actively acquire EBP knowledge and skills. More studies are needed to confirm our findings regarding this influential mechanism.

To the best of our knowledge, this study is the first to reveal the influential mechanism that organizational EBP culture and head nurses' implementation leadership mutually mediated their influence on nurses' EBP competencies and behaviors. As supported by our study and previous research, organizational EBP culture and head nurses' implementation leadership are two important elements in the context of the i‐PARIHS framework (Harvey & Kitson et al., 2016), and they have been confirmed as crucial factors influencing the successful implementation of EBP of nurses.

Our findings contribute to refining the i‐PARIHS framework (Harvey & Kitson et al., 2016) by providing a deeper understanding of the interaction mechanisms among these three factors. This can be a valuable guide for nurse researchers in effectively developing strategies using the i‐PARIHS framework (Harvey & Kitson et al., 2016) to promote clinical EBP. Additionally, our study suggests the need for further research to investigate the impact mechanisms of other factors within the context (e.g., police drivers, organizational priorities) of this framework to inform effective EBP implementation. Please refer to Appendix 7 for the additional reference list.

Limitations

This study has several limitations. First, we employed a self‐reported questionnaire to assess nurses' EBP competencies and behaviors, their leaders' implementation leadership, and nurses' perceptions of organizational EBP. Nurses might have responded with answers in the way they unintentionally met social desires or aligned with the perceived expectations of their leaders. Second, this study was conducted in hospitals in China with their own organizational cultures. Therefore, the results may not be generalizable to other countries. However, the methodology used in our study can provide valuable information for researchers globally to explore the relationships among organizational EBP culture, implementation leadership, and nurses' EBP competencies and behaviors. Third, despite our efforts to control for a range of factors, there might be additional variables (e.g., experience conducting research) that could impact the outcomes of interest. Fourth, we were unable to determine the exact number of nurses reached by our survey link distributed through WeChat. This lack of information prevented us from calculating the response rate. Therefore, the interpretation and generalization of our results may be affected. However, based on our sampling method, we invited nurses from all 100 units. We collected data from all nurses who consented to join the study and submitted the questionnaire to ensure the representation of nurses. Fifth, although WeChat is widely used in China, we confirmed with the hospital leaders during the data collection process that nurses from the 100 selected departments all use WeChat and can access the survey link through it. However, it is important to note that in some remote areas of China, there may still be a small percentage of nurses who do not use WeChat. The exclusion of nurses who do not use WeChat may introduce bias and limit the generalizability of our findings to this population.

CONCLUSION

Nurses' EBP competencies and behaviors improved alongside the development of EBP implementation in China. Organizational EBP culture and head nurses' implementation leadership were significant predictors of nurses' EBP competencies and behaviors. They also mediated each other's influence on nurses' EBP competencies and behaviors. Future interventions should focus more on nurturing positive organizational EBP culture and enhancing implementation leadership of head nurses to improve nurses' EBP competencies and behavior. Further research could explore the moderate role of participants' or organizational characteristics in the relationship among organizational EBP culture, head nurses' implementation leadership, and clinical nurses' EBP competencies and behaviors.

IMPLICATIONS FOR NURSING MANAGEMENT AND NURSING POLICY

Our study findings highlight the significance of fostering an EBP culture and enhancing head nurses' implementation leadership. These efforts are crucial for developing nurses' EBP competencies and behavior. Head nurses should proactively seek opportunities to enhance their implementation leadership, such as participating in training programs (e.g., mentoring and coaching programs) and attending conferences, workshops, or seminars on implementation leadership.

Nursing organizations should strive to cultivate a positive, evidence‐based culture that supports the growth of head nurses' implementation leadership and nurses' EBP competencies and behavior. This can be achieved by emphasizing the significance of EBP and its impact on patient outcomes through regular communication and by developing policies prompting EBP interventions. An important aspect to consider is conducting pre‐training assessments to understand each nurse's level of EBP competency and individual needs. Such assessments enable the development of personalized training plans, ensuring that the training is targeted and effective.

