An-Najah National University 

Faculty of Graduate Studies 

 
NURSES' PERCEPTIONS OF KNOWLEDGE, 

PRACTICE, ATTITUDES, AND PERCEIVED 

BARRIERS TOWARDS EVIDENCE-BASED 

PRACTICE (EBP) IN NABLUS CITY 

HOSPITALS 

 

 

By 

Tamara Raheeb Yassin 

 

 

Supervisor 

Dr. Suha Hamshari 
 

 

This Thesis is Submitted in Partial Fulfillment of the Requirements for the Degree of 

Master Public Health Management, Faculty of Graduate Studies, An-Najah National 

University, Nablus - Palestine. 

2024 



II 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

NURSES' PERCEPTIONS OF KNOWLEDGE, 

PRACTICE, ATTITUDES, AND PERCEIVED 

BARRIERS TOWARDS EVIDENCE-BASED 

PRACTICE (EBP) IN NABLUS CITY 

HOSPITALS 

By  

Tamara Raheeb Yassin 

 

 

This Thesis was Defended Successfully on 09/10/2024 and approved by 

Dr. Suha Hamshari 

Supervisor 

 

Signature 

Dr. Basma Salameh 

External Examiner 

 

Signature 

Dr. Aidah Alkaissi 

Internal Examiner 

 

Signature 



III 

 

Dedication 

This thesis is dedicated to my family, whose unwavering support and 

encouragement have been the foundation of my journey. Their love and belief in 

me have inspired every step of this work. 

. 

  



IV 

 

Acknowledgements 

First, I give all the glory to God, the source of my strength, for granting me both 

the mental and physical endurance to complete this monumental task. Then, I 

would like to Thank all participant that has been spending their time and 

knowledge to helping me for completion of our study. 

Also I would like to thank all of these hospitals Rafidia, Al-Watani Governmental 

and An-Najah National University hospital, Al-Arabi and Nablus Non-

Govermental Hospitals for their cooperation and leniency during the distribution 

of questionnaires which enabled us to finish the study without any obstacles. 

To Dr. Suha Hammshari my advisor, I extend special thanks and gratitude to you 

for your assistance, encouragement, and support. And to Dr. Hamzeh Al-Zabadi 

and thank you for believing in me and for your constant support and 

encouragement throughout this project. 

Thanks to my entire family, especially my loving mom, for her love, 

understanding, and support. 

To my father, may God have mercy on him, I know you proud of me now. 

To everyone who gave me the financial and moral support for the completion of 

this task, Thank you 

. 



V 

 

Declaration 

I, the undersigned, declare that I submitted the thesis entitled: 

NURSES' PERCEPTIONS OF KNOWLEDGE, PRACTICE, ATTITUDES, AND 

PERCEIVED BARRIERS TOWARDS EVIDENCE-BASED PRACTICE (EBP) 

IN NABLUS CITY HOSPITALS 

 

I declare that the work provided in this thesis, unless otherwise referenced, is the 

researcher’s own work, and has not been submitted elsewhere for any other degree or 

qualification. 

 

Tamara Raheeb Yassin Student's Name:  

Tamara Yassin Signature: 

09/10/2024 Date: 

 

 

 

 

 

 

 

 

 

 

 

 



VI 

 

List of Contents 
Dedication ....................................................................................................................... III 

Acknowledgements ......................................................................................................... IV 

Declaration ....................................................................................................................... V 

List of Contents ............................................................................................................... VI 

List of Tables ............................................................................................................... VIII 

List of Appendices .......................................................................................................... IX 

Chapter One: Introduction ................................................................................................ 1 

1.1 Background ................................................................................................................ 1 

1.2 Literature review ........................................................................................................ 4 

1.3 Problem statement ..................................................................................................... 7 

1.4 Objectives .................................................................................................................. 8 

1.5 Significance of the study ........................................................................................... 9 

1.6 Research questions ..................................................................................................... 9 

1.7 Hypothesis ............................................................................................................... 10 

Chapter Two: Materials and Methods ............................................................................ 11 

2.1 Design of study ........................................................................................................ 11 

2.2 Study site and setting ............................................................................................... 11 

2.3 Population of study .................................................................................................. 11 

2.4 Study sample and sampling technique ..................................................................... 11 

2.5 Inclusion and exclusion criteria ............................................................................... 13 

2.5.1 Inclusion criteria .................................................................................................... 13 

2.5.2 Exclusion criteria ................................................................................................... 13 

2.6 Study Instrument, validity and reliability ................................................................ 13 

2.7 Study variable (the independent and dependent variables) ..................................... 16 

2.7.1 Independent variables ............................................................................................ 16 

2.7.2 Dependent variables .............................................................................................. 16 

2.8 Procedures ................................................................................................................ 16 

2.9 Statistical Analysis ................................................................................................... 17 

2.9.1  Statistical Statistics……………………………………………………………….17 

2.10  Ethical considerations ............................................................................................. 18 

Chapter Three: Results .................................................................................................... 19 

4.1 Sociodemographic characteristics ........................................................................... 19 



VII 

 

3.2 Participation in Courses and Acknowledgment ....................................................... 21 

3.3 Descriptive Statistics of Variables Related to Evidence-Based Practice (EBP) ...... 21 

3.4 Analysis of knowledge, attitude, and practice Levels Related to EBP showed in table 

(5). ............................................................................................................................ 22 

3.5 Description of associations between nurses’ characteristics and practice ............... 23 

3.6 Description of associations between nurses’ characteristics and knowledge .......... 28 

3.7 Description of associations between nurses’ characteristics and attitudes .............. 31 

3.8 Description of associations between nurses’ characteristics and barriers to research 

utilization ................................................................................................................. 34 

3.9 Description of correlations between evidence-based practice, knowledge, attitudes, 

and barriers to research utilization ........................................................................... 37 

Chapter Four: Discussion ................................................................................................ 40 

4.1 Assessing Knowledge Levels to Evidence-Based Practice Among Nurses ............ 40 

4.2 Palestinian nurses' perceived knowledge associated with EBP, Attitude toward EBP, 

and EBP….. ............................................................................................................. 40 

4.3 Limitations and Future Directions ........................................................................... 47 

4.4 Conclusions and recommendations ......................................................................... 48 

4.4.1 Conclusions ......................................................................................................... 48 

4.4.2 Recommendations ............................................................................................... 51 

References ....................................................................................................................... 52 

Appendices ...................................................................................................................... 60 

 ب ............................................................................................................................... الملخص 

   

 

 

 

 

 

 

 



VIII 

 

List of Tables 

Table 1: Distribution of Questionnaires Among Hospitals Based on Nurse Population 12 

Table 2: Sociodemographic characteristics of the participants (n = 275) ....................... 20 

Table 3: Nurses’ participation in courses related to healthcare practice and research (n = 

275) ................................................................................................................. 21 

Table 4: Descriptive Statistics of Variables Related to Evidence-Based Practice (EBP)

 ........................................................................................................................ 22 

Table 5: Analysis of knowledge, attitude, and practice Levels Related to Evidence-Based 

Practice (n = 275) ........................................................................................... 22 

Table 6: Correlations between knowledge, attitudes, practice, and barriers to research 

utilization ........................................................................................................ 38 

 

 

 

 

 

 

 

 

 

 

 

 

 



IX 

 

List of Appendices 
Appendix A: Tables ........................................................................................................ 60 

Table 7: Associations between sociodemographic factors and evidence-based 

practice (n = 275) ....................................................................................... 60 

Table 8: Associations between sociodemographic factors and knowledge of 

evidence-based practice (n = 275) ............................................................. 62 

Table 9: Associations between sociodemographic factors and attitudes toward 

evidence-based practice (n = 275) ............................................................. 65 

Table 10: Associations between sociodemographic factors and barriers to research 

utilization (n = 275) ................................................................................... 67 

Table 11: Model Comparison: Coefficients, ANOVA, and Residuals .................... 69 

Appendix B: IRP Approval ............................................................................................. 70 

Appendix C: Study Instrument (Questionnaire) ............................................................. 71 

 

 

  

  

 

 

 

 

 

 

 

 

 



X 

 

NURSES' PERCEPTIONS OF KNOWLEDGE, PRACTICE, 

ATTITUDES, AND PERCEIVED BARRIERS TOWARDS 

EVIDENCE-BASED PRACTICE (EBP) IN NABLUS CITY 

HOSPITALS 

By 

Tamara Raheeb Yassin 

Supervisor 

Dr. Suha Hamshari 

  

Abstract 

Introduction: The importance of evidence-based practice in nursing is a genuine 

consideration in the provision of quality nursing care. This research study was assess the 

level of knowledge, attitude toward, and practice of EBP among nurses and the challenges 

experienced in implementing this level of practice in selected hospitals in Nablus City, 

Palestine. 

Methods: A total of 275 nurses completed the structured interview with questionnaires 

designed to obtain demographic information, attitude toward EBP, knowledge level and 

barriers to research use in nursing practice. 

Results: The results showed that most of the participants (82.2%) possessed a level of 

knowledge on EBP which was rated as high with a median score of knowledge being 

76.00. In spite of this encouraging level of knowledge, however, challenges in the 

effective use of EBP was noted where 41.1% of respondents indicated moderate 

challenges while 33.5% indicated high challenges. In statistical terms, positive EBP 

attitudes were significantly related to knowledge levels (r = .451, p < .001) while negative 

EBP attitudes correlates to research usage barriers (r = -.486, p < .001).  

Conclusion: The study presents knowledge as an essential facilitator for the promotion of 

EBP participation, emphasizing the need for appropriate educational measures to be put 

in place to overcome the challenges which have been identified already. In addition, the 

study shows that understanding the attitude of nurses towards scientific research helps to 

understand the problems they encounter. This is important for health care institutions that 



XI 

 

seek to improve the quality of patient care through the use of evidence-based practices. 

Nevertheless, in the subsequent studies, emphasis should be given to longitudinal studies 

which evaluate the effect of the implementation of educational programs on EBP and the 

results of patients over time. 

Keywords: Knowledge, Attitude, Practice, Evidence-Based Practice (EBP), BRU, 

Nurses.



1 

 

Chapter One 
Introduction 

1.1 Background  

In nursing, evidence-based practice has become increasingly popular, and the definitions 

vary across-the-board. Research findings, basic science knowledge, clinical knowledge, 

and expert opinion are all considered “evidence”; however, the use of the practices that 

are based on research findings has been proven to be the most successful in the pursuit of 

the patient's health gains across the various settings and locations in the world. The 

wellspring of evidence-based practice is found in payor and healthcare facility pressures 

for cost containment, more information availability, and even consumers have become 

technologically sassy about treatment and care choices. Evidence-based practice requires 

a shift in the education of students, more research that is relevant to practice, and better 

communication and interaction between clinicians and researchers. The introduction of 

the practice of evidence-based care is creating the space for nursing care to pay increased 

attention to the personal individuals, not the diseases, to be more effective, efficient, and 

agile, and to utilize the capacity of clinical judgment (Youngblut & Brooten, 2001). 

