Examining the competence status of nurses in evidence-based practices and the influencing factors: a multicenter study in Turkey

Abstract

Background

Evidence-based practices (EBP) are implemented at different levels in various countries around the world. It is known that no quantitative research has been conducted in Turkey to determine the implementation status of EBP in clinical settings, which does not have a distant past. This study may be the first known study conducted in Turkey on EBP in the clinical field.

Aim

The aim of this study is to evaluate nurses’ competencies in EBP and to investigate the demographic, educational and institutional factors affecting their practice.

Method

This study, planned as a cross-sectional and descriptive study, was completed with the participation of 482 nurses who interacted with patients one-on-one and worked in clinics in three separate hospitals, two private and one state. Data were collected online between September 20, 2023 and April 5, 2024 with the Nurse Identifier Form and the Evidence-Based Practice Questionnaire (EBPQ). The data collected with the online survey method was analyzed using the IBM SPSS Statistics23.0 program. The data were analyzed using number, percentage, standard deviation, minimum, maximum, one-way analysis of variance (ANOVA), Tukey’s test to test which group the significance originated from, Student’s t-test and multiple regression tests. The significance level was taken as p < 0.05.

Results

Nurses scored 118.65 ± 19.22 out of 154 points in EBPQ. They scored 30.87 ± 0.08 (range: 6–42) in the application sub-dimension and 87.74 ± 13.99 (range: 47–112) in the knowledge and attitude sub-dimension. It was found that having worked for two or more years in the unit where the nurses continue their duties was effective in increasing their competence. In the EBPQ application sub-dimension, it was found that young, single, with undergraduate and graduate education levels and two or more years of professional experience in the clinic where they were continuing their duties were more competent in practice than others.

Implications for practice

Implementing EBP is essential for improving patient care quality. EBP helps standardize practices, enhance care quality, reduce costs, and optimize patient outcomes. This study highlights the importance of increasing clinical nurses’ education levels, ensuring consistency in unit assignments, and minimizing frequent rotations to enhance nurses’ EBP competence. Healthcare institutions should provide up-to-date training and resources to facilitate EBP adoption and improve care quality.

Clinical trial number

not applicable.

Introduction

Evidence-based practices (EBP), known as a problem-solving method in clinical practices, are professional initiatives that take into account patient preferences and values. It also means using the most up-to-date information to answer questions about care [1, 2]. EBP have some goals such as eliminating practice differences, increasing the quality of care, reducing costs, and improving patient outcomes [3]. EBP includes the stages of correctly identifying the clinical problem, collecting reliable evidence, critically evaluating the evidence, considering patient conditions and preferences, and deciding on implementation [4, 5]. In order for EBP to be permanent and to ensure continuity in the relevant clinic, this information should be shared with other nurses in the clinic [5]. Nurses’ knowledge and skills in EBP are effective in the planning and implementation of these practices [6]. The level of education, access to articles, reading, access to computers in the workplace and institutional support provide a positive increase in the level of knowledge, attitude and behavior in the use of EBP [2]. Many factors are known to prevent nurses from implementing evidence-based practice. Some of these barriers include the lack of a standard and guide for teaching evidence-based practice in academia [7], nurses not being open to innovation, prejudice related to not having enough knowledge on the subject, clinical nurses not having managers who can be role models and support them, or managers not having enough knowledge on the subject [8–10]. In addition, it is known that nurses have obstacles such as time, obstacles in information and communication technologies, and lack of resources regarding EBP [2, 11, 12]. These obstacles indicate that EBPs are still in the development phase in Turkey, both in clinical practice and in education, and that in addition to the problems identified in the international literature, there are contextual differences specific to our country (such as the lack of a standard education style for EBP in undergraduate nursing education) [7, 13]. At this point, the current status of nurses’ knowledge, attitudes and behaviors may be an important indicator to more closely evaluate the impact of these structural differences on EBPs.