The International Council of Nurses advocates that nurses incorporate the latest evidence into their practice to enhance care quality and patient outcomes. Many other organizations (e.g., the World Health Organization and the Australian Nursing and Midwifery Board) have also developed policies emphasizing the importance of enhancing nurses' EBP competencies through training. Our research findings suggest that rather than directly focusing on developing nurses' EBP competencies, policymakers should also consider providing more policy support for implementation leadership development and cultivating a positive EBP culture. Examples include supporting research and funding initiatives aimed at strengthening implementation leadership and fostering an EBP culture, as well as developing global guidelines or standards for promoting implementation leadership and cultivating an EBP culture. Finally, establish international, national, or provincial centers dedicated to promoting implementation leadership and EBP culture.

AUTHOR CONTRIBUTIONS

Shuang Hu developed the study design, contributed to manuscript writing, and critically revised the manuscript for important intellectual content. Siying Liu and Xianfeng Li collected and analyzed the data, and contributed to manuscript writing. Junqiang Zhao collected and analyzed the data, and contributed to manuscript writing. Jia Chen contributed to the study design, supervised the study, and critically revised the manuscript for important intellectual content. Wenjun Chen contributed to the study design, supervised the study, and contributed to manuscript writing. Jiale Hu contributed to the study design, manuscript writing, and critically revised the manuscript for important intellectual content.

CONFLICT OF INTEREST STATEMENT

The authors declare that there is no conflict of interest regarding the publication of this paper.

ETHICS APPROVAL AND ETHICAL DESCRIPTION

Ethical approval was obtained from the Research Ethics Board of Xiangya Nursing School, Central South University (No. E202095). Informed consent forms were received from all participants.

Supporting information

Supporting information

INR-72-0-s001.docx (271.8KB, docx)

ACKNOWLEDGMENTS

We are grateful to the nursing directors of participating hospitals for the approval of data collection. We deeply appreciate middle‐level managers who participated in the questionnaire survey. This work was supported by the Hunan Provincial Key Laboratory of Nursing [Grant 2017TP1004] and 2023 Annual Independent Exploration and Innovation Project for Graduate Students at Central South University [Grant 2023ZZTS0836]. The funders had no role in the study design and will not have any role during its execution, analysis, interpretation of the data, decision to publish, or preparation of the manuscript.

Hu, S. , Liu, S. , Li, S. , Zhao, J. , Chen, J. , Chen, W. et al. (2025) Organizational evidence‐based practice culture, implementation leadership, and nurses: A bidirectional mediation model. International Nursing Review, 72, 1–11. 10.1111/inr.13054

Contributor Information

Wenjun Chen, Email: caxynursingcwj@csu.edu.cn.

Jiale Hu, Email: hlxycjia@csu.edu.cn.

DATA AVAILABILITY STATEMENT

The data/transcripts used during the current study are available from the corresponding author upon reasonable request.

