Content area
Aim/objective
To analyse and synthesise current evidence on educational strategies for teaching evidence-based practice (EBP) to undergraduate nursing students, with a specific focus on non-native English-speaking learner populations.
Background
Teaching EBP in non-native English-speaking settings presents distinct challenges, including language proficiency barriers, limited access to research literature and variability in pedagogical approaches. Despite the range of educational strategies introduced in the literature, a universally accepted or recommended method has yet to be established.
Design
An integrative literature review was conducted to examine peer-reviewed empirical studies on EBP education published between 2015 and 2025, with a focus on educational strategies. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Methods
Twelve studies met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. An inductive thematic analysis was employed to synthesise the findings.
Results
All reviewed studies employed quantitative methodologies with a pre-post or quasi-experimental design. Thematic analysis identified five key categories in teaching EBP: educational methods, technology integration, clinical focus, collaboration, intervention duration and outcomes. The studies showed that various educational methods demonstrated effectiveness in enhancing nursing students’ EBP competencies, as reflected in improved knowledge, attitudes and skills.
Conclusions
Diverse and scaffolded teaching methods enhance EBP competencies in non-native English-speaking nursing students. A longitudinal, multimodal and flexible approach emphasising collaboration, integration and practice orientation with technological support, appears most effective. Internationally informed guidelines are needed to ensure consistent development of core EBP competencies globally.
1 Introduction
Nursing education that incorporates evidence-based practice (EBP) is essential for developing competent nurses who are capable of critically appraising and translating evidence to improve patient outcomes, deliver high-quality care and remain committed to lifelong learning (2024; Patelarou et al., 2020). To ensure evidence-based healthcare in the future, nursing education curricula must include strategies for teaching EBP to nursing students ( Karlsholm et al., 2024). EBP is a learnable but complex skill ( Kyriakoulis et al., 2016) and it includes critical thinking, interpretation of statistical data, qualitative work and the use of bibliographic databases and research methodologies ( Lehane et al., 2019; Malik et al., 2018). Therefore, students first have to promote critical thinking and knowledge transfer; they also need to be introduced to the scholarly writing of theory before they are able to understand the relevance of research findings ( Aglen, 2016).
Nursing students gain foundational knowledge of EBP use during their practicums ( Alqahtani, 2015). To support effective knowledge transfer, EBP teaching at the bachelor level should prioritise learning situations that relate directly to clinical problems, as this enhances the students’ interest and ability to connect theory with real-world practice ( Aglen, 2016). Effective evidence-based teaching in nursing education requires a holistic approach that includes clear learning objectives, the integration of EBP principles into the curriculum, the application of theory in clinical settings, the use of interactive methods and technology and the promotion of collaborative learning ( Bhatarasakoon and Chiaranai, 2024). As learners’ needs evolve across generations, teaching methods must adapt. Nursing students need a combination of methods with an option to choose a preferred strategy ( Shorey and Chua, 2022). Multifactorial interventions and the use of technologies based on web and mobile devices seemed to be the most effective for teaching EBP a decade ago ( Kyriakoulis et al., 2016). Transitioning from traditional to innovative formats can be achieved through blended pedagogy, which combines face-to-face and online learning to enhance engagement and the application of knowledge ( Shorey and Chua, 2022). Interactive teaching strategies, used alongside traditional lectures, enhance research use skills ( Horntvedt et al., 2018). Multifaceted interventions, with combinations of methods including lectures, computer sessions, small group discussions, journal clubs and assignments, are more likely to improve knowledge, skills and attitude compared with single interventions or no interventions ( Kyriakoulis et al., 2016). Such dynamic educational environments foster a deeper understanding of EBP, the development of practical skills and the confidence to effect positive change in healthcare delivery ( Bhatarasakoon and Chiaranai, 2024).
Nursing education for EBP emphasises information literacy as the most important competence ( Aglen, 2016; Horntvedt et al., 2018). Limited proficiency in English has been identified as one of the most significant EBP learning barriers faced by non-native English-speaking nursing students ( Olson, 2012). A particularly notable challenge is the linguistic landscape of academic publishing, wherein most high-impact research journals are published in English, potentially limiting access and engagement for non-native English speakers ( Madhavanprabhakaran et al., 2023). For non-native English-speaking nurses, limited proficiency in academic English can impede their ability to critically appraise, interpret and apply research findings, thereby restricting equitable access to global scientific knowledge. Also, the structure and functioning of literature search systems further compound the linguistic barriers. Indexing systems such as Medical Subject Headings (MeSH) and Nursing Subject Headings are integral tools for systematically identifying and retrieving relevant scientific literature in nursing. However, these controlled vocabularies and the search algorithms that support them are primarily constructed in English, requiring users to formulate search queries using English terminology. This standardisation inadvertently marginalises non-native English speakers, impeding their engagement with evidence-based resources ( Labrague et al., 2019).