Health policy makers, practitioners, researchers and regulators have now acknowledged 

that evidence-based practice (EBP) bestows a safe as well as compassionate care on 

healthcare seekers worldwide (Brown et al., 2009; Malik et al., 2015). EBP is regarded 

as central element for enhancing health care services and attaining best patient healthcare 

outcomes (AbuRuz et al., 2017a). Also involves combining the best available evidence 

from systematic research that has been empirically tested and found to be reliable with 

clinical experience, expertise, values, by a physician as well as patient's own values 

(Sackett et al., 1996). The contribution of registered nurses in terms of “providing quality 

and continuity care to clients” (Adib‐Hajbaghery, 2009). cannot be overemphasized. The 

International Council for Nurses (ICN) has long urged nurses to ensure the creation of a 

body of nursing knowledge based on research and that this evidence be used in daily 

practice - i.e., EBP. 

 EBP is one of the key nursing practices related to better outcomes of care, higher quality, 

better safety, cost-effectiveness in the healthcare sector, shorter lengths in hospital stay, 



2 

 

and more feelings of job satisfaction and participation of nurses (Kim et al., 2017; Melnyk 

& Fineout-Overholt, 2022). 

EBP is a problem-solving strategy to clinical decision-making in a health care 

organization. It integrates the best available scientific evidence with the best available 

experiential (patient and practitioner) evidence. EBP considers internal and external 

influences on practice and encourages critical thinking in the judicious application of such 

evidence to the care of individual patients, a patient population, or a system. The 

challenge is for health care providers to apply the use of research and non-research 

evidence in order to implement the best interventions and practices. EBP supports and 

informs clinical, administrative, and educational decision-making. The integration of 

research, organizational experience (including quality improvement, program and 

evaluation data), clinical expertise, expert opinion, and patient preferences assures 

clinical decisions based on all available evidence. EBP improves efficacy (the capability 

to achieve a wanted outcome); efficiency (the accomplishment of a wanted outcome with 

minimal cost of money, time, and energy); and effectiveness (the capability to create 

wanted outcomes) (Newhouse et al., 2005). 

"Individual clinical experience combined with the best available external clinical data 

from systematic investigations" (Sackett et al., 1996)  is the definition of what EBP is. 

EBP is a culture in which practitioners routinely and naturally take into account the best 

available research (Dopson et al., 2003). His EBP has been proven clinically in all facets 

of practice (Dopson et al., 2003). Clinical decision-making with EBP includes combining 

information from clinical experts.  Examining the data in light of the resources at hand, 

patient preferences and behavior, clinical status, attitudes, and situations. Finding the 

right balance when weighing scientific findings is difficult in nursing  (Haynes et al., 

2002). EBP gives nurses authority within the care team, raises their professional standing, 

and brings them credibility as knowledge workers. In addition, it increases both the 

quality of care and the satisfaction of the patients, since patients take the view that they 

know their health and are therefore prepared to 'participate' in the decision-making . 

The Sigma Theta Tau International Honor Society of Nursing published its Position 

Statement on Evidence-Based Nursing in 2003 to advance the development of the society 

into the world's foremost resource for information and knowledge to enhance evidence-

based nursing practice (Thompson, 2005).  



3 

 

Many countries have developed evidence-based nursing centers that provide 

opportunities for training in the process of using evidence in clinical practice (Ciliska et 

al., 1999). Clearly measurable best quality treatment is in demand from patients, patient 

advocacy organizations, and other health-related organizations on clinical nurses. EBP is 

a requisite for this objective, and the role of nurses is to fill the knowledge gap by 

promoting quality clinical treatment in accordance with best practice evidence (Ingersoll, 

2000). 

Factors such as a more educated population, more access to information, altering 

workplace roles with a focus on efficiency in healthcare, and rising demands for 

accountability have all contributed to the increasing significance of evidence-based policy 

and practice. The current task is the effective management of risk and uncertainty in 

healthcare environments (Davies et al., 2000).  

These include the growth of a more educated and conscious population and an increase 

in the general availability of information; shifting workplace roles, with greater emphasis 

on efficiency and cost-effectiveness in the health sector; and increased demands for 

accountability and oversight. The current issue is to change the trend in the management 

of risk and uncertainty in healthcare settings (Davies et al., 2000).  

Evidence-based nursing seeks to equip nurses with the most reliable research resources 

to improve the quality of care, address healthcare challenges, and surpass established 

quality benchmarks (Grinspun et al., 2001; Salem, 2013) 

In order to meet the growing expectations for excellent treatment, nurses are now required 

to include research, experience, and patient preferences into their decision-making 

process, which is referred to as EBP (McSherry et al., 2002). Clinical nurses today are 

expected to systematically gather the best research, tap into nursing experience, and 

consider patient preferences in making professional decisions (Ingersoll, 2000). This 

approach is titled EBP. 

 

 

 



4 

 

1.2 Literature review  

EBP in the field of Western modern nursing is developing rapidly, with some success. 

Major numbers of systematic reviews, evidence summaries, and practice guidelines were 

searchable in the Cochrane Library and the Joanna Briggs Institute Library. Evidence 

implementation and dissemination are slowish compared with evidence synthesis and at 

times receive some resistance (Muhumuza et al., 2015). They do, however, go step by 

step. Several have reported positive outcomes for patients and caregivers after EBP. 

These include best practices implemented in support of EBP, which improved hand 

hygiene among Health Care Workers, HCWs, especially nurses , even in a resource-poor 

setting in Uganda (Muhumuza et al., 2015).  

Also, Schoville et al. did a cost-benefit analysis of his Electronic Clinical Procedural 

Resource in support of EBP with significant savings reported (Schoville et al., 2014). 

Furthermore, the evolution of EBP has integrated the aspect of international partnership 

and founded some of its own professional nursing associations and societies. Currently, 

our healthcare system is undergoing significant challenges, be it the poor-quality of 

services, as enumerated most significantly (Bikbov et al., 2020).  

Human agents are major causes of poor quality healthcare. Human forces are one leading 

factor in creating and causing the development and progress of health problems. They 

have long been emphasized by human development experts as one of the core components 

of any organization. Organizational goals seem to be very much dependent on the 

potential of the people within it. Nursing staff in health care are the people who do the 

direct health care. We live in an age where nurses and, generally, healthcare systems 

require a great extent of competencies and intelligence in order to achieve clinical 

responsibilities as expected (Ghrayeb, 2017).  

Consequently, nurses should update themselves with new research and increase their 

professionalism. You must have the competency to build up knowledge (Ghrayeb, 2017). 

 Nowadays, nurses need to be able to access and interpret a very wide clinical expertise 

and combine it with the clinical decision-making processes according to the new insights 

that will let lifelong learning reflect and change the clinical practice. Building research 

knowledge is important to minimize research-related anxiety in undergraduate nursing 

student (Ghrayeb, 2017). The nursing profession should, therefore, be advanced by 



5 

 

introducing a culture of research in undergraduate education and a positive attitude 

toward scientific research. They are strong advocates for becoming generators of new 

knowledge through nursing research. 

Attitude can be described as an intellectual state of values, feelings, or beliefs that are 

conscious or unconscious, or even behavior or predisposition to behavior. In the view of 

Almeida (Almeida et al., 2019), attitude is a major determinant of human behavior in 

attaining goals, meanings, and efficiently processing living knowledge. Traditionally, 

student nursing jobs have been rated very negatively with respect to unpleasant work in 

hospitals, vacation work with no appreciation of work done, and low wages-only jobs 

(Koushali et al., 2012).  

Nursing knowledge is very important to nurses for a number of reasons. Because nurses 

utilize vast arrays of ethical and practice acknowledgments in practice, it is imperative to 

be able to identify which nursing knowledge needs to be central to their practice. This 

knowledge is essential in raising awareness of personal and professional accountability 

and clarifying dilemmas in practice, thus improving patient care (Hall, 2005). 

The literature consequently shows that practitioners with the most positive attitudes 

towards the nursing process are most likely to be involved in its implementation 

(Ghrayeb, 2017). Determining attitudes of nurses towards scientific research is very vital 

in ensuring that there is future clinical research (Ünver et al., 2018). Practitioners who do 

not believe in the significance of clinical research are not likely to contribute to the 

advancement of the nursing profession and their practice is not evidence-based. 

According to research, implementation strategies of EBP are likely to be effective if 

administrators of hospitals overcome the barriers that have been identified (Baker et al., 

2010). While some researchers admit that EBP is hard to be established due to many 

obstacles or challenges like limited resources, insufficiency of time, lack of education or 

training, and lack of monitoring, the supporters of the EBP claim that in the framework 

of EBP all these issues could be handled by different kinds of adjustments  (Polykarpou 

et al., 2018; Tahan et al., 2016; Watters, 2019) 

The study assessed knowledge, attitude, and use of EBP among registered nurse-

midwives working in central hospitals in Malawi. Descriptive statistics showed that, 

when mean scores were presented, as mean ± standard deviation, nurse-midwives had an 



6 

 

attitude toward EBP of 78.7 ± 19.6 and this indicate that RNs had a relatively positive 

attitude towards EBP, and moderate levels of knowledge levels of 70.6 ± 15.1, However, 

their usage of EBP was notably lower 57.8 ± 23.0, and total EBP of 68.9 ± 14.2 reflects 

a mixed level of integration of EBP into their work. The results showed that research 

experience was associated with improved EBP practice (P = 0.005) and overall EBP 

scores (P = 0.035), better knowledge scores (P = 0.02) related to higher educational levels. 

Clinical experience (P = 0.006) and the hospital setting (P = 0.016) influenced attitudes. 

However, gender showed no effect on the EBP scores by the nurse-midwives (Kaseka & 

Mbakaya, 2022). 

A study that was conducted in Palestine and Saudia Arabia reported significant barriers 

to research utilization among medical and surgical nurses in private hospitals. The 

response rate from the sample population of 156 nurses was overwhelmingly high at 

86.67%. The mean age for participants was 29.41 years, while 49.4% reported less than 

six years of clinical experience. The majority (73.1%) of the participants were females, 

while 54.5% had a nursing diploma. In spite of the high levels of certification, perceived 

barriers to utilization of research were remarkable, with the mean perception score of 3.15 

out of 5 with a SD of 0.55. Of the barriers, those purported by the hospital setting and the 

research process were high at mean = 3.22, while barriers perceived to emanate from the 

nurses themselves were lower at a mean of 2.95. These causes included organizational 

environment and research methodologies as external factors, and individual factors of the 

nurses themselves. Evidence-based practice requires developing focused strategies that 

would strengthen organizational support and at the same time enable the nurses through 

education and available resources. Thus, the effort to address these barriers will translate 

into better implementation of research findings in clinical practices, leading to improved 

patient care outcomes for both regions (Fashafsheh et al., 2020). 