REFERENCES

  1. Aarons, G.A. , Ehrhart, M.G. & Farahnak, L.R. (2014) The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership. Implementation Science, 9(1), 45. 10.1186/1748-5908-9-45 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Aarons, G.A. , Ehrhart, M.G. , Moullin, J.C. , Torres, E.M. & Green, A.E. (2017) Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol. Implementation Science, 12(1), 29. 10.1186/s13012-017-0562-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Al‐Busaidi, I.S. , Al Suleimani, S.Z. , Dupo, J.U. , Al Sulaimi, N.K. & Nair, V.G. (2019) Nurses’ knowledge, attitudes, and implementation of evidence‐based practice in Oman: a multi‐institutional, cross‐sectional study. Oman Medical Journal, 34(6), 521–527. 10.5001/omj.2019.95 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Alqahtani, N. , Oh, K.M. , Kitsantas, P. & Rodan, M. (2020) Nurses’ evidence‐based practice knowledge, attitudes and implementation: a cross‐sectional study. Journal of Clinical Nursing, 29(1–2), 274–283. 10.1111/jocn.15097 [DOI] [PubMed] [Google Scholar]
  5. Alqahtani, N. , Oh, K.M. , Kitsantas, P. , Rodan, M. , Innab, A. , Asiri, S. , Kerari, A. , Bin Hayyan, F. , Alharbi, M. & Bahari, G. (2022) Organizational factors associated with evidence‐based practice knowledge, attitudes, and implementation among nurses in Saudi Arabia. International Journal of Environmental Research and Public Health, 19(14), 1–13. 10.3390/ijerph19148407 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bach‐Mortensen, A.M. , Lange, B.C.L. & Montgomery, P. (2018) Barriers and facilitators to implementing evidence‐based interventions among third sector organisations: a systematic review. Implementation Science, 13(103), 1–19. 10.1186/s13012-018-0789-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bianchi, F.P. , Stefanizzi, P. , De Nitto, S. , Larocca, A.M.V. , Germinario, C. & Tafuri, S. (2020) Long‐term immunogenicity of measles vaccine: an Italian retrospective cohort study. Journal of Infectious Diseases, 221(5), 721–728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bianchi, M. , Bagnasco, A. , Bressan, V. , Barisone, M. , Timmins, F. , Rossi, S. , Pellegrini, R. , Aleo, G. & Sasso, L. (2018) A review of the role of nurse leadership in promoting and sustaining evidence‐based practice. Journal of Nursing Management, 26, 918–932. 10.1111/jonm.12638 [DOI] [PubMed] [Google Scholar]
  9. Birken, S.A. , Carolina, U.N. , Hill, C. , Clary, A. , Carolina, U.N. , Hill, C. , Tabriz, A.A. , Carolina, U.N. , Hill, C. , Larson, M. & Minnesota, U. (2018) Middle managers’ role in implementing evidence‐based practices in healthcare: a systematic review. Implementation Science, 13(149), 1–33. 10.1186/s13012-018-0843-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Birken, S.A. , Lee, S.‐Y.D. , Weiner BJ., Chin, M.H. , Chiu, M. & Schaefer, C.T. (2015) From strategy to action: how top managers’ support increases middle managers’ commitment to innovation implementation in healthcare organizations. Health Care Management Review, 40(2), 159–168. 10.1097/HMR.0000000000000018.From [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Castiglione, S.A. (2020) Implementation leadership: a concept analysis. Journal of Nursing Management, 28(1), 94–101. 10.1111/jonm.12899 [DOI] [PubMed] [Google Scholar]
  12. Chen, L. , Wu, Y. , Zhou, C. , Li, X. & Zhao, H. (2020) Value, knowledge and implementation on evidence‐based practice among nurse managers in China: a regional cross‐sectional survey. Journal of Nursing Management, 28(1), 139–147. 10.1111/jonm.12907 [DOI] [PubMed] [Google Scholar]
  13. Chen, W. , Chen, J. , Hu, J. , Zhao, J. , Zhang, J. , He, G. & Gifford, W. (2021) The professional activities of nurse managers in Chinese hospitals: a cross‐sectional survey in Hunan province. Journal of Nursing Management, 29(2), 143–151. 10.1111/jonm.13110 [DOI] [PubMed] [Google Scholar]
  14. Cleary‐Holdforth, J. , Leufer, T. , Baghdadi, N.A. & Almegewly, W. (2022) Organizational culture and readiness for evidence‐based practice in the Kingdom of Saudi Arabia: A pre‐experimental study. Journal of Nursing Management, 30(8), 4560–4568. 10.1111/jonm.13856 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Damschroder, L. , Reardon, C.M. , Widerquist, M.A.O. & Lowery, J.C. (2022) The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17, 75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ehrhart, M.G. , Aarons, G.A. & Farahnak, L.R. (2014) Assessing the organizational context for EBP implementation: the development and validity testing of the Implementation Climate Scale (ICS). Implementation Science, 9, 157. 10.1186/s13012-014-0157-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Elm, E.V , Altman, D.G. , Egger, M. , Pocock, S.J. , Gøtzsche, P.C. & Vandenbroucke, J.P. (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet, 370(9596), 1453–1457. [DOI] [PubMed] [Google Scholar]