The literature highlights the specific educational needs of non-native English-speaking nursing students, which can be addressed through adaptations in the nursing curricula ( Choi, 2005). According to Crawford (2004), second language learners benefit from tailored instructional programmes, alternative teaching models and comprehensive assessment and monitoring strategies. While EBP is acknowledged as an essential element of nursing curricula, there remains a lack of resources and tailored strategies to support its instruction among nursing students studying in a second language.
2 Aim
The purpose of the present integrative literature review was to recognise the existing educational strategies used to teach EBP in non-native English-speaking undergraduate nursing students. The review question was: “What teaching strategies are used to enhance competency in EBP nursing education in non-native English-speaking undergraduate students?” This study may contribute to gathering ideas and recommendations for teaching EBP to nursing students all over the globe.
3 Methods
The study protocol was guided by the PICO scheme. The review process was reported in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (
Page et al., 2021) (
A literature search was conducted in March and April 2025 across the following databases: CINAHL, the Cochrane Library, MEDLINE, PubMed, ProQuest, ScienceDirect, Scopus, SpringerLink and Web of Science. The target population included non-native English-speaking students enrolled in undergraduate nursing study programmes. The intervention involved the educational delivery of EBP, with programme impact serving as the primary evaluative outcome. The keywords were: (1) “Students, Nursing”, “Non-native-English-speaking”; (2) “Evidence-Based Practice”, “Evidence-Based Nursing”; (3) “Education”, “Learning”, “Teaching strategies”, “Teaching methods”; and (4) “Programme evaluation”. We used all the identified keywords and index terms to search for relevant articles, applying the Boolean operators AND and OR appropriately. Additionally, we employed the NOT operator to exclude terms such as “clinical nursing” and “medical students”. The search was supplemented by a manual review of the reference lists for each article.
From the identified papers, studies meeting the following eligibility criteria were selected: (1) Papers published in peer-reviewed journals as high-quality literature was of interest; (2) Papers published during the last 10 years as up-to-date knowledge was considered necessary; (3) Study designs including randomised controlled trials, controlled trials or cohort studies (pre-post longitudinal studies); and (4) Studies that focused on educational interventions. Studies not meeting these criteria were excluded and studies meeting the criteria were shortlisted for inclusion in the review. The search was not limited to articles published in English, as the research articles were translated (when needed) using a web engine. For each database, the search strategy was reviewed, revised and modified based on the indexes found (
4 Results
4.1 Characteristics of the included studies
The database search identified 1792 records. Studies were conducted from 2015 to 2025. After duplicates were eliminated using My End Note Web, the researcher screened the titles and abstracts of 758 articles. Following the screening of titles and abstracts, 715 articles were excluded due to their focus on clinical interventions or insufficient relevance to nursing education. During the subsequent full-text review phase, 15 articles were excluded as they were (systematic) reviews and an additional two studies were excluded because they did not involve the undergraduate nursing student population. In the next stage, we selected the literature from countries where English is not the native language (China, Iran, Italy, Norway, Palestine, Portugal, South Korea, Spain and Taiwan) and excluded those with a native English-speaking population (the United States of America, Canada, England and Ireland) (n = 10). Ultimately, 12 full-text articles met the inclusion criteria and were retained for detailed analysis.
4.2 Quality assessment of the included studies
The methodological quality of the studies was assessed using appropriate JBI Critical appraisal tools consisting of 9–11 questions. The response options for each question are “Yes”, “No”, “Unclear” and “Not Applicable”. The overall appraisal of the study quality is categorised as “Include”, “Exclude”, or “Seek Further Information”. All 12 selected studies met the minimum quality criteria as defined by the JBI guidelines and were included in the final synthesis. The included articles were documented with information on the authors, publication year, country of the first author or research, design, intervention details and outcomes using Microsoft Word. The characteristics of the studies are summarised in
We did not find any study that directly reports on the specifics of teaching EBP to non-English-language nursing students. Most topics were focused on the effectiveness and outcomes of EBP teaching strategies. We analysed articles with thematic analysis and identified five main categories that were considered in teaching EBP: Educational methods, Use of technology, Clinical focus, Collaboration, Length of intervention and Outcomes (
4.3 Educational methods
Traditional face-to-face instruction in EBP was examined by Du et al. (2023), who delivered EBP content concurrently with nursing research. Ruzafa-Martínez et al. (2023) evaluated a mandatory EBP course that integrated face-to-face teaching with independent student work and the flipped classroom. This course employed a variety of multimedia resources, including videos, clinical scenarios, questionnaires, educational games and other interactive tools. Similarly, Liou et al. (2023) and Pendoni et al. (2024) highlighted the effectiveness of mixed-ability classrooms and a multimodal instructional approach that combined online learning, flipped classrooms and traditional in-person teaching. Support for blended learning, defined as the integration of conventional classroom instruction with e-learning modalities, was also provided by Oh and Yang (2019). Estalella et al. (2023) used online strategies centred on clinical scenarios to support EBP learning, while Kim et al. (2019) demonstrated the benefits of combining didactic lectures with practical sessions. Notably, Mena-Tudela et al. (2018) reported that university-based EBP interventions yielded more substantial improvements in student outcomes compared with those delivered during clinical clerkships.