In a previous study cross-sectional, descriptive study, a sample of 303 nurses participated 

to assess their practices, attitudes, and knowledge in relation to EBP in the city of Al-

Madinah Al-Munawarah, Kingdom of Saudi Arabia. Different levels of engagement were 

shown in the results, wherein the highest mean scored was that for knowledge with EBP 

at 4.66 ± 1.16, followed by utilization at 4.09 ± 1.31 and attitudes at 3.81 ± 1.13 this 

indicates that while the nurses had a good understanding of EBP, their practical 

application of it was lower, similar to findings from the Saudi Arabia. The outcome 



7 

 

showed that younger nurses and those with BSc degrees had more positive attitudes and 

higher rates of utilization. On the other hand, years of experience were significantly 

inversely related to EBP utilization with r=-0.12, p< 0.05. The findings emerged that 

targeted interventions are needed to motivate Saudi nurses to adopt the EBP, which would 

lead to improved patient care outcome (AbuRuz, 2017). 

A cross-sectional descriptive study was carried out in Jordan with a sample of 447 nurses 

to identify the barriers to research involvement through the BRU. 8.9 %of the sample 

rated obstacles to research participation as low while 53.3% rated them at the severe end 

of difficulty. It also had the highest score among identified domains in organization-

related barriers as compared to others. Age, work experience as well as nationality were 

related to obstacles for research participation and explained by regression analysis 

(Abuhammad et al., 2020). 

Understanding nurses' attitudes toward scientific research is thus very instrumental in 

gaining insight. The study aimed to investigate the attitudes, knowledge, practice, and 

perceived barriers to the use of EBP among Palestinian nurses from hospitals in the West 

Bank. 

The findings from this study can be utilized to inform strategies and approaches that will 

motivate nurses. Only with a positive attitude toward research and its use in nursing 

practice is EBP achieved. 

1.3 Problem statement  

EBP is very critical in the delivery of quality patient care. It can be challenging sometimes 

to include EBP into healthcare services, especially in regard to nurses. Many nurses do 

not apply EBP consistently in their daily care for patients despite extensive research and 

guidelines about the existence of EBP. The problem addressed in this study, therefore, is 

to determine the perceptions of nurses towards EBP and to identify the barriers hindering 

their implementation into clinical practice. Knowing the perceptions of knowledge 

,practice ,attitude and barriers to implementing EBP among nurses would help the 

establishment of strategies to overcome such obstacles and thus encourage the uptake of 

EBP in nursing practice (Alatawi et al., 2020). Also the challenge of effectively 

implementing Evidence-Based Practice in clinical nursing environments despite its 

proven benefits in improving healthcare quality and patient outcomes. Some of the 



8 

 

barriers that prevent nurses from fully adopting EBP include lack of time, insufficient 

skills in searching and evaluating research evidence, language issues, and knowledge 

deficits. In addition, the attitude, knowledge, and belief of nurses about EBP are critical 

determinants of its successful implementation. 

The Middle East, together with the Mediterranean and North African regions, is an area 

that experiences a high rate of illnesses and recurrent humanitarian crises. Thus, it is very 

challenging for midwives and nurses. A scoping review indicates that even though nurses 

play a critical role in delivering healthcare, there is an observable variation in applying 

EBP (Alhusaini et al., 2016). For example, less than 50% of UAE nurses felt competent 

to critically appraise research or to lead EBP initiatives, while more than 60% reported 

they could use internal evidence to inform clinical decisions (Akkawi et al., 2023). This 

underscores that focused training interventions are needed. 

These results underline the critical need for changes in current practices and continuing 

professional development, which must close the gap between knowledge and evidence-

based standards. We can improve patient care and better serve the needs of the healthcare 

system in the hospitals of Nablus City by focusing on these areas. 

1.4 Objectives  

The purpose of this study is to evaluate nurses' perceptions of knowledge, attitude and 

practice, as well as the barriers to using, EBP in hospitals in West Bank, State of Palestine. 

Specifically, the research has these objectives: 

To determine the perception of knowledge, attitudes, and practices related to EBP among 

nurses working in hospitals in Nablus city, Palestine. 

To determine perceived barriers to utilizing Research, EBP among nurses working in 

hospitals in Nablus city, Palestine. 

To explore if there were any differences between knowledge, attitudes, and practice of 

EBP among nurses based on their education level, gender, length of experience, and 

department of work.  

 

 



9 

 

1.5 Significance of the study 

The significant of this study is the examination of nurses' perception of knowledge, 

practice,  attitude and barriers to the approaching of EBP. These findings have the 

potential to improve the quality of care and the outcomes for patients. EBP is important 

in healthcare services as it ensures that interventions are carried out based on the most 

dependable evidence to get the best possible patient outcomes.  

Although the merits of EBP are very well known, very few have been translated into 

nursing practice. An important way to implement EBP must, therefore, start with 

understanding factors that may influence nurses' perceptions and willingness to use EBP, 

in a bid to surmount its barriers to implementation. 

Perceptions and barriers to the use of EBP by nurses, if known, can enable appropriate 

healthcare organizations to design interventions. While EBP is globally recognized for its 

potential to improve healthcare, there is a partial implementation of this practice due to 

lack of time, insufficient skills to manage research evidence, and knowledge deficits. For 

instance, educational programs can be designed to enhance the knowledge and skills of 

nurses in respect of EBP, and organizational policies can be changed in a way that would 

facilitate the implementation of EBP. 

Ultimately, research into nurses' perceptions and the barriers to the use of EBP bears 

important implications for patients since it can result in effective interventions for the 

improvement of EBP in nursing (Alatawi et al., 2020). 

1.6 Research questions 

1. What are the level of knowledge, attitudes, and practices related to EBP among nurses 

working in hospitals in Nablus city, Palestine? 

2. What are the perceived barriers to the utilization of research, and EBP among nurses 

working in hospitals in Nablus city, Palestine? 

3. Are there any differences between knowledge, attitudes, and practice among nurses 

working in hospitals in Nablus city, Palestine based on their education level? 

4. Are there any differences between knowledge, attitudes, and practice among nurses 

working in hospitals in Nablus city, Palestine based on their gender? 



10 

 

5. Are there any differences between knowledge, attitudes, and practice among nurses 

working in hospitals in Nablus city, Palestine based on their work experience? 

6. Are there any differences between knowledge, attitudes, and practice among nurses 

working in hospitals of Nablus city, Palestine based on their place of work (clinical 

unit)? 

1.7 Hypothesis 

The study aims to test the following hypotheses: 

H0: At the level of significance represented by a p-value of 0.05, the null hypothesis 

proposes that there is no significant link between the sociodemographic characteristics of 

nurses and EBP 

H0: At the level of significance represented by a p-value of 0.05, the null hypothesis 

proposes that there is no significant link between the sociodemographic characteristics of 

nurses and Attitude to use EBP 

H0: At the level of significance represented by a p-value of 0.05, the null hypothesis 

proposes that there is no significant link between the sociodemographic characteristics of 

nurses and Knowledge of EBP 

H0: At the level of significance represented by a p-value of 0.05, the null hypothesis 

proposes that there is no significant link between the sociodemographic characteristics of 

nurses and BRU for using research  

H0: At the level of significance represented by a p-value of 0.05, the null hypothesis 

proposes that there is no significant difference between the EBP, Attitude, Knowledge 

and BRU in governmental and nongovernmental hospitals 

 

 

 

  



11 

 

Chapter Two 

Materials and Methods  

2.1 Design of study 

This study employed a descriptive, cross-sectional design to investigate the knowledge, 

attitudes, and practice of EBP, as well as the perceived barriers to its implementation 

among Nurses in hospitals located in Nablus City, Palestine. The study, conducted from 

December 2023 to June 2024. 

2.2 Study site and setting 

The study was conducted between December 2023 to June 2024, in Nablus City, situated 

within Palestine, which encompass Nablus Specialized Hospital, Al Arabi Specialized 

Hospital, An-Najah National University Hospital, Al-Watani Government Hospital, and 

Rafidia Governmental Hospital. These hospitals are the main healthcare centers in the 

city of Nablus Palestine. The study looked at different parts of these hospitals such as 

Medical/Surgical wards, Intensive Care Units (ICUs), Emergency Rooms, Oncology 

departments, and other special units found in the hospitals. This approach allowed to 

manifest realities well and work out the experiences, opinions of HCWs from a various 

clinical perspective in Nablus hospitals. 

2.3 Population of study 

The population of interest for this study comprises nurses working in Nablus hospitals, 

including Nablus Specialized Hospital, Al Arabi Specialized Hospital, An-Najah 

National University Hospital, Al-Watani Government Hospital, and Rafidia 

Governmental Hospital. The total population size is 660 nurses (Abukhader et al., 2020) 

(Zabin et al., 2022), encompassing both governmental and non-governmental hospitals 

within Nablus city. 

2.4 Study sample and sampling technique 

In the current study, a combination of sampling techniques was employed to ensure a 

representative sample of nurses from Nablus hospitals. Initially, The Raosoft sample size 

calculator (Raosoft, 2004) was utilized to determine the appropriate number of 

participants from a total population of 660 nurses. By specifying a 95% confidence level, 

a 5% margin of error, and a response of 50%, a required sample size of 244 nurses was 



12 

 

obtained. However, to anticipate potential non-response or incomplete responses, 

additional considerations were made. 

Out of 300 questionnaires distributed, 275 questionnaires were returned (response rate 

91.67%), to account for potential non-response or incomplete responses. 

Convenience sampling was used to choose the sample for the study. Participants were 

selected depending on their availability and desire to take part.  

Sample Size Calculation and Distribution 

To distribute the questionnaires among hospitals, proportions were calculated based on 

their respective nurse populations: 

The number of nurses in each hospital according to the hospital records show in table (1). 

Table 1 

Distribution of Questionnaires Among Hospitals Based on Nurse Population 

Total 

Nurses 
 

Percentage 

of Nurses 
 

Number of 

Questionnaires 

Distributed 
 

Hospital 

67 27.27% 180 Rafidia Hospital 

36 15.15% 100 

AL-WATANI 

GOVEREMNATL 

HOSPITAL 

89 36.36% 240 
An-Najah National University 

Hospital 

22 9.09% 60 Nablus Specialized Hospital 

30 12.12% 80 Al Arabi Specialized Hospital 

244 100% 660 Total 
 

 

 

 

 

 

 

 

 



13 

 

2.5 Inclusion and exclusion criteria 

2.5.1 Inclusion criteria  

1. Clinical experience at least one year  

2. Nurses working in governmental and nongovernmental hospitals. 

2.5.2 Exclusion criteria 

Temporary Employment Status: Nurses who are not permanently employed at the 

hospitals. 