Since evidence-based practices are closely related to the knowledge, attitudes and behaviors of nurses, it is reported that evaluating the knowledge, attitudes and behaviors of nurses is the most ideal way to understand evidence-based practice problems [2]. The aim of this study is to evaluate nurses’ competencies in EBP and to investigate the demographic, educational and institutional factors affecting their practice. This study provides an original contribution to the literature as the first known quantitative study evaluating EBP competence in clinical settings in Turkey and conducted with a large sample from multiple institutions.

Methods

Type of the study

This study was planned as multicenter, cross-sectional and descriptive.

Universe and sample of the study

The data for this study were collected between September 20, 2023 and April 5, 2024. Nurses working in clinics providing direct care to patients in three hospitals, two private (Private Hospital 1: 58 nurses, Private Hospital 2: 34 nurses) and one state hospital (State Hospital A: 495 nurses) in two different provinces, between the dates when the data were collected constitute the universe of the study (N = 587). The sample size in this study was calculated according to the known universe sampling method. Considering the number of nurses working in the three hospitals (N = 587), it was concluded that a minimum sample of 232 people would be sufficient with a 95% confidence level and a 5% margin of error. The participation rate in the study was 82.11% and it was completed with 482 nurses. In the state hospital, the general intensive care area is determined by the hospital management, and there is a distribution according to applications within this area (for example; cardiology intensive care, cardiovascular surgery intensive care, pediatric intensive care, neonatal intensive care, etc.). Therefore, the number of nurses working here may be equal to or more than the number of nurses working in other units.

Inclusion and exclusion criteria

Inclusion criteria include; declaring in writing that being willingly participate in the study and being a nurse providing direct care to patients in the clinics of the relevant hospitals. Reasons for exclusion from the study included not being in the groups where the survey link was shared, having internet connection problems, not being able to provide direct care to patients due to their managerial duties, and completing the survey incompletely.

Data collection tools and implementation

The data collection form was prepared in a digital environment and data was collected between September 20, 2023 and April 5, 2024. The nurse managers of private hospitals were contacted and an online survey was sent to the nurses working in the departments through the nurse managers. In the state hospital, the researcher shared the survey link with the head nurses of departments and the unit managers sent it to the nurses working in the clinic. Filling out the data form took an average of 8 min. An online survey method was preferred due to ease of access to participants across different hospitals, time efficiency, and cost-effectiveness. Although direct contact information was not included in the form, the researcher’s full name and institutional affiliation were clearly provided, making it possible for participants to reach out if needed. To minimize potential misunderstandings or incomplete responses, clear instructions were given at the beginning of the survey regarding the study’s aim, voluntary participation, confidentiality, and the importance of answering all questions.

Nurse Identification Form: Prepared by the researcher in line with the literature. It consists of eight questions that include the socio-demographic and professional characteristics of the nurses data of the nurses participating in the study (age, gender, marital status, educational status, years of work in the profession and the years of work in the unit assigned, current department and the number of patients given daily care) [1, 14, 15].

Evidence-Based Practice Questionnaire (EBPQ): The questionnaire was developed by Upton and Upton to assess the competence of nurses in evidence-based practices. The original scale consists of 24 items and three sub-dimensions [5]. The questionnaire, whose Turkish validity and reliability study was conducted by Çakı et al.; It consists of two sub-dimensions, Knowledge and Attitude (16 items) and Practice (6 items), and 22 items. Each item of the questionnaire, which was developed in likert type, is scored as 1–7 (1-weak, 7-very good). The lowest possible score from the questionnaire is 22 and the highest score is 154. A high score from the questionnaire indicates a more positive attitude towards clinical effectiveness, evidence-based practice and high knowledge of clinical effectiveness [16]. The cronbach alpha value of the questionnaire was stated as 0.963 in the validity and reliability study [16]. In the present study, the reliability analysis yielded Cronbach’s alpha coefficients of 0.914 for the practice subscale, 0.921 for the knowledge and attitude subscale, and 0.928 for the overall scale, indicating a high level of internal consistency. There is no reverse coding in the questionnaire.

Data analysis

The data collected with the online survey method was analyzed using the IBM SPSS Statistics 23.0 program. The Kolmogrov-Smirnov test was used to evaluate whether the data met the prerequisite for normal distribution. The data were analyzed using number, percentage, standard deviation, minimum, maximum, one-way analysis of variance (ANOVA), Tukey’s test to test which group the significance originated from, Student’s t-test and multiple regression tests. The significance level was taken as p < 0.05.