4.4 Using technology
A variety of technology-enhanced teaching strategies have been implemented to support instruction in EBP. For instance, blended learning approaches frequently incorporate interactive web-based platforms that feature components such as quiz-based games to reinforce learning ( Park et al., 2020). The flipped classroom model has also gained prominence, particularly when augmented with multimedia resources, instructional videos and interactive activities to promote active learning and student engagement ( Ruzafa-Martínez et al., 2016, 2023). Similarly, virtual education (delivered through both synchronous and asynchronous formats) has demonstrated effectiveness in broadening students’ exposure to EBP concepts by offering a flexible and accessible learning environment ( Shamsaee et al., 2021). Additional studies have explored the use of computer-based and distance learning modalities, which further enhance accessibility and accommodate diverse learning needs ( Oh and Yang, 2019). Beyond structured instructional methods, technology has also been employed to foster student motivation and communication. Tools such as email and messaging applications (e.g., WhatsApp) have been used to deliver timely reminders, offer encouragement and facilitate interaction between students and educators ( Shamsaee et al., 2021).
4.5 Clinical focus
Integrating clinical nurses into the teaching process or encouraging students to conduct literature reviews in response to actual clinical questions from healthcare settings are effective educational methods ( Pendoni et al., 2024). These approaches are especially appreciated by students who perceive a meaningful link between their academic work and practical clinical application ( Estalella et al., 2023). Complementary to this, educational interventions that combine theoretical foundations with practical exercises, such as those incorporating the critical incident technique and problem-based learning, can significantly reinforce the students’ ability to understand and apply the EBP process in real-world contexts ( Mena-Tudela et al., 2018; Oh and Yang, 2019).
4.6 Collaboration
Collaboration emerged as a recurring instructional element across studies. Ruzafa-Martínez et al. (2016) incorporated small group discussions, peer learning and team-based project work to support knowledge exchange and cooperative problem-solving. Pendoni et al. (2024) also integrated collaborative tasks into their EBP programme, which contributed to improved learning outcomes and satisfaction. Flexible grouping strategies, allowing students to choose their preferred collaboration format, were found to promote autonomy and engagement ( Liou et al., 2023).
In addition, interdisciplinary collaboration in the design and delivery of EBP education emerged as a promising strategy. Educational interventions co-designed by teams comprising clinical and academic nurses, along with librarians, were found to strengthen the connection between evidence generation and its practical application ( Estalella et al., 2023). A notable example is the inclusion of specialised EBP lectures delivered jointly by a clinical expert and a university librarian, illustrating the value of cross-sector collaboration in deepening students’ understanding of EBP ( Oh and Yang, 2019).
4.7 Length of intervention
The duration and intensity of EBP educational interventions varied considerably across studies. Ruzafa-Martínez et al. (2016) reported the effectiveness of a structured 60-hour programme, while Cardoso et al. (2021) implemented an 18-hour curriculum delivered over 17 weeks. Similarly, Pendoni et al. (2024) observed beneficial outcomes following a 15-hour intervention. Kim et al. (2019) evaluated a 20-hour programme and Oh and Yang (2019) employed a 30-hour intensive course, both of which led to significant improvements in EBP competencies. A more comprehensive 150-hour course spanning 15 weeks was assessed by Ruzafa-Martínez et al. (2023), yielding notable improvements in EBP-related attitudes and skills. In addition, Mena-Tudela et al. (2018) demonstrated that the use of the critical incident technique during 12 weeks of clinical clerkships contributed meaningfully to the development of students’ EBP competencies.