  18. Farahnak, L.R. , Ehrhart, M.G. , Torres, E.M. & Aarons, G.A. (2020) The influence of transformational leadership and leader attitudes on subordinate attitudes and implementation success. Journal of Leadership and Organizational Studies, 27(1), 98–111. 10.1177/1548051818824529 [DOI] [Google Scholar]
  19. Finch, J. , Ford, C. , Grainger, L. & Meiser‐Stedman, R. (2020) A systematic review of the clinician related barriers and facilitators to the use of evidence‐informed interventions for post traumatic stress. Journal of Affective Disorders, 263, 175–186. 10.1016/j.jad.2019.11.143 [DOI] [PubMed] [Google Scholar]
  20. Furuki, H. , Sonoda, N. & Morimoto, A. (2023) Factors related to the knowledge and skills of evidence‐based practice among nurses worldwide: a scoping review. Worldviews on Evidence‐Based Nursing, 20(1), 16–26. 10.1111/wvn.12623 [DOI] [PubMed] [Google Scholar]
  21. Gifford, W. , Graham, I.D. , Ehrhart, M.G. , Davies, B.L. & Aarons, G.A. (2017) Ottawa Model of Implementation Leadership and Implementation Leadership Scale: mapping concepts for developing and evaluating theory‐based leadership interventions. Journal of Healthcare Leadership, 9, 15–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Gifford, W. , Squires, J. , Angus, D. , Ashley, L. , Brosseau, L. , Craik, J. , Domecq, M. , Egan, M. , Holyoke, P. , Juergensen, L. , Wallin, L. , Wazni, L. & Graham, I.D. (2018) Managerial leadership for research use in nursing and allied health care professions: a systematic review. Implementation Science, 13(127), 1–23. 10.1186/s13012-018-0817-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Gifford, W. , Zhang, Q. , Chen, S. , Davies, B. , Xie, R. , Wen, S. & Harvey, G. (2018) When east meets west: a qualitative study of barriers and facilitators to evidence‐based practice in Hunan China. BMC Nursing, 17(26), 1–12. 10.1186/s12912-018-0295-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Guerrero, E.G. , Frimpong, J. , Kong, Y. , Fenwick, K. & Aarons, G.A. (2020) Advancing theory on the multilevel role of leadership in the implementation of evidence‐based health care practices. Health Care Management Review, 45(2), 151–161. 10.1097/HMR.0000000000000213 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Guerrero, E.G. , Padwa, H. , Fenwick, K. , Harris, L.M. & Aarons, G.A. (2016) Identifying and ranking implicit leadership strategies to promote evidence‐based practice implementation in addiction health services. Implementation Science, 11(69), 1–13. 10.1186/s13012-016-0438-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Harvey, G. & Kitson, A. (2016) PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice. Implementation Science, 11(1), 1–13. 10.1186/s13012-016-0398-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Hayes, A.F. (2022) Introduction to mediation, moderation, and conditional process analysis: A regression‐based approach (3rd ed.). New York: Guilford Publications Inc. [Google Scholar]
  28. Hu, J. , Gifford, W. , Ruan, H. , Harrison, D. , Li, Q. , Ehrhart, M.G. , Harrison, M.A. , Barrowman, N. & Aarons, G.A. (2021) Validating the Implementation Leadership Scale in Chinese nursing context: a cross‐sectional study. Nursing Open, 8(6), 3420–3429. 10.1002/nop2.888 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Corp I.B.M.. (2017) IBM SPSS Statistics for Windows (Version 25.0). IBM Corp. [Google Scholar]
  30. Juckett, L.A. , Wengerd, L.R. , Faieta, J. & Griffin, C.E. (2020) Evidence‐based practice implementation in stroke rehabilitation: A scoping review of barriers and facilitators. American Journal of Occupational Therapy, 74(1), 1–14. 10.5014/ajot.2020.035485 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Lai, J. , Maher, L. , Li, C. , Zhou, C. , Alelayan, H. , Fu, J. & Wu, Y. (2023) Translation and cross‐cultural adaptation of the National Health Service Sustainability Model to the Chinese healthcare context. BMC Nursing, 22(1), 1–14. 10.1186/s12912-023-01293-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Li, Q. , Hu, J. , Yu, L. , Liu Y. & Yuan, H. (2019) Relationship of head nurses’ leadership in evidence implementation and nurses’ evidence‐based practice ability. Nursing Journal of Chinese PLA, 36(6), 40–43. [Google Scholar]
