Investigation of evidence-based practices of nurses in a rural public hospital: a mixed methods study

Evidence-based practice was essential for ensuring high-quality patient care, improving safety, and reducing healthcare costs. As the largest group of healthcare providers, nurses played a pivotal role in implementing evidence-based practice. However, they often encountered multiple personal and organizational barriers, particularly in rural settings characterized by limited resources and geographic isolation. This study aimed to comprehensively examine nurses’ attitudes toward evidence-based nursing in a rural public hospital and to assess how these attitudes influenced clinical care practices. An explanatory sequential mixed-methods design was employed. Quantitative data were collected from 86 nurses using a Nurse Information Form and the Scale of Attitudes Toward Evidence-Based Nursing. Qualitative data were obtained through three mini–focus group interviews with nine nurses purposefully selected based on variations in their evidence-based practice attitudes and professional characteristics. Descriptive statistics, one-way ANOVA, LSD post hoc tests, and thematic analysis were used to analyze the data. The mean attitude score was 58.09 ± 9.17, with significantly higher scores among nurses with 1–10 years of professional experience. Thematic analysis revealed three overarching themes: facilitators, barriers, and suggestions. Facilitators included peer collaboration, innovation, nursing professionalism, and improved quality of patient care. Barriers comprised patient reactions, professional challenges, organizational limitations, insufficient knowledge, and workplace conflicts. Nurses’ recommendations emphasized enhancing patient and nurse education, fostering a culture of discussion, updating clinical guidelines, and strengthening shared decision-making mechanisms. Although nurses demonstrated generally positive attitudes toward evidence-based practice, they encountered substantial challenges in applying it in clinical settings. Establishing structured support systems, leadership training, and policy-level interventions is essential to foster effective and sustainable implementation of evidence-based practice in rural hospitals.