4.8 Outcomes
A range of teaching strategies grounded in EBP principles have demonstrated positive outcomes in enhancing students' EBP-related competencies. Across multiple studies, these interventions were shown to improve the knowledge, skills, attitudes and future application of EBP ( Du et al., 2023; Kim et al., 2019; Mena-Tudela et al., 2018; Ruzafa-Martínez et al., 2023). For example, Ruzafa-Martínez et al. (2023) found comparable improvements in students' EBP knowledge, skills and attitudes regardless of the instructional approach, suggesting that varied teaching modalities can be equally effective. In contrast, Cardoso et al. (2021) observed that while both intervention and control groups experienced significant gains in knowledge and skills, the intervention group demonstrated more substantial improvements, underscoring the potential benefits of tailored instructional strategies.
The impact of online and blended learning modalities has also been examined. Web-based interactive learning was found to be significantly more effective than traditional methods in improving EBP knowledge, skill acquisition and confidence in formulating clinical questions ( Park et al., 2020). Estalella et al. (2023) reported high levels of student satisfaction with an online EBP course, particularly appreciating the alignment between course assignments and clinical practice, as well as the provision of immediate feedback. Oh and Yang (2019) found that a blended learning approach led to significant increases in students’ EBP knowledge, self-efficacy and the use of evidence sources, including databases and clinical resources.
Liou et al. (2023) implemented a course based on differentiated instruction, which yielded positive outcomes in student engagement, collaborative learning, learning satisfaction, attitudes toward EBP and EBP-related knowledge. Similarly, a 15-week quasi-experimental course resulted in significant improvements across the domains of EBP attitudes, knowledge and skills ( Ruzafa-Martínez et al., 2016). However, subsequent research by Ruzafa-Martínez et al. (2023) indicated that while there were notable gains in overall EBP competence, improvements in knowledge were not statistically significant. Finally, a before–after study by Pendoni et al. (2024) demonstrated significant gains in students’ EBP knowledge, attitudes, competencies and satisfaction following an educational intervention, further supporting the efficacy of well-structured EBP instruction.
5 Discussion
The study discusses the results from the integrative review of research on EBP education interventions in undergraduate nursing students from non-native English-speaking countries. Regardless of whether students are native or non-native English speakers, everyone needs to be equipped with the skills to critically appraise scientific literature and integrate evidence into clinical decision-making. However, limited proficiency in academic and professional English can pose a significant barrier to accessing and understanding research evidence.
One promising approach is the implementation of a longitudinal evidence-based programme. Studies report a wide range of educational interventions, varying from 15 to 150 h in length ( Pendoni et al., 2024; Ruzafa-Martínez et al., 2023). Sanzhez-Garcia et al. (2019) stated that the effect of educational intervention in EBP cannot be observed in courses shorter than 40 h and reported a positive link between instructional hours in research methods and EBP competency. However, the findings across studies are not entirely consistent in this regard. Despite the assumption that longer interventions are more effective, current evidence shows no clear dose-response relationship. While brief, well-structured interventions may yield measurable gains, longer and more intensive courses appear to offer greater benefits in reinforcing skills and shaping attitudes. This suggests that the effectiveness of EBP education may depend less on length and more on the educational approach and learning context. In contrast, there is research claiming that extended exposure provides students with more time to immerse themselves in the professional language required for comprehending and applying the EBP literature effectively ( Skela-Savič et al., 2017). The effective development of EBP competencies in nursing students requires a structured, stepwise educational approach ( Pashaeypoor et al., 2017). This approach should facilitate the gradual acquisition of terminology and scientific discourse, thereby enhancing the ability to integrate evidence into clinical decision-making. This finding emphasizes the need for strategic curriculum planning and institutional support to ensure that EBP is embedded across all levels of nursing education. The discrepancies among the various studies’ findings are likely attributable to methodological limitations, particularly the predominant reliance on short-term outcome measurements conducted immediately post-intervention, rather than long-term follow-up assessments.
Another area of ongoing debate pertains to the pedagogical approaches used in EBP education. Contemporary literature highlights a clear shift away from conventional lecture-based instruction toward the adoption of diverse, interactive and learner-centred strategies. Active learning techniques are being employed to enhance student engagement and critical thinking. Also, a blended educational design integrating diverse teaching methods appears particularly well suited for EBP training ( Du et al., 2023; Ruzafa-Martínez et al., 2016, 2023). The initial stages may benefit from didactic instruction, including practice tasks, tutorials and lectures, combined with collaborative activities such as group discussions and team-based learning ( Cardoso et al., 2021; Horntvedt et al., 2018). As learners advance, however, a shift towards individualised, problem-based learning would enhance critical thinking. At some point the activities should support students’ active role through the use of multimedia, videos, interactive games, the flipped classroom, e-learning and simulations ( Estalella et al., 2023; Park et al., 2020; Ruzafa-Martínez et al., 2023). The integration of advanced educational technologies into EBP education demands careful consideration to ensure pedagogical effectiveness.