  33. Li, S.A. , Jeffs, L. , Barwick, M. & Stevens, B. (2018) Organizational contextual features that influence the implementation of evidence‐based practices across healthcare settings: a systematic integrative review. Systematic Reviews, 7(72), 1–19. 10.1186/s13643-018-0734-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Li, X. , Huang, J. & Zhang, H. (2008) An analysis of hospital preparedness capacity for public health emergency in four regions of China: Beijing, Shandong, Guangxi, and Hainan. BMC Public Health, 8, 1–11. 10.1186/1471-2458-8-319 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Liu, W. , Ding, Y. , Man, G. & Zhao, S. (2016) Status quo of evidence‐based practice nursing and its influencing factors among nurse specialist in operating rooms. Chinese Journal of Modern Nursing, 22(6), 839–842. [Google Scholar]
  36. Lunden, A. , Kvist, T. , Teräs, M. & Häggman‐Laitila, A. (2021) Readiness and leadership in evidence‐based practice and knowledge management: a cross‐sectional survey of nurses’ perceptions. Nordic Journal of Nursing Research, 41(4), 187–196. 10.1177/2057158520980687 [DOI] [Google Scholar]
  37. Mao, Q. , Zhao, M. & Zeng, T. (2014) Validation of the Chinese version organizational culture and readiness for system‐wide integration of evidence‐based practice: testing the reliability and validity. Journal of Nursing (Chinese), 29(4), 61–64. [Google Scholar]
  38. Mathieson, A. , Grande, G. & Luker, K. (2018) Strategies, facilitators and barriers to implementation of evidence‐based practice in community nursing: a systematic mixed‐ studies review and qualitative synthesis. Primary Health Care Research & Development, 20(e6), 1–11. 10.1017/S1463423618000488 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. McArthur, A. , Munn, Z. , Lizarondo, L. , Porritt, K. , Stephenson, M. , Stern, C. , Lockwood, C. , Moola, S. , Pearson, A. & Jordan, Z. (2020) The ripple effect of evidence implementation: a descriptive evaluation of JBI's Evidence‐based Clinical Fellowship Program. JBI Evidence Implementation, 19(2), 142–148. 10.1097/XEB.0000000000000258 [DOI] [PubMed] [Google Scholar]
  40. Melnyk, B.M. & Fineout‐Overholt, E. (2022) Evidence‐based practice in nursing and healthcare: A guide to best practice (5th edition). Philadelphia: Lippincott Williams & Wilkins. [Google Scholar]
  41. Melnyk, B.M. , Hsieh, A.P. & Mu, J. (2022) Psychometric properties of the Organizational Culture and Readiness Scale for System‐Wide Integration of Evidence‐Based Practice. Worldviews on Evidence‐Based Nursing, 19(5), 380–387. 10.1111/wvn.12603 [DOI] [PubMed] [Google Scholar]
  42. Melnyk, B.M. , Tan, A. , Hsieh, A.P. & Gallagher‐Ford, L. (2021) Evidence‐based practice culture and mentorship predict EBP implementation, nurse job satisfaction, and intent to stay: aupport for the ARCC© model. Worldviews on Evidence‐Based Nursing, 18(4), 272–281. 10.1111/wvn.12524 [DOI] [PubMed] [Google Scholar]
  43. Metwally, D. , Ruiz‐Palomino, P. , Metwally, M. & Gartzia, L. (2019) How ethical leadership shapes employees’ readiness to change: the mediating role of an organizational culture of effectiveness. Frontiers in Psychology, 10(November), 1–18. 10.3389/fpsyg.2019.02493 [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Nilsen, P. (2015) Making sense of implementation theories, models and frameworks. Implementation Science, 10(1), 1–13. 10.1186/s13012-015-0242-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Nilsen, P. & Bernhardsson, S. (2019) Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Services Research, 19(1), 1–21. 10.1186/s12913-019-4015-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Osei, H.V. , Osei‐Kwame, D. & Osei Amaniampong, L. (2017) The effects of individual mechanisms on work self‐efficacy of nurses: the mediating role of organisational commitment. International Journal of Healthcare Management, 10(4), 219–237. 10.1080/20479700.2016.1268798 [DOI] [Google Scholar]
  47. Peng, L. & Ye, D. (2018) Daily active users for WeChat exceeds 1 billion. People’ Daily. http://tc.people.com.cn/n1/2019/0110/c183008‐30513620.html