Incomplete Data: Nurses who have incomplete or missing data required for the study. 

Non-Consent: Nurses who do not give consent to participate in the study. 

Extended Leave: Nurses who are on extended leave during the study period (e.g., 

maternity leave, sick leave). 

Recent Employment: Nurses who have been employed for a very short period (e.g., less 

than 1 year), and thus might not have sufficient experience relevant to their studies.  

2.6 Study Instrument, validity and reliability 

The study followed a systematic approach, beginning with the development of study 

tools. Subsequently, the study sample was identified. To ensure the quality of the 

questionnaire, its face and content validity were evaluated by expert academicians in the 

relevant field. This assessment encompassed considerations such as completeness, 

appropriateness, clarity of terms, logical sequence of statements, and overall organization 

and accuracy. 

Prior to the commencement of the study, a pilot test of the final questionnaire was 

conducted among 38 nurses, constituting 10% of the sample. This pilot aimed to assess 

the clarity and feasibility of the questionnaire. Furthermore, to ensure accessibility to all 

participants, the final English version was retranslated into Arabic by five proficient 

Arabic experts, each holding a PhD in nursing. 

Reliability testing was conducted using Cronbach’s Alpha formula to evaluate the 

consistency and reliability of the tool. 



14 

 

The questionnaire consists of four parts:  

In the first part, the questionnaire includes the introduction, several elements which 

emphasize the target of the study, kind of data that the researchers need to collect from 

the study sample in addition to a paragraph aiming at encouraging the targeted individuals 

to respond frankly on the study questions after satisfying the tested nurses that the 

information will remain highly confidential and will not be used except for the scientific 

research only. Additionally, the introduction includes the respondent's approval of 

responding to the questionnaire items by his signature and date.  

The second part focused on gathering demographic information with 10 questions 

covering aspects such as age, sex, marital status, type of hospital, job title, academic 

degree, years of service in the hospital, and participation in courses related to scientific 

evidence and if taken any course related to scientific research, as well as acknowledgment 

of the link between scientific research and healthcare practice. 

The third part involved the administration of the Evidence- Based Practice questionnaire 

(EBPQ), is a self-completed questionnaire, consisting of twenty-four items divided into 

three sub-domains: knowledge or skills (14 items), attitudes (4 items), and practice (6 

items). Each item is scored on a scale of one to seven, with a higher score associated with 

a more positive attitude toward EBP or use and knowledge of EBP, and a lower score 

associated with a negative attitude or use and knowledge of EBP. Responses to each item 

were considered positive if the scores were greater than 4 (Ammouri et al., 2014). This 

tool consists of three subscales: practice, knowledge or skills, and attitudes, Internal 

consistency for EBPQ, the Cronbach’s alpha coefficient was 0.91 for the entire 

questionnaire, 0.84 for the practice subscale, 0.74 for the attitudes subscale and 0.94 for 

the knowledge/skills subscale  (Ammouri et al., 2014).  

Previous studies showed that this instrument is substantial and dependable. The past study 

done to check the validity and reliability of the instrument illustrated a Cronbach's alpha 

of 0.87 for the whole survey, 0.85 for the practice of EBP sub-scale, 0.79 for the attitudes 

sub-scale, and 0.91 for the knowledge or skills sub-scale (Upton & Upton, 2006). 

Construct validity was established using an independent EBP measure yielding a 

modestly positive relationship between scales. A study done by AbuRuz, Hayeah, Al-

Dweik and Al-Akash (AbuRuz et al., 2017b) supported the reliability of this instrument 

as the following: the Cronbach's alpha coefficient was 0.96 for the entire questionnaire, 



15 

 

0.93 for the practice subscale, 0.82 for the attitudes subscale, and 0.95 for the 

knowledge/skills subscale . 

In this study, the Cronbach’s alpha coefficient was 0.926 for the entire questionnaire, 

0.867 for the practice subscale. 0.811 for the attitude subscale and 0.930 for the 

knowledge/skill subscale.  

Lastly, fourth  part focused on the Barriers to Research Utilization (BRU) questionnaire 

was developed to evaluate healthcare workers 'and administrators’ perceptions of 

obstacles to implementing research findings in practice (Funk et al., 1991).  Barriers to 

using research/a scale consisting of an item of barriers, each item is rated on a scale from 

1 to 4 (1 = not at all, 2 = slightly, 3 = medium, 4 = very severe) reflecting the degree to 

which it is seen as an obstacle. degree). A "no opinion" response is also allowed.  

In Funk’s psychometric article, Cronbach’s alpha values for the four subscales were 0.80, 

0.80, 0.72, and 0.65, individually (Funk et al., 1991), which implies that the tool has good 

reliability.  

(Kajermo et al., 1998) conducted a study to explore nurses' perceptions of barriers to and 

facilitators of research utilization at two hospitals in Sweden, utilizing The Barriers Scale. 

Through factor-analytic procedures, they identified four factors: the adopter, the 

organization, the innovation, and the communication. The Cronbach’s alpha coefficient 

were found to be 0.81, 0.87, 0.86, and 0.83, respectively. In contrast, (Dunn et al., 1997) 

applied the same scale in a study involving 316 nurses and identified similar factors: 

nurse, setting, research, and presentation. The total scale exhibited a Cronbach’s alpha of 

0.85. Factor loadings for the subscales ranged from 0.48 to 0.78. 

In this study, the Cronbach’s alpha coefficient was 0.869 for EBPQ, and 0.856, 0.850, 

and 0.831, respectively. The BRU total scale exhibited a Cronbach’s alpha of 0.932. 

The total scale for total tool exhibited Cronbach’s alpha of 0.822. 

 

 

 



16 

 

2.7 Study variable (the independent and dependent variables) 

The study includes the following variables:  

2.7.1 Independent variables 

Sociodemographic characteristics of nurses, including age, sex, marital status, type of 

hospital, job title, clinical unit (place of work), academic degree, years of service in the 

hospital, participation in courses related to scientific evidence, participation in courses 

related to scientific research, and acknowledgment of the link between scientific research 

and healthcare practice. 

2.7.2  Dependent variables 

Nurses' EBP knowledge or skills. 

Nurses' attitudes towards EBP. 

Nurses' EBP practices. 

Perceived barriers to EBP utilization, assessed through the BRU scale, which includes 

characteristics of the nurse, characteristics of the organization, characteristics of the 

innovation, and characteristics of communication with the organization. 

2.8 Procedures 

The study followed a systematic approach, beginning with the development of study 

tools. Subsequently, the study sample was identified. To ensure the quality of the 

questionnaire, its face and content validity were evaluated by two expert academicians in 

the relevant field. This assessment encompassed considerations such as completeness, 

appropriateness, clarity of terms, logical sequence of statements, and overall organization 

and accuracy. 

Prior to the commencement of the study, a pilot test of the final questionnaire was 

conducted among 38 nurses, they were not included in the study. This pilot aimed to 

assess the clarity and feasibility of the questionnaire. Furthermore, to ensure accessibility 

to all participants, the final English version was retranslated into Arabic by five proficient 

Arabic experts, each holding a PhD in nursing, the Cronbach’s alpha for pilot study was 

0.703. 



17 

 

2.9 Statistical Analysis 

This chapter discusses the methodology and statistical procedures used to analyze the 

relationship between nurses' perceptions of EBP and barriers to its utilization in Nablus 

City hospitals. The EBPQ, statements about the practice, attitude, and knowledge as 

related to EBP were rated by the respondents on the 1-7 Likert scale, ranging from 1= 

lowest/negative to 7= highest/positive response. Low response categories were defined 

to identify priority learning needs: scores ≤ 24 for practice indicated low adherence, 

scores ≤ 16 for attitude reflected negative attitudes, and scores ≤ 56 indicated insufficient 

knowledge (Brown et al., 2009), and BRU scale consisting of four subscales: 1) 

characteristics of the nurse, including their own awareness; 2) characteristics of the 

organization; 3) characteristics of the innovation; and 4) characteristics of communication 

within the organization, with total scores ranging from 28 to 112; scores from 28 to 56 

are considered low, from 57 to 74 moderate, and between 75 and 112 high (Abuhammad 

et al., 2020). Normality tests were carried out with the Shapiro-Wilk and Kolmogorov-

Smirnov tests. Consequently, non-parametric tests for analysis were used accordingly. 

The version of SPSS used for data analysis is version 21. Descriptive statistics were used 

to summarize data on sociodemographic characteristics, as well as their responses to 

practice, knowledge, attitude, and BRU scores. These statistics included: 

 Frequencies and Percentages: For categorical variables such as gender, marital 

status, job title, and hospital type. 

 Median with Interquartile Range (IQR): For non-normally distributed continuous 

variables. 

 Mean ± Standard Deviation (SD): For normally distributed continuous variables. 

2.9.1 Inferential Statistics 

At a significance level of p&lt;0.05p &lt; 0.05p&lt;0.05, the following non-parametric 

tests were employed: 

Kruskal-Wallis Test: To evaluate whether there were statistically significant differences 

in practice, knowledge, attitude, and BRU scores with respect to age, job title, degree, 

clinical unit, place of study, and years of service in the hospital. 



18 

 

Mann-Whitney U Test: To compare practice, knowledge, attitude, and BRU scores with 

respect to gender, marital status, hospital type, and specific questions about EBP-related 

courses and the link between research and practice. 

Additionally, the research studied the associations of EBP utilization and attitude towards 

EBP and knowledge associated with EBP and BRU by using Pearson Correlation 

Coefficient. 

2.10  Ethical considerations 

To address ethical concerns, this study got approval from An-Najah National University's 

Institutional Review Board (IRB). The IRB examined the research plan (Ref: 

Mas.ay.2023/14) to make sure it met ethical standards and protected participants' rights 

throughout the study. Also, all participants gave verbal informed consent through an 

official consent form before joining the study. The consent form explained the study's 

purpose, steps involved possible risks and benefits, privacy measures, and participants' 

rights. The study assured participants that they could join and leave at any time without 

any consequences. 

The Belmont Report subsequently codifies the ethical protections for individuals, based 

on principles of respect for persons, beneficence and justice. With IRB approval and 

informed consent from the participants, these strict ethical standards were desired to 

maintain the safety and rights of all parties involved. 