A major limitation in current EBP education is the absence of a standardised international curriculum and evaluation framework. As Tian et al. (2025) noted, many existing university-level EBP courses suffer from inconsistencies and structural deficiencies, which hinder the comparability and quality of educational outcomes across institutions. While advances in educational technology present substantial opportunities to enhance EBP education, their implementation must be guided by evidence, grounded in sound pedagogical principles and tailored to meet the diverse needs of learners. Current evidence suggests that employing a combination of instructional modalities (such as blended learning, simulation and interactive digital platforms) can significantly improve the effectiveness of EBP education in nursing. These multimodal strategies promote active engagement, flexibility and the contextual application of knowledge. The findings highlight the need for greater standardisation in the design and delivery of EBP curricula, particularly for non-native English-speaking students, who face the dual challenge of mastering the EBP process while simultaneously developing digital literacy and the ability to search for and critically appraise scientific literature.
A key element in the effective teaching of EBP is the integration of academic instruction with real-world clinical experience through problem-based tasks, realistic scenarios and reflective methods such as the critical incident technique ( Estalella et al., 2023; Pendoni et al., 2024). The competence most fundamental for EBP is not the ability to understand the research process, interpret research studies, or evaluate research findings. Knowledge about how evidence relates to practise is the important prerequisite for EBP ( Aglen, 2016). The transition from theory to practise in EBP education should be implemented in a realistic and context-sensitive manner, acknowledging that the clinical environment may not consistently support or prioritise EBP-related activities. Mena-Tudela et al. (2018) stated that EBP interventions delivered in university settings show greater impact than those during clinical clerkship, likely due to stronger pedagogical support. Bridging the gap between academic instruction and clinical practice is a fundamental challenge in EBP education for nursing students. Embedding clinical realities into EBP instruction strengthens educational impact and promotes meaningful, practice-oriented learning. These strategies not only enhance students’ EBP competences but also contribute to the cultivation of evidence-informed practitioners.
Studies of EBP have increasingly emphasised the effectiveness of group- or team-based learning formats. Collaborative learning environments promote nursing knowledge and skill performance, improving student clinical competency, as well as promoting student group skills and learning behaviour ( Zhang and Cui, 2018). Group work facilitates the integration of diverse perspectives, particularly when teams include participants from varied educational and professional backgrounds such as undergraduate nursing students, clinical nurses, academic nurses and university librarians ( Estalella et al., 2023; Oh and Yang, 2019; Pendoni et al., 2024). As many professionals practise as a team, a trans-cultural approach will equip students with a shared EBP language, knowledge and skills. This will facilitate their future engagement in multidisciplinary teams, debates and practice development ( Redmond et al., 2024). McNeill et al. (2024) suggested teaching students at different graduate levels in the same EBP course, as this would promote collaboration and demonstrate how the various degrees can work together. Collaboration contributes to a supportive learning environment and facilitates a gradual immersion into the language of science. These activities bridge theoretical knowledge and practical understanding, while also encouraging the exchange of ideas, the construction of shared knowledge and the furthering of critical discussion.
The findings of this review have broad applicability extending beyond the specific countries where the original studies were conducted. Despite contextual differences, several consistent pedagogical principles emerge: a) the effectiveness of blended learning modalities; b) the advantages of collaborative teaching strategies; c) the critical importance of aligning EBP education with real-world clinical practice; and d) the significance of the duration of educational interventions, with longer programmes potentially offering greater benefits particularly for non-native English-speaking learners. These insights underscore core educational approaches that are relevant across the diverse nursing education systems worldwide.
While most studies report significant improvements in EBP competences, sustained knowledge retention remains a challenge, highlighting the need for ongoing curriculum refinement. Integrating flexible digital approaches with traditional methods presents a promising strategy. To address these challenges, we propose a pedagogical approach which integrates AI-supported learning, micro-credentialing and interprofessional collaboration to overcome the key limitations of conventional EBP instruction. This approach is structured around four foundational components: a) Longitudinal clinical integration, providing sustained exposure to EBP throughout clinical placements; b) AI-driven platforms, offering real-time support for literature searching and critical appraisal; c) Modular curricula, organized into stackable micro-credentials aligned with core EBN competencies, each accompanied by interactive learning modules and applied clinical tasks; and d) Interprofessional collaboration, engaging students from diverse health disciplines so as to address clinical questions from multiple perspectives. Rather than delivering EBN content in a single isolated course, the proposed EBN approach embeds inquiry-based learning longitudinally across clinical placements. Students identify clinical questions during their rotations and work in interdisciplinary teams guided by both academic and clinical mentors.