Ethics approval and consent to participate

Permission was obtained from the T.C. Kilis 7 Aralik University Non-Interventional Ethics Committee (Date and Number: 04 September 2023- E-76062934-044-32870), and permission was also obtained from the institution where the study was conducted. “Questionnaire use permission” was obtained via e-mail from the authors who adapted the questionnaire into Turkish. In addition, all participants were informed about the study, and informed written consent was obtained from nurses who wanted to participate in the study. This study was conducted in accordance with the Declaration of Helsinki.

Supplementary material description

No review records were performed for this study. This study followed a checklist Strengthening the Reporting of Observational studies in Epidemiology (STROBE) designed to clarify what is planned and implemented in observational studies [17].

Results

Of the nurses participating in the study, 67.4% were female, 38.6% were between the ages of 25–28, 64.7% were single, 69.7% had a bachelor’s degree or higher, and 69.9% had 0–5 years of professional experience. 50.6% of the nurses were currently working in the clinic where they worked, 49.4% were working in emergency and intensive care units, and 33.6% of the nurses reported that the number of patients they cared for in a day was 8 eight or more (Table 1).

Table 1.

Socio-demographic and professional characteristics of the nurses

Socio-demographic data	n	%
Gender
Female	325	67.4
Male	157	32.6
Age (mean ± sd: 27 ± 5.68; min:19, max:58)
24 years and below	163	33.8
25–28 years	186	38.6
29 years and above	133	27.6
Marital status
Married	170	35.3
Single	312	64.7
Educational Status
High School	72	14.9
Associate Degree	74	15.4
Undergraduate	330	68.5
Postgraduate	6	1.1
How many years have you been working in the profession?
0–5 years	337	69.9
6 years and above	145	30.1
How many years have you been working in the unit where you are assigned? (mean ± sd: 2 ± 83; min:1, max:26)
0–1 year	238	49.4
2 years and above	244	50.6
Current Department
Internal Medicine	86	17.8
Surgery	64	13.3
Other departments (palliative care, gynecology, cardiology-neurology etc.)	94	19.5
Emergency and intensive care department	238	49.4
Number of patients a nurse provides daily care (mean ± sd:15 ± 65; min:1, max:100)
1 or 2	159	33.0
3 to 7	161	33.4
8 and above	162	33.6

The total score of the nurses’ EBPQ application sub-dimension was found to be 30.87 ± 0.08 (min-max:6–42). In the application sub-dimension of the questionnaire, nurses aged 24 and under received significantly higher scores than nurses aged 29 and over (F = 3.44, P = 0.03); single nurses received significantly higher scores than married nurses (T=-2.11, P = 0.03); nurses with undergraduate and graduate degrees received significantly higher scores than nurses with associate degrees (F = 5.89, P = 0.003), and nurses with two years or more professional experience received significantly higher scores than nurses with one year or less professional experience (T:-2.28, P:0.02) (p < 0.05). It was observed that there was no significant difference in terms of the EBPQ application sub-dimension and other demographic data (p > 0.05) (Table 2). The total score of the nurses’ EBPQ attitude and knowledge sub-dimension was calculated as 87.74 ± 13.99 (min-max:47–112). It was observed that nurses with 2 years or more professional experience had significantly higher scores (T=-2.35, P = 0.01) than nurses with 1 year or less professional experience in the attitude and knowledge sub-dimension of the questionnaire (Table 2). The total score of the nurses on the EBPQ was calculated as 118 − 65 ± 19.22 (min-max:61–154). It was observed that nurses with 2 years or more professional experience had significantly higher scores (T=-2.63, P = 0.001) than nurses with 1 year or less professional experience in the attitude and knowledge sub-dimension of the questionnaire (Table 2).

Table 2.