 

 

 

 

 

 

 

 



19 

 

Chapter Three 

Results  

4.1 Sociodemographic characteristics 

A total of 275 nurses participated in the study as shown table (2), with 46.9% females and 

53.1% males. For age, 51.3% were between 20-29 years old, 39.6% between 30-39, while 

9.1% were 40 years or older. The current level of education reported indicated that 67.3% 

had obtained a bachelor's degree, 10.9% a master's degree, and 21.8% had a university 

nursing diploma. For marital status, 68% were married and 32% were unmarried. 

Regarding professional experience, 36.7% had less than 5 years, 39.6% had 6-10 years, 

and 23.6% had over 10 years. Participants worked in the following clinical units: 47.6% 

in medical/surgical wards, 37.8% in ICUs, 9.5% in the Emergency Department, 1.5% in 

Oncology, and 3.6% in other wards. As for hospital type, 38.5% were in governmental 

hospitals and 61.5% in nongovernmental hospitals. Most held the title of registered nurse 

(89.5%), with 7.3% as Head nurses and 3.3% as practical nurses. 

 

 

 

 

 

 

 

 

 

 

 



20 

 

Table 2  

Sociodemographic characteristics of the participants (n = 275) 

Variable Frequency (%) Percentage % 

Age   

20-29 141 51.3% 

30-39 109 39.6% 

≥40 25 9.1% 

   

Gender   

Male 146 53.1% 

Female 129 46.9% 

Marital status   

   

Married 187 68% 

Unmarried 88 32% 

Hospital type   

Governmental 106 38.5% 

   

Non-Governmental 169 61.5% 

Job title   

PN 9 3.3% 

RN 246 89.5% 

HN 20 7.3% 

Degree   

Diploma 60 21.8% 

BA 158 67.3% 

Master 30 10.9% 

   

Clinical unit   

Medical/Surgery 131 47.6% 

ICUs 104 37.8% 

ER 26 9.5% 

Oncology 4 1.5% 

Others 10 3.6% 

Place of study   

An AL-Najah National 

University 
131 47.6% 

   

Al-Tira College/Ramallah 7 2.5% 

Al-Quds University 11 4% 

Al-Andalib college 15 5.5% 

Al-Rawda College 35 12.7% 

University of Jordan 4 1.5% 

Ibn Sina 33 12% 

Al-Asriya College/ Ramallah 3 1.1% 

American University 36 13.1% 

   

Years of service in the hospital   

From 0-5 Years 101 36.7% 

From 6-10 Years 109 39.6% 

More than 10 Years 65 23.6% 

 



21 

 

3.2 Participation in Courses and Acknowledgment 

A notable proportion of participants as shown in table (3), reported engagement in 

educational courses relevant to evidence-based practice, with 21.5% indicating 

participation in courses related to utilizing scientific evidence in practice. Moreover, 

45.1% of participants reported completion of courses specifically focused on scientific 

research. Importantly, a significant majority (76%) acknowledged the vital connection 

between scientific research and healthcare practice. 

Table 3 

Nurses’ participation in courses related to healthcare practice and research (n = 275) 

Statement Frequency (%) Percentage % 

Receiving courses related to 

practice using scientific 

evidence 

59 21.5% 

Receiving courses related to the 

scientific research 
124 45.1% 

There is a link between 

scientific research and 

healthcare practice 

209 76% 

 

3.3 Descriptive Statistics of Variables Related to Evidence-Based Practice (EBP) 

The study's descriptive statistics reveal that nurses in Nablus city have a mean score of 

32.52 for evidence-based practice (EBP), with scores ranging from 30.00 to 36.00 and a 

median of 34.00. Attitudes toward EBP have a mean score of 22.81, interquartile range 

from 21.00 to 26.00, and a median of 24.00. Knowledge associated with EBP is reported 

with a mean of 66.78, an interquartile range from 61.00 to 75.00, and a median of 68.00. 

For barriers to research utilization (BRU), the mean score is 2.08, with an interquartile 

range from 1.00 to 3.00 and a median of 2.00, showed in table (4). 

 

 

 

 



22 

 

Table 4  

Descriptive Statistics of Variables Related to Evidence-Based Practice (EBP) 

Descriptive Statistics 

 N Mean Q1-Q3 Median (Q2) 

Practice 275 32.52 30.00-36.00 34.00 

Attitude toward EBP 275 22.81 21.00-26.00 24.00 

Knowledge 

associated with EBP 
275 66.78 61.00-75.00 68.00 

The scores of BRU 

scale range 
275 2.08 1.00-3.00 2.00 

 

3.4 Analysis of knowledge, attitude, and practice Levels Related to EBP showed in 

table (5). 

Practice: 92.7% scored above 24, showing a high adherence to EBP practices. 

Attitude: 90.5% of the respondents scored above 16, indicating an exceptionally positive 

attitude toward EBP. 

Knowledge: 82.2% of the respondents scored above 56, reflecting a good level of 

knowledge regarding concepts about EBP. 

 

Table 5 Analysis of knowledge, attitude, and practice Levels Related to Evidence-Based Practice 

(n = 275) 

Statement Frequency (%) Percentage % 

Practice   

=or less than 24 20 7.3 

More than 24 255 92.7 

Total 257 100 

   

Attitude   

= or less than 16 26 9.5 

More than 16 249 100.0 

Total 257 100 

   

Knowledge   

= or less than 56 49 17.8 

More than 56 226 100.0 

Total 257 100 

 



23 

 

3.5 Description of associations between nurses’ characteristics and practice 

Individuals between the ages of 20 and 29 had the highest practice scores, with a median 

score of 34.00 and an interquartile range (IQR) between 31.00 and 37.00 (Q1-Q3). 

Members of this group showed the highest level of participation in the activities under 

review, reflecting a strong commitment to practicing and reacting to uncertainty. 

Individuals between the ages of 30 and 39 had practice scores slightly lower than 

participants in other age groups, with a median score of 33.00 and an interquartile range 

from 30.00 to 36.00 (Q1-Q3). Although they were still actively involved, their level of 

participation seemed slightly less intense than that of younger individuals in the 20-29 

age bracket. People over the age of 40: This age group experienced the lowest scores in 

terms of practice, with a median of 30.00 and an interquartile range between 25.00 and 

33.00 (Q1-Q3). Individuals in this group showed the lowest level of engagement in the 

activities looked at, suggesting a decreased participation in practice and reactions to 

uncertainty. 

Age was found to have a significant impact on evidence-based practice (EBP) practices, 

with a p-value of less than 0.001.  

Men involved in the study had better performance scores, averaging at 34.00 with a range 

of 31.00 to 37.00 (Q1-Q3). This indicates a steady and fairly strong participation in the 

activities observed among male participants, showing their active engagement in 

practicing and responding to uncertainty. Female participants claimed to have lower 

practice scores, averaging 33.00 with a range of 29.00 to 36.00 (Q1-Q3). This suggests 

that women were slightly less engaged in the activities than men, indicating a difference 

in levels of involvement. 

Gender had a notable impact on practice (p-value = 0.004), indicating a discrepancy 

between male and female engagement levels in practice and reactions to uncertainty. Men 

typically showed greater levels of engagement in comparison to women. Additional 

research may be needed to uncover the root causes of these disparities and create tactics 

to encourage equal involvement of all genders in healthcare settings. 

Non-governmental hospitals: Individuals from non-governmental hospitals showed better 

performance results, averaging at 34.00 with a range from 31.00 to 37.00 (Q1-Q3). This 

shows a steady and fairly strong level of participation in the activities studied among 



24 

 

people in non-governmental hospitals, indicating an engaged approach to dealing with 

uncertainties. Governmental hospitals had lower practice scores, averaging at 33.00 with 

a range from 29.00 to 35.00 (Q1-Q3) according to respondents. This implies that people 

working in governmental hospitals were slightly less engaged in activities than those in 

non-governmental hospitals, possibly pointing to a difference in levels of involvement. 

In the analysis, the following findings were observed regarding practice and responses to 

uncertainty across job titles: 

Registered Nurses (RN): Registered Nurses demonstrated the highest practice scores, 

with a median of 34.00 and an interquartile range (IQR) from 30.00 to 37.00 (Q1-Q3). 

This indicates consistent and robust engagement in the examined activities among 

Registered Nurses, highlighting their active involvement in practice and responses to 

uncertainty. Head Nurses (HN): Head Nurses exhibited slightly lower practice scores 

compared to Registered Nurses, with a median of 34.00 and an interquartile range from 

30.50 to 36.00 (Q1-Q3). While still demonstrating a moderate level of engagement, it 

appears that Head Nurses were slightly less involved compared to Registered Nurses, 

suggesting a slightly diminished level of participation. Practical Nurses (PN): Practical 

Nurses reported the lowest practice scores among the job titles, with a median of 27.00 

and an interquartile range from 26.00 to 35.00 (Q1-Q3). This suggests that Practical 

Nurses were less frequently involved in the examined activities compared to Registered 

Nurses and Head Nurses, indicating a lower level of engagement. 

Job Title did not significantly influence evidence-based practice (EBP) practices (p-value 

= 0.090). These findings imply variations in engagement levels across different job titles, 

with Registered Nurses demonstrating the highest level of involvement, followed by Head 

Nurses, and then Practical Nurses. Understanding these differences can help tailor 

strategies to enhance engagement and improve practice and responses to uncertainty 

among healthcare professionals in different roles. 

The type of hospital had a significant impact on practice (p-value = 0.010). The results 

suggest a potential link between the type of hospital and the levels of engagement in 

practice and responses to uncertainty. Participants from non-governmental hospitals show 

greater involvement compared to those from governmental hospitals. 



25 

 

Additional investigation may be needed to comprehend the root causes of these variations 

and to create tactics for enhancing involvement in various hospital settings. 

Master's Degree: Those with a Master's degree showed the best performance, scoring a 

median of 36.50 and an interquartile range (IQR) between 35.00 and 39.00 (Q1-Q3). This 

shows that individuals with a Master's degree consistently and strongly participate in the 

activities studied, demonstrating their active engagement in practice and ability to 

respond to uncertainty. Bachelor's degree holders showed practice scores slightly below 

those with a Master's degree, with a median of 34.00 and an interquartile range of 31.00 

to 37.00 (Q1-Q3). Although still moderately engaged, individuals with a Bachelor's 

degree exhibited slightly less involvement than those with a Master's degree, indicating a 

slightly lower level of participation. Degree Diploma: Individuals holding a diploma had 

the lowest practice scores compared to other degrees, with a median of 30.50 and an 

interquartile range of 26.00 to 34.00 (Q1-Q3). This indicates that people with a diploma 

participated less often in the activities studied in comparison to individuals with 

Bachelor's or Master's degrees, pointing to a decreased level of involvement. 