Instructional strategies within the EBN should include innovative didactic methods such as: (simulated) clinical case discussions, EBN escape rooms, AI-assisted literature search labs, collaborative simulation scenarios integrating real-time EBP decision-making and student-led mini-conferences, where learners present their EBN projects in a peer-reviewed academic format. This comprehensive and adaptive strategy aims to build EBP knowledge and skills while also fostering critical thinking and collaboration, the essential competences for modern nursing practice.
6 Study limitations
Different approaches to teaching EBP and the diverse assessment tools can make it challenging to compare and synthesise findings consistently. Many of the included studies employed short-term evaluations, meaning that the long-term effectiveness and sustainability of EBP teaching strategies may not have been adequately assessed.
Studies included in the review could come from institutions with varying levels of resources, curriculum design, faculty expertise and student populations. Such diversity in the educational context can introduce bias into the review’s findings. Differences in the local healthcare systems, pedagogical approaches and student demographics between non-native English-speaking countries could also lead to varying levels of EBP knowledge and practice, making comparisons challenging.
The populations studied in the included research may differ significantly in terms of experience and language proficiency. The diverse outcome measures used to evaluate the effectiveness of EBP teaching (e.g., student satisfaction, knowledge, skills, attitudes and clinical application) made it difficult to compare the results across studies.
7 Suggestions for future research
Research should explore how the language proficiency of non-native English-speaking nursing students influences their ability to engage with and apply EBP. This could involve examining the challenges these students face in accessing, interpreting and critically appraising English-language scientific literature and how these barriers affect their competency development in EBP.
Research should focus on the development and evaluation of language support strategies, such as bilingual resources, language tutoring or specialised courses. Investigating the effectiveness of these strategies could provide valuable insights into how language barriers can be mitigated in EBP education.
Comparative research on how EBP is taught in non-native English-speaking countries versus native English-speaking countries could include examining the efficacy of various teaching methods in overcoming language barriers and improving EBP competencies.
Investigating the effectiveness of collaborative learning strategies in non-native English-speaking countries could provide insights into how group work helps mitigate language barriers.
Further exploration of technology-enhanced learning tools, such as web-based platforms or mobile applications, could provide valuable insights into how these technologies can support non-native English-speaking nursing students in learning EBP. Research could investigate how these tools improve access to evidence-based resources and help overcome the challenges of language proficiency.
Investigating the direct impact of EBP education on clinical practice outcomes in non-native English-speaking countries is essential. Studies could examine how the EBP competencies gained by nursing students during their education translate into improved clinical decision-making and patient care in their home countries, where the healthcare system and language may differ significantly from English-speaking countries.
8 Conclusions
Although the integration of EBP into undergraduate nursing curricula has become increasingly widespread, the optimal educational approach remains unclear. Current evidence supports using and blending diverse instructional strategies, including didactic lectures, tutorials, web-based platforms, simulation and team-based learning. A longitudinal, scaffolded approach appears particularly beneficial, allowing for sustained exposure to EBP concepts and the gradual acquisition of professional English. Collaborative learning environments such as peer discussion groups and interdisciplinary teams can enhance EBP competencies.
Given the substantial global variation in nursing education, there is a need for the development of internationally informed guidelines that balance pedagogical flexibility with a structured, integrated and practice-oriented approach to teaching. Such guidelines should aim to ensure the consistent attainment of core competences in EBP. The integration of digital innovation, interprofessional collaboration and longitudinal clinical inquiry offers a cohesive and future-oriented framework that equips nursing students to address the complexities of modern nursing practice.
CRediT authorship contribution statement
Melita Peršolja: Writing – review & editing, Writing – original draft, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization.
Funding statement
The internal research programme
Declaration of Competing Interest
Nothing to declare.