Distribution and comparison of participants’ mean scores in EBPQ sub-dimensions and total scores according to some demographic characteristics

Demographic Variables	n	%	Practice	Attitude and Knowledge	Total
			±SD	±SD	±SD
Gender
Female	325	67.4	30.71 ± 8.01	88.25 ± 13.49	119.03 ± 18.26
Male	157	32.6	31.18 ± 8.23	86.67 ± 14.96	117.87 ± 21.09
			T:-0.0616 P:0.53	T:1.16 P:0.24	T:0.61 P:0.53
Age (±SD) (27 ± 5.68)
24 years and below	163	33.8	31.74 ± 7.51	86.88 ± 14.00	118.74 ± 19.41
25–28 years	186	38.6	31.18 ± 7.55	87.48 ± 13.53	118.67 ± 18.05
29 years and above	133	27.6	29.36 ± 9.24	89.15 ± 14.59	118.51 ± 20.66
			F:3.44 P:0.03*	F:0.01 P:0.36	F:0.005 P:0.99
Marital Status
Married	170	35.3	29.75 ± 9.04	88.90 ± 13.90	118.66 ± 19.19
Single	312	64.7	31.47 ± 7.45	87.10 ± 14.02	118.65 ± 19.26
			T:-2.11 P:0.03*	T:1.34 P:0.17	T:0.01 P:0.99
Educational Status
High School	72	14.9	29.81 ± 8.82	88.80 ± 16.65	118.62 ± 22.49
Associate Degree	74	15.4	28.35 ± 9.20	85.39 ± 15.26	113.74 ± 19.66
Undergraduate and Postgraduatea	336	69.7	31.65 ± 7.52	88.03 ± 13.03	119.74 ± 18.23
			F:5.89 P:0.003**	F:1.32 P:0.26	F:2.97 P:0.052
How many years have you been working in the profession?
0–5 years	337	69.9	31.22 ± 7.85	87.17 ± 13.75	118.44 ± 18.68
6 years and above	145	30.1	30.05 ± 8.56	89.06 ± 14.49	119.12 ± 20.47
			F:1.45 P:0.14	F:-1.36 P:0.17	F:-0.35 P:0.72
How many years have you been working in the unit where you are assigned? (mean ± sd: 2 ± 83; min:1. max:26)
0–1 year	238	49.4	30.02 ± 8.33	86.23 ± 13.86	116.32 ± 18.37
2 years and above	244	50.6	31.69 ± 7.76	89.21 ± 13.99	120.91 ± 19.78
			T:-2.28 P:0.02*	T:-2.35 P:0.01*	T:-2.63 P:0.001**
Current Department
Internal Medicine	86	17.8	30.45 ± 8.32	87.36 ± 12.65	117.81 ± 16.89
Surgery	64	13.3	30.18 ± 8.43	87.92 ± 12.36	118.10 ± 17.77
Other units (palliative, gynecology, cardiology-neurology etc.)	94	19.5	30.11 ± 8.43	87.73 ± 16.21	118.05 ± 21.24
Emergency and intensive care	238	49.4	31.50 ± 7.75	87.83 ± 13.99	119.33 ± 19.64
			F:0.97 P:0.40	F:0.02 P:0.99	F:0.20 P:0.89
Number of patients a nurse provides daily care (mean ± sd:15 ± 65; min:1, max:100)
1 or 2	159	33.0	31.29 ± 7.17	87.30 ± 13.69	118.59 ± 18.64
3 to 7	161	33.4	30.17 ± 8.59	86.92 ± 13.39	117.21 ± 18.61
8 and above	162	33.6	31.14 ± 8.40	88.98 ± 14.83	120.12 ± 20.35
			F:0.90 P:0.40	F:0.99 P:0.37	F:0.92 P:0.39
Total	482	100	30.87 ± 0.08 min-max:6–42	87.74 ± 13.99 min-max:47–112	118.65 ± 19.22 min-max:61–154

^aSix people have postgraduate education. *p < 0.05 and **p < 0.01

Table 3 shows the effects of demographic variables on practice, attitude and knowledge and the total questionnaire. It is observed that demographic data explains 4% of the variance on the application sub-dimension (Adjusted R Square: 0.04), 0.5% of the variance on the attitude and knowledge sub-dimension total score (Adjusted R Square: 0.005) and 1% of the variance on the scale total score (Adjusted R Square: 0.010). It was seen that age, education level and years of working in the unit had an effect on the practice sub-dimension. It was found that the duration of working in the unit was the only effective demographic data on the total questionnaire.