A Scientific Degree had a major impact on the implementation of evidence-based practice 

(EBP) (p-value < 0.001). These results emphasize differences in levels of engagement 

among individuals with varied educational backgrounds, showing that those with a 

Master's degree exhibit the greatest involvement, followed by those with a Bachelor's 

degree, and then individuals with a diploma. Comprehending these distinctions can guide 

specific actions to increase involvement and enhance skills and reactions to 

unpredictability in healthcare professionals with varying levels of education. 

An AL-Najah National University: Engagement levels varied among 131 participants, 

with a median practice score of 35.00 and quartiles ranging from 32.00 to 37.00 (Q1-Q3). 

This suggests a relatively consistent level of engagement among participants from this 

institution. Al-Tira College/Ramallah: Engagement levels varied among 7 participants, 

with a median practice score of 31.00 and quartiles ranging from 30.50 to 31.50 (Q1-Q3). 

This indicates a narrower range of engagement compared to other institutions. Al-Quds 

University: Engagement levels varied among 11 participants, with a median practice 

score of 27.00 and quartiles ranging from 22.50 to 34.50 (Q1-Q3). This institution showed 

a wider range of engagement levels, with some participants demonstrating lower levels 

of involvement. Al-Andalib College: Engagement levels varied among 15 participants, 



26 

 

with a median practice score of 32.00 and quartiles ranging from 25.00 to 34.50 (Q1-Q3). 

Similar to Al-Quds University, this institution exhibited a wide range of engagement 

levels. Al-Rawda College: Engagement levels varied among 35 participants, with a 

median practice score of 30.00 and quartiles ranging from 26.00 to 34.00 (Q1-Q3).  

This institution also showed a diverse range of engagement levels. University of Jordan: 

Engagement levels varied among 4 participants, with a median practice score of 35.00 

and quartiles ranging from 30.00 to 36.00 (Q1-Q3). Despite the small sample size, this 

institution demonstrated relatively consistent engagement levels. Ibn Sina: Engagement 

levels varied among 33 participants, with a median practice score of 33.00 and quartiles 

ranging from 30.00 to 35.00 (Q1-Q3). This institution exhibited a moderate range of 

engagement levels. Al-Asriya College/Ramallah: Engagement levels varied among 3 

participants, with a median practice score of 33.00 and quartiles ranging from 27.50 to 

33.00 (Q1-Q3). This institution had a smaller sample size but still showed variability in 

engagement. An-American University: Engagement levels varied among 36 participants, 

with a median practice score of 34.50 and quartiles ranging from 31.50 to 37.50 (Q1-Q3). 

This institution also exhibited a wide range of engagement levels. 

Place of study significantly influenced evidence-based practice (EBP) practices (p-value 

< 0.001). These findings highlight the importance of considering the educational 

background of healthcare professionals when designing strategies to address variations in 

practice and responses to uncertainty. Tailored approaches may be necessary to 

effectively support healthcare professionals from different institutions. 

0-5 Years of Service: Participants in this group demonstrated varied engagement levels, 

with a median practice score of 32.00 and quartiles ranging from 30.00 to 37.00 (Q1-Q3). 

This suggests that healthcare professionals in the early stages of their careers exhibit 

diverse levels of involvement in practice and responses to uncertainty. 6-10 Years of 

Service: Participants with 6-10 years of service displayed consistent engagement, with a 

median practice score of 35.00 and quartiles ranging from 32.00 to 37.00 (Q1-Q3). This 

indicates a relatively stable level of involvement among healthcare professionals in this 

mid-career stage. More than 10 Years of Service: Healthcare professionals with more than 

10 years of service exhibited varied engagement levels, with a median practice score of 

33.00 and quartiles ranging from 27.00 to 35.00 (Q1-Q3). This suggests that those with 

extensive experience may demonstrate differing levels of involvement in practice and 



27 

 

responses to uncertainty, possibly influenced by factors such as burnout or changing 

responsibilities over time. 

Years of service in the hospital significantly influenced evidence-based practice (EBP) 

practices (p-value < 0.001). 

In the examination of practice and responses to uncertainty, participants were assigned to 

five distinct clinical units: Medical/Surgery, Intensive Care Units (ICUs), Emergency 

Room (ER), Oncology, and Other Wards. While there were variations in practice scores 

across different units, the clinical unit did not significantly influence evidence-based 

practice (EBP) practices (p-value = 0.134). The observations across units were as follows: 

Intensive Care Units (ICUs): Participants in ICUs demonstrated the highest practice 

scores, with a median of 35.00 and an interquartile range (IQR) from 31.00 to 37.00 (Q1-

Q3), indicating consistent and robust engagement in relevant activities. 

Other Wards: Similarly, individuals in Other Wards displayed commendable practice 

scores, with a median of 33.50 and an IQR from 31.00 to 37.00 (Q1-Q3), suggesting a 

moderate level of engagement. 

Medical/Surgery Ward: Participants in the Medical/Surgery ward reported slightly lower 

practice scores compared to ICUs and Other Wards, with a median of 33.00 and an IQR 

from 30.00 to 36.00 (Q1-Q3), still indicating substantial involvement. 

Oncology Ward: Participants in the Oncology ward demonstrated a decline in practice 

scores, with a median of 32.50 and an IQR from 28.50 to 34.50 (Q1-Q3), suggesting 

reduced engagement compared to other units. 

Emergency Room (ER): Participants in the Emergency Room (ER) reported the lowest 

practice scores among the clinical units examined, with a median of 32.00 and an IQR 

from 30.00 to 34.00 (Q1-Q3), indicating limited involvement. 

These findings underscore variations in engagement levels across different clinical units, 

with individuals in ICUs demonstrating the highest level of involvement, followed by 

Other Wards, Medical/Surgery wards, Oncology, and Emergency Room. Understanding 

these differences can inform strategies to enhance engagement and improve practice and 

responses to uncertainty among healthcare professionals in various clinical settings.  



28 

 

Taking a scientific research course influenced participant engagement levels. Among 124 

course completers, engagement varied but skewed towards moderate to high levels, with 

an interquartile range of 30.00 to 37.00 and a practice score median of 34.00. Conversely, 

the 151 non-completers showed similar engagement levels, with a range of 30.00 to 36.00 

and a median score of 33.00. Despite lacking formal training, some non-completers still 

exhibited moderate to high participation. Overall, enrolment in the course led to a 

significant difference in participation responses, as indicated by a p-value of 0.032. 

Participants who believed in the link between scientific research and healthcare practice 

showed varying engagement levels, with quartiles between 31.00 and 37.00 and a median 

score of 34.00. Those who did not see the connection had quartiles between 30.00 and 

36.00 and a median score of 32.00. This suggests that awareness of the relationship 

between research and practice influenced engagement, with believers showing more 

participation in practice. The impact of this connection on practice was statistically 

significant (p-value < 0.001), highlighting the importance of recognizing and utilizing 

scientific research in healthcare decision-making for improved outcomes, showing in 

appendix A, table 7. 

3.6 Description of associations between nurses’ characteristics and knowledge  

Head Nurses (HN) showed the highest level of knowledge, with a median score of 74.50 

and an interquartile range (Q1-Q3) from 64.50 to 78.00, demonstrating steady 

involvement. Nurses who are registered (RN) showed slightly lower knowledge scores, 

with a middle value of 68.00 and a range of scores from 61.00 to 74.00 (Q1-Q3), 

indicating a moderate level of involvement. Practical Nurses (PN) had the lowest 

knowledge scores, with a median of 57.00 and an interquartile range of 51.00 to 68.00 

(Q1-Q3), suggesting they participated less in the activities analyzed. 

Knowledge had a notable impact on job title (p-value = 0.018). 

In the examination of knowledge and responses to uncertainty across three age groups - 

20-29, 30-40, and ≥40 - notable differences in engagement levels emerged. Participants 

aged 20-29 demonstrated the highest knowledge scores, with a median of 69.00 and an 

interquartile range (Q1-Q3) spanning from 63.00 to 76.00. Conversely, individuals aged 

30-39 exhibited slightly lower knowledge scores, with a median of 67.00 and an 

interquartile range spanning from 61.00 to 74.00 (Q1-Q3). Those aged 40 and above 

reported the lowest knowledge scores, with a median of 60.00 and an interquartile range 



29 

 

spanning from 43.00 to 74.00 (Q1-Q3), indicating less frequent involvement in the 

examined activities.  

Age did not significantly influence knowledge (p-value = 0.060). 

Examining knowledge and responses to uncertainty across different degrees revealed 

distinct engagement levels. Participants with a Master's degree showed the highest 

knowledge scores (median 76.00), indicating consistent engagement. Bachelor's degree 

holders had slightly lower scores (median 68.00), suggesting moderate engagement. 

Diploma holders reported the lowest scores (median 57.50), indicating less involvement. 

Scientific degree was significantly influenced by knowledge (p-value < 0.001). Higher 

education levels show to correlate with higher engagement levels.  

NNU experienced differing engagement levels among 131 participants, with a median of 

69.00 and quartiles of 65.00 to 75.00 (Q1-Q3), suggesting a moderate to high level of 

engagement. On the other hand, 7 participants from Al-Tira College/Ramallah showed 

decreased levels of participation, with a median of 53.00 and quartiles spanning from 

41.50 to 59.00 (Q1-Q3), indicating less regular engagement in the activities under 

scrutiny.  

Al-Quds University had 11 participants with engagement levels ranging from 52.50 to 

75.00 (Q1-Q3), and a median of 73.00, showing a combination of moderate to high 

engagement. Attendees from Al-Andalib College displayed a range of involvement levels 

among 15 participants, with a median of 56.00 and quartiles spanning from 50.00 to 62.00 

(Q1-Q3), indicating diverse levels of participation. At Al-Rawda College, engagement 

levels among 35 participants showed variation, with a median of 61.00 and quartiles 

between 53.00 and 69.00 (Q1-Q3), suggesting a moderate level of engagement. The 

University of Jordan observed different levels of involvement from 4 individuals, with an 

average of 75.50 and quartiles between 64.00 and 84.00 (Q1-Q3), indicating a 

combination of moderate and high engagement. At Ibn Sina, the degree of participation 

differed for 33 individuals, with a middle value of 70.00 and quartiles stretching from 

63.00 to 76.00 (Q1-Q3), showing steady engagement. Attendees from Al-Asriya 

College/Ramallah showed differing levels of participation among 3 attendees, with a 

median of 62.00 and quartiles spanning from 54.50 to 62.00 (Q1-Q3), suggesting a 

moderate level of engagement. In conclusion, engagement levels differed among 36 



30 

 

participants at An-American University, with a median of 68.50 and quartiles of 60.50 to 

74.00 (Q1-Q3), indicating a combination of moderate to high engagement. 