Acknowledgements
None
Table 1
| 1. students, nursing
2. non-native English-speaking 3. #1 AND #2 4. evidence-based practice 5. evidence-based nursing 6. evidence based 7. #4 OR #5 OR #6 8. education 9. learning 10. teaching strategies 11. teaching methods 12. #8 OR #9 OR #10 OR #11 13. programme evaluation 14. evaluation 15. outcomes 16. #13 OR #14 OR #15 17. #3 AND #7 AND #12 AND #16 18. clinical nursing 19. medical students 20. #17 NOT #18 NOT #19 |
Table 2
| Author, year
Country |
Methods | Intervention | Conclusions |
|
Cardoso et al., (2021)
Portugal |
Quasi-experiment | The program was implemented in 6 sessions over 17 weeks. During the first 7 weeks the expository methods with practice tasks to groups of 20–30 students, during the last 10 weeks active methods through mentoring of groups of 2–3 students were used.
The intervention included EBP contents regarding models of thinking EBP, systematic review types, review question development, searching for studies, study selection process, data extraction, and data synthesis. |
Both groups improved their EBP knowledge and skills. The study results show that the improvement was greater in the intervention group. |
|
Du et al., (2023)
China |
Quasi-experiment | Face-to-face classroom teaching activities characterised by EBP were performed. The educational activities to teach nursing research course were blended with EBP. They developed high-impact teaching activities by analysing nursing research and EBP, linking EBP with research process, incorporating EBP elements into research methodology system. | Compared with conventional teaching, the teaching characterised by EBP can improve the students’ EBP competence in terms of attitudes and skills and enhance the students’ comprehensive ability in nursing research. |
|
Estalella et al., (2023)
Spain |
Pre-test, post-test study | The online intervention promoted evidence incorporation into clinical decision in hypothetical scenarios. It included 17 questions related to nursing practice and decision-making based on clinical cases. The feedback was immediate. | Online teaching strategies based on clinical scenarios that focus on EB decision-making have the potential to increase the confidence of nursing students. Interventions designed by teams have the potential to bridge the evidence-practice gap in nursing education. |
|
Kim et al., (2019)
South Korea |
Quasi-experiment | The 20-h programme, spread over 4 weeks and 8 sessions, was delivered. It consisted of a five-step EBP. Training modules based on more than 100 clinical questions. The programme included two sessions, and the lectures and practice were combined. The educational methods used were: lecture, group discussion and presentation. | The EBP-EPUNS programme was effective in improving knowledge, skills, attitudes, competencies, future use of EBP and critical thinking among undergraduate nursing students. |
|
Liou et al., (2023)
Taiwan |
Pre-test, post-test study | A course was designed based on the five steps of EBN organized in seven programme units over 11 weeks. Teaching aids were developed (electronic, non-electronic) – power point, vivid illustrations, graphs, case scenarios; supplemental instructions were offered. Included classroom activities, laboratory sessions using physical and online library resources. They combined use of differentiated instruction and student-centred teaching strategies. | The application of differentiated instruction in mixed-ability classrooms improved students’ learning outcomes, attitudes towards EB nursing, EB nursing knowledge and learning satisfaction. |
|
Mena-Tudela et al., (2018).
Spain |
Quasi-experiment | Two hours of EBP theory, and two hours of computer lab sessions. During 12 weeks of clerkships, the critical incidence technique was used. Students identified a minimum of eight critical incidents related to the content of the course and their daily practice and document the critical incident information (case description, emotions, coping with the case, result of action, dilemmas, learning). Students developed a clinical question (following the PICO format) for each critical incident and tried to resolve it through a literature search. | The first part of the intervention was conducted at the university and had a greater positive effect compared to the part carried out during clinical clerkship. The effect of the educational intervention is lower during clinical clerkships. |
| Myonghwa
Park et al., (2020)
Sauth korea |
Quasi-experiment | An interactive web-based experiential learning programme basing on IOWA model was used. It comprised of six modules (overview of EBP, formulating clinical questions, evidence search, critical appraisal, implementation, and evaluation), where each module included two to four quiz games. | Web-based experiential learning strategies were effective at significantly improving the EBP knowledge and skills score and the score for confidence in asking clinical questions. |
| Oh et al., 2019
Republic of Korea |
Quasi-experiment | The intensive 30-hours EBP education programme basing on ADDIE model (Analysis-Design-Development-Implement – Evaluation. was provided. Teaching methods used were: lectures, team-based learning with flipped learning, computer-based learning, problem-based learning, group activity with student presentation. | Students had significant improvements in EBP self-efficacy, knowledge and evidence utilisation. |