Table 3.

Multiple regression

Sociodemographic Characteristics	Practice		Attitude and Knowledge		Total
	β	p	β	p	Β	p
Gender	0.027	0.55	-0.072	0.12	-0.042	0.371
Age	-0.176	0.01*	0.002	0.98	-0.075	0.283
Marital Status	0.037	0.51	-0.041	0.46	-0.014	0.800
Educational Status	0.129	0.00**	0.028	0.54	0.076	0.107
Years of Working in the Profession	0.043	0.49	0.016	0.80	0.030	0.630
Years of Service in the Unit	0.173	0.00**	0.108	0.02*	0.150	0.002**
Clinical	0.021	0.65	0.025	0.60	0.026	0.578
Number of Patients	0.018	0.69	0.043	0.35	0.039	0.401

*p < 0.05 and **p < 0.01

Discussion

The aim of this study is to evaluate nurses’ competencies in EBP and to investigate the demographic, educational and institutional factors affecting their practice. As a result of study it was concluded that nurses scored above the average in EBP, and that working for two years or more in the unit where they continue to work was effective in increasing their competence status.

In the application sub-dimension of EBPQ, it was found that nurses who were young, single, had undergraduate and graduate education levels, and had two years or more professional experience in the clinic where they continue to work were more competent in practice than others. In this study, the EBP application status of nurses was calculated as 30.87 out of 42 points. In the study conducted by Yoo et al., this rate was 15 out of 72 points [10]. While the EBP application status was reported as 18.9 in the study of Melnyk et al. [8]; it was reported as 33.07 out of 72 points in the study of Kang and Yang [18]. The fact that this study result is higher than other study results may be related to the age group. Because in other studies, the average age of the nurses participating in the study is higher than the average age of the nurses participating in this study [8, 10, 18]. The fact that young nurses are equipped with up-to-date knowledge and possess high professional motivation may explain their faster adaptation to evidence-based practices. At this point, strengthening institutional support mechanisms is crucial to maintain the advantages of nurses at the beginning of their careers. As it is known, the scores obtained from the application sub-dimension of the EBP decrease as age increases [10]. In addition to the existing information, this situation may be due to the desire of the nurses who are new to the profession, whose evidence-based practice knowledge is new, to put their knowledge into practice. The nurses participating in the study received 118.65 ± 19.22 points out of 154 points for EBP competence. In the study conducted by Yoo et al., it was reported that it was 52.5 ± 11.1 out of 98 [10]. In the study conducted by Melnyk et al., it was reported as 53.5 ± 16.1 [8]. In the study conducted by Cleary-Holdforth et al., the evidence-based practice status of clinical nurses was reported as 12.85 out of 72 points [19]. The findings indicate that evidence-based practice is adopted more actively in our study group’s nursing practice. This may be attributed to the positive effects of factors such as educational level and clinical experience. The results of this study reported relatively better results compared to the studies in the literature. This may be due to the fact that our study group was younger than the sample group of other studies. However, it is known that the history of EBP is new in the world and even newer in Turkey [7, 13, 16]. Some studies conducted in Turkey have reported that there are not enough studies on evidence-based practices [20, 21]. Of course, this score obtained from the questionnaire cannot be considered sufficient. However; the fact that the history of EBP dates back to a recent history can be evaluated as a clear indicator that there is interest in evidence-based practices both in academia and among clinical nurses in our country and that it will gain momentum throughout the country [7, 13]. The fact that the number of participants in this study was higher than the literature, that nurses working in all departments were included, and that the study was conducted in different cities and three hospitals increases the generalizability of the findings and is also thought to make a significant contribution to the literature [15, 16, 21, 22]. Moreover, the large sample size and multicenter design of this study provide a realistic overview of the current status of evidence-based practice in Turkey and shed light on future intervention programs.