Participants with 0-5 years of service demonstrated varied engagement levels among 101 

participants, with a median of 69.00 and quartiles ranging from 63.00 to 75.00 (Q1-Q3), 

indicating a moderate to high level of involvement. Those with 6-10 years of service 

displayed consistent engagement among 109 participants, with a median of 69.00 and 

quartiles ranging from 63.00 to 76.00 (Q1-Q3), suggesting sustained participation over 

time.  

However, participants with more than 10 years of service exhibited varied engagement 

levels among 65 participants, with a median of 64.00 and quartiles ranging from 55.00 to 

72.00 (Q1-Q3), indicating a mix of moderate to lower involvement. These findings 

underscore the complexity of engagement levels across different tenure groups, 

suggesting a need for tailored strategies to maintain or enhance involvement, particularly 

among more experienced healthcare professionals. 

Knowledge significantly influenced years of service in the hospital (p-value = 0.002). 

Out of the 59 individuals who completed the course, there was a range in engagement 

levels, with quartiles between 67.00 and 83.00 (Q1-Q3), and a median of 76.00, 

demonstrating a moderate to high level of participation. On the other hand, out of the 216 

individuals who had not participated in the course, there was a range of engagement 

levels, with quartiles falling between 60.00 and 73.00 (Q1-Q3), and a median of 67.00, 

indicating a combination of moderate to minimal participation. 

Influence of knowledge on participation in courses related to practice using scientific 

evidence was significant (p-value < 0.001). 

Knowledge and responses on course engagement in scientific research were analyzed 

among 124 participants who had taken the course and 151 who had not. Both groups 

showed comparable engagement levels, ranging from moderate to high, with quartiles 

from 57.00 to 78.00 and medians of 66.00 and 71.00, respectively. Participation in 

scientific research courses was found to be significantly influenced by knowledge (p-

value < 0.001). These results suggest that taking a scientific research course may not 

impact overall engagement levels in knowledge and responses. 



31 

 

Participant perceptions of the relationship between scientific research and healthcare 

practice were examined, revealing varied engagement levels. Among those who 

perceived a link, engagement ranged from 64.00 to 78.00 (Q1-Q3) with a median of 

71.00, while those who did not perceive the link had engagement levels ranging from 

57.00 to 71.00 (Q1-Q3) with a median of 66.00. Knowledge significantly impacted 

perceptions (p-value < 0.001), showing in appendix A, table 8. 

3.7 Description of associations between nurses’ characteristics and attitudes  

The study examined attitudes and responses to uncertainty across three age groups: 20-

29, 30-39, and 40+. The 20-29 group showed the highest engagement in Attitude, with 

scores ranging from 21.00 to 26.00 and a median of 24.00. Participants aged 30-39 had 

slightly lower scores but still engaged actively. Those 40 and above reported the lowest 

Attitude scores, ranging from 18.00 to 23.00 with a median of 20.00, indicating less 

participation. Age significantly influenced attitudes (p-value = 0.025), with younger 

individuals demonstrating stronger engagement in the analyzed activities compared to 

older age groups. 

Male and Female distinct differences were observed. Male participants demonstrated 

higher Attitude scores, with quartiles ranging from 22.00 to 27.00 (Q1-Q3) and a median 

of 25.00, indicating consistent engagement. Conversely, female participants reported 

lower Attitude scores, with quartiles ranging from 20.00 to 25.00 (Q1-Q3) and a median 

of 22.00, suggesting less frequent involvement in the examined activities. 

Attitude significantly influenced gender (p-value = 0.001). 

In the examination of attitudes and responses to uncertainty across different job titles - 

Practical Nurse (PN), Registered Nurse (RN), and Head Nurse (HN) - distinct patterns of 

practice engagement were identified. Registered Nurses (RN) demonstrated the highest 

Attitude scores, with quartiles ranging from 21.00 to 26.00 (Q1-Q3) and a median of 

24.00, indicating consistent engagement. Head Nurses (HN) exhibited slightly lower 

Attitude scores, with quartiles ranging from 22.50 to 25.50 (Q1-Q3) and a median of 

24.00, suggesting a moderate level of engagement. Conversely, Practical Nurses (PN) 

reported the lowest Attitude scores, with quartiles ranging from 19.00 to 26.00 (Q1-Q3) 

and a median of 19.00, indicating less frequent involvement. 

 



32 

 

Attitude did not significantly influence job title (p-value = 0.106). 

Participants from non-governmental hospitals demonstrated higher Attitude scores, with 

quartiles ranging from 22.00 to 27.00 (Q1-Q3) and a median of 25.00, indicating 

consistent engagement. Conversely, participants from governmental hospitals reported 

lower Attitude scores, with quartiles ranging from 20.00 to 25.00 (Q1-Q3) and a median 

of 22.00, suggesting less frequent involvement.  

 Attitude significantly influenced hospital type (p-value = 0.001). 

Participants with a Master's degree demonstrated the highest Attitude scores, with 

quartiles ranging from 23.00 to 27.00 (Q1-Q3) and a median of 25.00, indicating 

consistent engagement. Bachelor's degree holders exhibited slightly lower Attitude 

scores, with quartiles ranging from 22.00 to 27.00 (Q1-Q3) and a median of 25.00, 

suggesting a moderate level of engagement. Conversely, those with a diploma reported 

the lowest Attitude scores, with quartiles ranging from 18.00 to 22.00 (Q1-Q3) and a 

median of 20.50, indicating less frequent involvement.  

Attitude significantly influenced scientific degree (p-value < 0.001). 

Participants in ICUs exhibited the highest Attitude scores, with quartiles ranging from 

22.00 to 27.00 (Q1-Q3) and a median of 25.00, indicating consistent engagement in 

relevant activities. Similarly, individuals in Other Wards displayed commendable 

Attitude scores, with quartiles ranging from 20.00 to 27.00 (Q1-Q3) and a median of 

23.50, suggesting a moderate level of engagement. Participants in the Medical/Surgery 

ward reported slightly lower Attitude scores, with quartiles ranging from 21.00 to 26.00 

(Q1-Q3) and a median of 23.00, still indicating substantial involvement. However, 

participants in the Oncology ward demonstrated a decline in Attitude scores, with 

quartiles ranging from 23.50 to 26.00 (Q1-Q3) and a median of 25.00, suggesting reduced 

engagement. Finally, participants in the Emergency Room (ER) reported the lowest 

Attitude scores, with quartiles ranging from 20.00 to 24.00 (Q1-Q3) and a median of 

21.00, indicating limited involvement in the examined activities.  

Attitude significantly influenced clinical unit (p-value = 0.020). 

Engagement levels varied among participants at different institutions. At NNU, 131 

participants had a median engagement level of 25.00, while at Al-Tira College/Ramallah, 



33 

 

7 students had a median of 20.00. Al-Quds University had 11 participants with 

engagement levels ranging from 14.00 to 21.50 and a median of 20.00. 15 participants 

from Al-Andalib College had a midpoint of 19.00. Al-Rawda College had 35 individuals 

with a middle value of 21.00. The University of Jordan saw different levels of 

participation from 4 individuals, Ibn Sina had 33 people involved, and Al-Asriya 

College/Ramallah had 3 students participating. Finally, An-American University had 36 

participants with a median engagement level of 25.00. 

Attitude significantly influenced place of study (p-value < 0.001). 

Participants with 0-5 years of service demonstrated varied engagement levels, with 

quartiles ranging from 21.00 to 26.00 (Q1-Q3) and a median of 23.00 among 101 

participants. Those with 6-10 years of service displayed consistent engagement, with 

quartiles ranging from 21.00 to 27.00 (Q1-Q3) and a median of 25.00 among 109 

participants. However, participants with more than 10 years of service exhibited varied 

engagement levels, with quartiles ranging from 19.00 to 25.00 (Q1-Q3) and a median of 

22.00 among 65 participants.  

Attitude significantly influenced years of service in the hospital (p-value = 0.002). 

Among the 59 participants who had taken such a course, engagement levels exhibited 

variance, with quartiles ranging from 20.00 to 25.00 (Q1-Q3) and a median of 23.00. 

Conversely, among the 216 participants who had not taken the course, engagement levels 

also displayed variability, with quartiles ranging from 21.00 to 26.00 (Q1-Q3) and a 

median of 24.00.  

Participation in Courses related to Practice Using Scientific Evidence: Attitude did not 

significantly influence participation in courses related to practice using scientific 

evidence (p-value = 0.066). 

Among the 124 participants who had taken such a course, engagement levels ranged from 

moderate to high, with quartiles spanning from 21.00 to 26.00 (Q1-Q3) and a median of 

23.00. Conversely, among the 151 participants who had not taken the course, engagement 

levels were comparable, ranging from moderate to high, with quartiles from 20.00 to 

26.00 (Q1-Q3) and a median of 24.00.  



34 

 

Participation in Courses related to Scientific Research: Attitude not significantly 

influenced participation in courses related to scientific research (p-value = 0.563). 

 Participants who perceived a link between scientific research and healthcare practice 

exhibited engagement levels with quartiles ranging from 21.00 to 26.00 (Q1-Q3) and a 

median of 23.00. On the other hand, participants who did not perceive the link displayed 

engagement levels with quartiles ranging from 20.00 to 26.00 (Q1-Q3) and a median of 

24.00. 

Attitude significantly influenced the perception of the link between scientific research 

and healthcare practice (p-value < 0.001), showing in appendix A, table 9. 

3.8 Description of associations between nurses’ characteristics and barriers to 

research utilization  

A non-parametric analysis was performed to evaluate the relationship between several 

professional and demographic characteristics and nurses' perceptions of barriers to using 

research. Below is a summary of the findings: 

Age: For individuals aged 20–29 (n = 141), the median barrier score was 2.00 [1.00-3.00], 

for those aged 30-39 (n = 109) it was likewise 2.00 [1.00-3.00], and for those aged 40 and 

above (n = 25), the median was 3.00 [2.00-3.00]. In the age group comparison, the p-

value was 0.004, which suggests that there is a statistically significant difference between 

the age groups. 

Gender: For male participants (n = 146), the median barrier score was 2.00 [1.00-3.00], 

while for female participants (n = 129), it was 2.00 [2.00-3.00]. For the gender 

comparison, the p-value was 0.003, which means that there is a statistically significant 

difference between the genders. 

Hospital Type: The median barrier score for participants in governmental hospitals (n = 

106) was 3.00 [2.00-3.00], whereas the median score for those in non-governmental 

hospitals (n = 169) was 2.00 [1.00-2.00]. Given that the p-value was less than 0.001, a 

statistically significant difference was present. 

Degree: The median barrier score for nurses with a diploma (n = 60) was 2.00 [2.00-3.00], 

a bachelor's degree (n = 185) was 1.00 [1.00-3.00], and a master's degree (n = 30) was 



35 

 

1.00 [2.00-2.00]. There was a statistically significant difference between the degree 

levels, as indicated by the p-value of less than 0.001. 

