Exploring the influence of organizational culture on evidence-based practice adoption among nurses in tertiary hospitals: a qualitative study
Abdulaziz M. Alodhialah
Abstract
BACKGROUND: Evidence-based practice (EBP) is widely acknowledged as a foundation for safe, high-quality nursing care. Despite institutional support and training initiatives, the integration of EBP into daily clinical practice remains inconsistent, particularly in tertiary healthcare settings. Organizational culture plays a critical role in shaping nurses' engagement with evidence, yet its influence remains underexplored in Middle Eastern contexts. This study explored how organizational culture affects EBP adoption among nurses in tertiary hospitals in Riyadh, Saudi Arabia. METHODS: A qualitative study using a phenomenological design was conducted between January and March 2025. Semi-structured interviews were carried out with 20 registered nurses from three tertiary hospitals. Participants were purposively sampled for diversity in roles and departments. Data were analyzed thematically using Braun and Clarke's six-phase framework. RESULTS: Four key themes emerged: (1) Culture of Hierarchy and Silence, where leadership distance suppressed nurse agency; (2) Inconsistent EBP Messaging, reflecting a gap between institutional rhetoric and practice; (3) Peer Influence and Informal Norms, showing how unit-level cultures shaped EBP behaviors; and (4) Agency, Identity, and Professional Growth, highlighting nurses' resilience and internal motivation to apply evidence despite systemic barriers. CONCLUSIONS: Organizational culture significantly influences nurses' EBP adoption. Hierarchical norms, symbolic compliance, and inconsistent leadership engagement hinder implementation, while peer support and professional agency act as enablers. Cultural and relational change strategies are needed alongside technical training to promote EBP in tertiary settings.