It is known that there is a relationship between age and EBP. In the study conducted by Yoo et al., it was reported that knowledge of evidence-based practice increases with age; however, practice status does not change with age [10]. In some other studies, evidence-based practice status of younger nurses was reported to be significantly higher than others [8, 19]. In this study, the EBP competencies of younger nurses increase. This situation may be explained by the fact that the EBP history is new and information about EBP is provided in undergraduate and graduate education, and the higher scores obtained in younger individuals. However, while knowledge and attitude scores increase as age increases, practice scores decrease significantly. While this increase in knowledge can be explained by the high number of cases encountered, it is thought that the decrease in practice may be due to the complexity of family life, the increase in the responsibility of social life, the increase in physical and mental fatigue, and the lack of updating of information as age increases [23]. In addition, as age increases, professional experience increases and practice status decreases, which may be related to compassion fatigue [24] or burnout and increased mental workload. It has also been stated in previous studies that factors such as excessive workload, burnout or compassion fatigue in the work environment may negatively affect nurses’ attitudes towards EBPs [24–26]. The findings of this study support that young nurses have a strong motivation to translate theoretical knowledge into practice, while signs of professional burnout emerging with age may overshadow practical competencies. In this respect, it is important to develop training programs that leverage the experience of senior nurses while also supporting their adaptation to current practices.

Studies have reported that education status is effective in the implementation of evidence-based nursing practices [8, 10, 19, 27, 28]. In some studies, it has been reported that education is not effective in evidence-based practices [1, 18]. Yoo et al. reported in their study that there is a direct relationship between nurses’ knowledge levels and EBP implementation [10]. In our study, it was seen that the level of education and evidence-based practices were effective in the application sub-dimension. We can say that this situation is due to the effect of knowledge on application. Indeed, as a result of the advanced examination made in the analysis of the study, it was seen that knowledge had a direct effect on application as well as an indirect effect (through attitude). At the same time, it was seen that knowledge had an effect on attitude. It can be recommended that health institutions and nurse managers organize and encourage the participation of clinical nurses in in-service training, seminars and other activities outside the institution in order to improve their knowledge and attitudes about evidence-based practice. Nurses with high school and associate degree education levels should be encouraged to complete their bachelor’s degree, and bachelor’s degree graduates should be encouraged to complete their master’s degree. At the same time, nurse managers should be supported in planning and conducting scientific studies on the subject [29]. These findings indicate that education is an important determinant for both the knowledge and practice dimensions. Therefore, it may be recommended to strengthen EBP-focused modules in nursing curricula and to make continuous post-graduation training programs mandatory.

In this study, it is observed that the total scores of the EBPQ and its sub-dimensions increase with the extension of the working period in the unit where the duty is continued. According to this not surprising result, seeing similar cases in the same clinic and producing solutions according to the problems encountered in the cases may have contributed to the use of evidence-based practices and may have improved nurses individually in terms of EBP. At the same time, the communication dynamics and experience sharing among nurses in clinics may have increased individual development in terms of EBP [23]. In order to contribute to the development of evidence-based practices, instead of assigning nurses to clinics temporarily, assigning them to clinics permanently and in clinics suitable for their area of ​​expertise will contribute to both the individual development of the nurse, the increase in the quality of care provided to the patient receiving care, and the improvement of the institution’s own image. In addition, planning and implementing information sharing sessions on sample cases and approaches to cases among nurse groups in clinics can contribute to the individual development of nurses in terms of EBP. Because it does not seem possible to sustain EBP without a suitable environment and institutional culture that supports EBP [23, 30, 31].