Clinical Unit: The median scores of nurses in ICUs (n = 104) and medical/surgery units 

(n = 131) were 2.00 [2.00-3.00] and 2.00 [1.00-2.50], respectively. The medians of the 

other units varied. There was a statistically significant difference among units, as 

indicated by the p-value of 0.007. 

place of study : The research revealed that the median barrier scores varied among the 

study locations, with NNUH scoring 2.00 [1.00–2.00] and other institutions scoring 3.00 

[2.00–3.00]. Given that the p-value was less than 0.001, a statistically significant 

difference was present. 

Years of Hospital Service: The median barrier score for nurses with 0–5 years of service 

(n = 101) was 2.00 [2.00–3.00], for those with 6–10 years of service (n = 109) it was 2.00 

[1.00–2.00], and for those with more than 10 years of service (n = 65), it was 3.00 [2.00–

3.00]. Given that the p-value was less than 0.001, a statistically significant difference was 

present. 

In the examination of BRU and responses to uncertainty across job titles - Practical Nurse 

(PN), Registered Nurse (RN), and Head Nurse (HN) - significant differences were 

observed. Practical Nurses (PN) demonstrated the highest BRU scores, with a median of 

70.00 and an interquartile range (Q1-Q3) spanning from 66.00 to 81.00, indicating 

consistent engagement. Registered Nurses (RN) exhibited slightly lower BRU scores, 

with a median of 68.00 and an interquartile range spanning from 56.00 to 78.00 (Q1-Q3), 

suggesting a moderate level of engagement. In contrast, Head Nurses (HN) reported the 

lowest BRU scores, with a median of 68.00 and an interquartile range spanning from 

58.00 to 74.50 (Q1-Q3), indicating less frequent involvement in the examined activities 

compared to Practical and Registered Nurses. 

BRU did not significantly influence job title (p-value = 0.470). 

Link Between Scientific Research and Healthcare Practice: A majority of participants (n 

= 209) believed there was a link between scientific research and healthcare practice, with 

a median barrier score of 2.00 [1.00-3.00], while participants who did not believe in a 



36 

 

link (n = 66) had a median score of 2.00 [2.00-3.00]. The p-value was 0.006, indicating a 

statistically significant difference. 

These results highlight the associations between different variables and perceived barriers 

to research utilization. Further research is needed to explore these relationships in depth. 

In the examination of BRU and responses to the question of whether participants received 

a course on practice using scientific evidence, noteworthy distinctions in engagement 

levels were observed. Among the 59 participants who had taken such a course, 

engagement levels exhibited variance, with a median of 71.00 and an interquartile range 

(Q1-Q3) spanning from 58.50 to 83.00. Conversely, among the 216 participants who had 

not taken the course, engagement levels also displayed variability, with a median of 66.50 

and an interquartile range spanning from 56.00 to 77.00 (Q1-Q3). Participation in Courses 

related to Practice Using Scientific Evidence: BRU did not significantly influence 

participation in courses related to practice using scientific evidence (p-value = 0.058). 

In the analysis of BRU and responses concerning whether participants had taken a course 

on scientific research, intriguing results emerged. Among the 124 participants who had 

taken such a course, engagement levels ranged from moderate to high, with a median of 

70.00 and an interquartile range (Q1-Q3) spanning from 58.00 to 77.00.  Conversely, 

among the 151 participants who had not taken the course, engagement levels were 

comparable, with a median of 65.00 and an interquartile range spanning from 55.50 to 

80.00 (Q1-Q3). These findings suggest consistent engagement levels across both groups, 

regardless of participation in the scientific research course. 

Link Between Scientific Research and Healthcare Practice: Participants who did not 

believe in a link (n = 66) had a median barrier score of 2.00 [2.00-3.00], whereas the 

majority of participants (n = 209) believed there was a link between scientific research 

and healthcare practice. With a p-value of 0.006, a statistically significant difference was 

shown, showing in appendix A, table 10. 

 

 

 



37 

 

3.9 Description of correlations between evidence-based practice, knowledge, 

attitudes, and barriers to research utilization    

Correlation Between EBP and Attitudes Toward Evidence-Based Healthcare Providers: 

Pearson correlation coefficient (r) = 0.619** 

p-value < 0.001 

Interpretation: There is a strong positive correlation (r = 0.619, p < 0.001) between EBP 

utilization and attitudes toward evidence-based healthcare providers. This indicates that 

as EBP utilization increases, attitudes toward evidence-based practice also tend to become 

more positive. 

Correlation Between EBP and Knowledge Associated with EBP in Healthcare Providers: 

Pearson correlation coefficient (r) = 0.406**p-value < 0.001 

Interpretation: There is a moderate positive correlation (r = 0.406, p < 0.001) between 

EBP utilization and knowledge associated with evidence-based practice in healthcare 

providers. This suggests that higher levels of EBP utilization are associated with greater 

knowledge of evidence-based practices. 

Correlation Between EBP and Barriers of Research Utilization (BRU) in Healthcare 

Providers: 

Pearson correlation coefficient (r) = -0.461** p-value < 0.001 

Interpretation: There is a moderate negative correlation (r = -0.461, p < 0.001) between 

EBP utilization and barriers of research utilization (BRU) in healthcare providers. This 

implies that as EBP utilization increases, barriers responses to uncertainty tend to 

decrease. 

Correlation Between Attitudes Toward EBP and Knowledge Associated with EBP in 

Healthcare Providers: 

Pearson correlation coefficient (r) = 0.451** p-value < 0.001 

Interpretation: There is a moderate positive correlation (r = 0.451, p < 0.001) between 

attitudes toward evidence-based practice and knowledge associated with evidence-based 



38 

 

practice in healthcare providers. This suggests that more positive attitudes toward EBP 

are associated with higher levels of knowledge in evidence-based practices. 

Correlation Between Attitudes Toward EBP and BRU in Healthcare Providers: 

Pearson correlation coefficient (r) = -0.486** p-value < 0.001 

Interpretation: There is a moderate negative correlation (r = -0.486, p < 0.001) between 

attitudes toward evidence-based practice and barriers of research utilization (BRU) in 

healthcare providers. This indicates that more positive attitudes toward EBP are 

associated with lower levels of barriers response to uncertainty. 

Correlation Between Knowledge Associated with EBP and BRU in Healthcare Providers: 

Pearson correlation coefficient (r) = -0.342** p-value < 0.001 

Interpretation: There is a weak negative correlation (r = -0.342, p < 0.001) between 

knowledge associated with evidence-based practice and barriers (BRU) in healthcare 

providers. This suggests that higher levels of knowledge in evidence-based practices may 

be associated with lower levels of barriers response to uncertainty, although the 

correlation is weak, showed in table 6. 

Table 6 

Correlations between knowledge, attitudes, practice, and barriers to research utilization  

  
Attitude toward 

EBP 

Knowledge 

associated with 

EBP 

BRU total score 

EBP 
Correlation 

Coefficient 
0.619** 0.406** -0.461-** 

 P-value < 0.001 < 0.001 < 0.001 

Attitude toward 

EBP 

Correlation 

Coefficient 
 0.451** -0.486-** 

 P-value  < 0.001 < 0.001 

Knowledge 

associated with 

EBP 

Correlation 

Coefficient 
  -0.342-** 

 P-value   < 0.001 

**Correlation is significant at the 0.01 level (2-tailed). 

The key findings from the regression analyses in appendix A table 11 were: 

evidence-based practice (EBP) - The model accounted for 16.6% of the variance 

explained, R² = 0.166. Degree was a positive predictor, B = 3.194, p < 0.001; age was 



39 

 

negatively associated with EBP, B = -2.119, p = 0.005, while gender, marital status 

and hospital type were not significant predictors of the model. 

Attitude to EBP: The model accounted for 17.4% of the variance, R² = 0.174. Degree 

contributed significantly and positively, B = 2.533, p < 0.001, while age, gender, and 

years of service showed insignificant associations. Type of hospital was also 

significant, B = 1.167, p = 0.028. 

Knowledge Associated with EBP: The model accounted for 20.9% of the variance (R² 

= 0.209). Degree again was significantly positively related (B = 9.193, p < 0.001) and 

age was negatively associated (B = -1.936, p = 0.217). Other predictors such as gender, 

marital status, and hospital type were not significant predictors.  

BRU Scale Range: The model accounted for 24.7% of variance, R² = 0.247. Degree 

negatively predicted BRU scale scores, B = -0.270, p < 0.001, while the type of hospital 

had a significant negative effect, B = - 0.619, p < 0.001. Age, gender, and years of 

service did not reach statistical significance in predicting BRU scale scores.  

Education level repeatedly emerged as a strong predictor: degree positively predicted 

EBP, attitudes about EBP, and knowledge. Age was negatively associated with EBP 

and associated knowledge. Other variables came in and out of strength across the 

different models. 

 



40 

 

Chapter Four 

Discussion 

4.1 Assessing Knowledge Levels to Evidence-Based Practice Among Nurses 

While score over 56%, at 82.2% of the participants, expressed a higher level of knowledge 

about EBP, it can be said that most have a good command of EBP concepts. This is similar 

to other studies, such as one by (Hammad et al., 2020), where the same level of knowledge 

was found in Jordanian nurses. This is, however, contrary to studies done elsewhere, 

which reported poor knowledge levels; hence, these results could signal that local 

educational drives within Nablus City have borne fruits in the acquisition of knowledge 

among the nurses. The statistically significant relationship between knowledge and 

involvement in EBP activities, established in this study (p-value < 0.001), asserts the role 

of knowledge in encouraging the involvement of individuals in EBP, as evidenced in 

literature by an indication for continuous professional development. 

4.2 Palestinian nurses' perceived knowledge associated with EBP, Attitude toward 

EBP, and EBP 

In this study, across the three aspects (Knowledge, Attitude, and Practice), knowledge got 

the highest median score (76.00). This indicates a strong understanding and awareness 

among participants regarding the principles and importance of EBP, followed closely by 

practice (36.50), which suggests that participants are actively engaged in implementing 

EBP principles in their clinical practice, demonstrating a practical application of their 

knowledge, then attitude (25.00), This reflects a positive and supportive attitude among 

participants towards EBP, indicating their willingness and openness to adopting 

evidence-based approaches in healthcare delivery. In the  previous study among Jordanian 

nurses found that attitude toward EBP had the highest mean score, followed by 

knowledge connected with EBP, and finally EBP implementation (practice) (Ma'moun & 

Abu-Moghli, 2020). However, Previous studies in Saudi Arabia found that knowledge of 

EBP had the highest mean score, while EBP implementation had the highest mean score 

in another study. However, a study from the Arab world (Ammouri et al., 2014; Ma'moun 

& Abu-Moghli, 2020) and other countries such as California ,Bir