  48. Powell, B.J. , Mettert, K.D. , Dorsey, C.N. , Weiner, B.J. , Stanick, C.F. , Lengnick‐Hall, R. , Ehrhart, M.G. , Aarons, G.A. , Barwick, M.A. , Damschroder, L.J. & Lewis, C.C. (2021) Measures of organizational culture, organizational climate, and implementation climate in behavioral health: a systematic review. Implementation Research and Practice, 2, 1–29. 10.1177/26334895211018862 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Rodríguez‐Pérez, M. , Mena‐Navarro, F. , Domínguez‐Pichardo, A. & Teresa‐Morales, C. (2022) Current social perception of and value attached to nursing professionals’ competences: an integrative review. International Journal of Environmental Research and Public Health, 19(3), 1–19. 10.3390/ijerph19031817 [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Shuman, C. (2017) Addressing the practice context in evidence‐based practice implementation: Leadership and climate (Doctoral dissertation). Ann Arbor: University of Michigan. [Google Scholar]
  51. Shuman, C.J. , Ehrhart, M.G. , Torres, E.M. , Veliz, P. , Kath, L.M. , VanAntwerp, K. , Banaszak‐Holl, J. , Titler, M.G. & Aarons, G.A. (2020) EBP Implementation Leadership of Frontline Nurse Managers: Validation of the Implementation Leadership Scale in Acute Care. Worldviews on Evidence‐Based Nursing, 17(1), 82–91. 10.1111/wvn.12402 [DOI] [PubMed] [Google Scholar]
  52. Shuman, C.J. , Liu, X. , Aebersold, M.L. , Tschannen, D. , Banaszak‐Holl, J. & Titler, M.G. (2018) Associations among unit leadership and unit climates for implementation in acute care: A cross‐sectional study. Implementation Science, 13(62), 1–10. 10.1186/s13012-018-0753-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Upton, D. & Upton, P. (2006) Development of an evidence‐based practice questionnaire for nurses. Journal of Advanced Nursing, 53(4), 454–458. 10.1111/j.1365-2648.2006.03739.x [DOI] [PubMed] [Google Scholar]
  54. Wang, H. (2022) Decoding Wenjuan Star—The Growth Path of the Survey Industry “Unicorn.” China Economic Network. Accessed October 15, 2024. Available at: http://www.cctvjingji.com/part‐117/3013.html
  55. Williams, N.J. , Wolk, C.B. , Becker‐Haimes, E.M. & Beidas, R.S. (2020) Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence‐based practice: a 5‐year panel analysis. Implementation Science, 15(1), 1–15. 10.1186/s13012-020-0970-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Williamson, K.M. , Almaskari, M. , Lester, Z. & Maguire, D. (2015) Utilization of evidence‐based practice knowledge, attitude, and skill of clinical nurses in the planning of professional development programming. Journal for Nurses in Professional Development, 31(2), 73–80. 10.1097/NND.0000000000000140 [DOI] [PubMed] [Google Scholar]
  57. Yang, R. (2010) The Preliminary Revision and Application ofthe Evidence‐Based Practice Questionnaire and the Developing Evidence‐Based Practice Questionnaire. Central South University. [Google Scholar]
  58. Yoo, J.Y. , Kim, J.H. , Kim, J.S. , Kim, H.L. & Ki, J.S. (2019) Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence‐based practice: The first step to creating an evidence‐based practice culture. PLoS ONE, 14(12), 1–15. 10.1371/journal.pone.0226742 [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Zhang, Y. , Wang, W. & He, X. (2023) Impact of nurse manager's implementation leadership on pediatric oncology nurses’ evidence‐based nursing beliefs: the mediating role of evidence‐based practice work environment. Chinese Journal of Nursing Management, 23(6), 1–5. [Google Scholar]
  60. Zhao, J. , Bai, W. , Zhang, Q. , Su, Y. , Wang, J. , Du, X. , Zhou, Y. , Kong, C. , Qing, Y. , Gong, S. , Meng, M. , Wei, C. , Li, D. , Wu, J. , Li, X. , Chen, W. & Hu, J. (2022) Evidence‐based practice implementation in healthcare in China: A living scoping review. Lancet Regional Health ‐ Western Pacific, 20(100355), 1–15. 10.1016/j.lanwpc.2021.100355 [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Zhou, Y. , Huang, N. , Hu, Y. , Xing, W. & Zhu, Z. (2020) Studies on evidence implementation in clinical nursing practice in China: a scoping review. Chinese Journal of Nursing Management, 20(4), 513–518. [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supporting information

INR-72-0-s001.docx (271.8KB, docx)

Data Availability Statement

The data/transcripts used during the current study are available from the corresponding author upon reasonable request.

Articles from International Nursing Review are provided here courtesy of Wiley

RESOURCES