In some studies in the literature, it is reported that the biggest obstacle to nurses’ evidence-based practice studies is workload [1, 10, 32]. As a result of this study, no significant difference was observed between the groups in terms of the number of patients receiving care and therefore workload. It was even observed that the total questionnaire score of nurses with a large number of patients was higher than the others. Although this finding seems to contradict studies suggesting that workload is an obstacle to evidence-based practice, the reasons underlying this contradiction cannot be determined with certainty. One possible explanation is that nurses working in departments with increased workload may have more developed stress coping skills (psychological resilience). Such individuals may continue evidence-based practice despite increased workload. Nurses working with increased workload may have been more careful and conscious because they had to focus more on their work. On the other hand, the fact that the measurement tool used was self-reporting may have led to measurement bias and nurses may have reported their own performances by perceiving them higher than they actually were. Therefore, further research is needed to determine the reasons for this finding. The limited number of studies on EBP in Turkey, the multicenter design of this study, the large sample size, and the comprehensive analysis of nurses’ demographic characteristics in relation to their EBP competence make this study a unique and valuable contribution to the field. These results are considered open to different interpretations. Moreover, this finding highlights the need to evaluate nurses’ subjective assessments together with objective workload measures. Future studies examining the impact of workload on EBP practices using both quantitative and qualitative data will provide stronger evidence for policymakers.

In this study, the explanatory power of the regression model is limited (Adjusted R² = 0.04). This finding shows that demographic values alone may be insufficient to explain nurses’ evidence-based practice competencies and that organizational, professional or attitudinal factors should also be taken into account.

In conclusion, the findings of this study indicate that improving nurses’ evidence-based practice competencies requires focusing not only on demographic factors but also on institutional support mechanisms, motivation-enhancing strategies, and improvements in the work environment.

Conclusion and recommendations

The aim of this study is to evaluate nurses’ competencies in EBP and to investigate the demographic, educational and institutional factors affecting their practice. As a result of study it was concluded that nurses scored above the average in EBP, and that working for two years or more in the unit where they continue to work was effective in increasing their competence status.

1. Nurses demonstrate above-average proficiency in EBP, highlighting the effectiveness of current training and professional standards.

2. Professional experience (≥ 2 years in the same unit) significantly enhances EBP competence, underlining the importance of continuty in clinical practice.

3. Higher levels education are strongly correlated with increased knowledge and application of EBP, emphasizing the need for advanced academic preparation.

4. Healthcare institutions should prioritize stable employment assignments. For the sustainability of evidence-based practices, it is recommended that structured professional development programs be supported by concrete formats, especially in-service training, workshops, clinical guideline reading groups, and case discussion sessions focused on evidence-based practice.

5. Institutional adoption of KDU in our country should be considered as a priority requirement in order to increase the quality of nursing care. Policies and administrative regulations are needed to ensure systematic implementation of KDU in health institutions.

6. The higher EBP scores of nurses with a high patient volume may be due to the fact that they encounter more cases in their clinical decision-making processes and therefore need to refer to current information more frequently. In this context, facilitating institutional access to electronic databases (such as Ulakbim, PubMed, Cochrane Library) that will provide nurses working in healthcare institutions with rapid access to current evidence may increase the quality of practices.

Limitations of the study

Since the EBPQ is a self-reporting, the results may have been exaggerated or underestimated. The results are limited to the clinical nurses of the three hospitals that constitute the universe of the study, and therefore the results can only be generalized to this group. Hospitals’ work policies, educational support, and management approaches may have different effects on nurses’ EBP practices. Since institutional support levels or health policies vary between countries, this may affect the interpretation of the results. The content, duration, and effectiveness of the EBP training received by nurses may vary. No detailed analysis was made on how it was structured in the study. It may be recommended that the training methodology and content be evaluated more systematically in similar studies to be conducted on EBP. Working time alone may not be sufficient for EBP competence. It may be recommended that different training programs, working environments, and individual learning processes be evaluated together with working time. In this study, inhibitory factors such as time constraints affecting nurses’ attitudes towards evidence-based practices could not be examined in depth with qualitative data. Therefore, the findings were limited to quantitative evaluations only.

Author contributions

G.Y: He has completed all stages of the study.

Funding

The author did not receive funding from any institution or organization during this study.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Permission was obtained from the T.C. Kilis 7 Aralik University Non-Interventional Ethics Committee (Date and Number: 04 September 2023- E-76062934-044-32870), and permission was also obtained from the institution where the study was conducted. “Questionnaire use permission” was obtained via e-mail from the authors who adapted the questionnaire into Turkish. In addition, all participants were informed about the study, and informed written consent was obtained from nurses who wanted to participate in the study. This study was conducted in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.