|
Pendoni et al., (2024)
Italy |
Pre-test, post-test study | A 15 h EBP programme basing on Kolb’s theoretical frame work was carried out. Through an online learning platform, educators refreshed student knowledge about how to use a scientific database, asked to document nursing interventions during clinical internship, engaged in guided reflection in the classroom, reflect on how clinical practice could be improved. | The study provides support to nurse educators to develop EBP competencies within university programmes. There is a need to continue evaluating EBP competencies so students are able to shape their decisions based on the best evidence available. |
| Ruzafa-Martinez 2016
Spain |
Quasi experiment | The 15-week educational intervention comprised 60 h in class plus 90 h of student work. A variety of learning strategies were adopted: theoretical classes, practical classes with access to computers, peer group discussions in small groups, individual work, teamwork, and oral presentation of a final project. | Students increased their EBP knowledge, skills, and attitudes. |
| Ruzafa-Matinez et al., 2023
Spain |
Quasi-experiment | The EBP course lasted over 15 weeks, for a total of 150 h, of which 40 were face-to-face and 110 were independent student work. Included seminars, practical laboratory work, the flipped classroom organised in 7 open access modules using multimedia, videos, clinical scenarios, questionnaires, interactive games and many other activities. | The flipped classroom model is adequate for teaching EBP to undergraduate nursing students. It produced a slight increase in attitude, skills and global competence in EBP. This increase was not significantly different from face-to-face learning in terms of the impact on EBP knowledge. |
|
Shamsaee et al., (2021)
Iran |
Pre-test, post-test study | Virtual education materials were uploaded on a website in the form of six modules delivered in four weeks. Reminder messages were sent by WatsApp and SMS. Also used Power point slides, video tutorials, textual help, question and answer, hands-on exercise, homework, e-mails. | Virtual education had a significant effect on information seeking skills and knowledge about search operators in nursing students. |
Table 3
| Criteria | Codes | Authors |
| Education methods | lectures, presentations, seminars, face-to-face learning, project-based approach, research courses, mixed-ability classrooms, multifaceted approach, multiple teaching strategies, interactive methods, combination of methods, blended approaches, students choose their preferred instructional strategy, student centred teaching, teaching group, discussion, guided reflection, practical classes, individual work, presentation, quiz games, case scenarios, theoretical classes, problem based, step-by-step, practical laboratory work, questionnaires, simulations, tutorials, hands-on-exercises, homework, differential instruction | ( Cardoso et al., 2021; Du et al., 2023; Estalella et al., 2023; Kim et al., 2020; Liou et al., 2023; Mena-Tudela et al., 2018; Oh and Yang, 2019; Park et al., 2020; Pendoni et al., 2024; Ruzafa-Martínez et al., 2023; Shamsaee et al., 2021; Sánchez-García et al., 2019) |
| Using technology | mobile devices, simulation, video, PowerPoint, distant learning, flipped classroom, e-learning, online teaching, interactive teaching strategy, online courses, multimedia, interactive games, audio, e-mail, WatsApp | ( Estalella et al., 2023; Kim et al., 2020; Liou et al., 2023; Mena-Tudela et al., 2018; Oh and Yang, 2019; Park et al., 2020; Pendoni et al., 2024; Ruzafa-Martínez et al., 2016; Shamsaee et al., 2021) |
| Clinical focus | links with clinical practicum, clinical problem, practice tasks, tasks-based learning, clinical scenarios, critical incident technique, non-judgemental environment | ( Estalella et al., 2023; Mena-Tudela et al., 2018; Oh and Yang, 2019; Pendoni et al., 2024) |
| Collaboration | academic nurses, clinical nurses, mentoring, teams, team-based learning, small groups, librarians, group work, flexible grouping, discussions, role modelling, active educators and students | ( Estalella et al., 2023; Liou et al., 2023; Oh and Yang, 2019; Pendoni et al., 2024; Ruzafa-Martínez et al., 2016) |
| Length of intervention | 3-cycle education, one semester, 150 h, 30 h, 20 h, 18 h, 15 h, 3 h weekly, short courses, 10 weeks, course 11 weeks, 12 weeks, step-by-step guidance | ( Cardoso et al., 2021; Liou et al., 2023; Mena-Tudela et al., 2018; Oh and Yang, 2019; Pendoni et al., 2024; Ruzafa-Martínez et al., 2023) |
| Intervention outcomes | satisfaction, learning, EBP skills, EBP knowledge, confidence, attitudes, self-efficacy, competencies, ability in research, expectations, critical thinking, nursing outcomes, decision-making, evidence utilization, information seeking skills, developing clinical question | ( Cardoso et al., 2021; Du et al., 2023; Estalella et al., 2023; Kim et al., 2019; Liou et al., 2023; Oh and Yang, 2019; Park et al., 2020; Pendoni et al., 2024; Ruzafa-Martínez et al., 2023) |
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