Efficacy of Problem Based Learning approach for teaching Evidence Based Practice for midwifery and nursing professionals: a systematic review.

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Grace Komuhangi, Valerie Louis, Florian Neuhann, Alison Annet Kyinengyere, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6120932/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Problem-Based Learning (PBL) has emerged as a potential educational strategy for teaching Evidence-Based Practice (EBP) to nursing and midwifery professionals. However, the effectiveness of this approach remains inadequately synthesized in the literature. Objective To systematically review and evaluate the efficacy of Problem-Based Learning approaches in teaching Evidence-Based Practice to nursing and midwifery professionals. Methods A systematic review was conducted across multiple databases. 18 studies met the inclusion criteria, representing diverse geographical locations and methodological approaches. Studies were analyzed for their methodological quality, implementation strategies, and outcomes related to EBP competencies. Results Three studies specifically explored PBL as a training approach for EBP among nursing students. PBL demonstrated significant improvements in students' knowledge, attitudes, and behaviors toward implementing EBP compared to traditional teaching methods. Studies showed enhanced critical thinking, systematicity, analyticity, and open-mindedness among participants. Implementation challenges included limited time, insufficient resources, and the need for proper infrastructure. Higher education levels consistently correlated with improved evidence-based behaviors. The review identified substantial heterogeneity in teaching methodologies, populations, and interventions, making it challenging to determine the most effective EBP teaching approach. Conclusions While PBL shows promise in teaching EBP to nursing and midwifery professionals, the current evidence base is characterized by methodological heterogeneity and varying quality. PBL may enhance learners' ability to apply theory to clinical practice and develop problem-solving skills. However, successful implementation requires adequate organizational support, resources, and infrastructure. Future research should focus on standardizing outcome measures and conducting more rigorous comparative studies to establish the optimal approach for EBP education in nursing and midwifery. Nursing Problem-Based Learning Evidence-Based Practice Nursing Education Midwifery Education Systematic Review Healthcare Education Figures Figure 1 Figure 2 Introduction The evolution of nursing and midwifery education from apprenticeship models to academic institutions marks a crucial transformation in healthcare professional development. This shift, occurring predominantly in the latter half of the 20th century, fundamentally changed how Evidence-Based Practice (EBP) is integrated into educational curricula (Dagne & Beshah, 2021). The transition to higher education institutions addresses several key objectives: Integration of scientific principles and research methodology into clinical practice. Development of advanced clinical reasoning and decision-making skills. Enhancement of professional judgment through evidence-based approaches(Young, Rohwer, Volmink, & Clarke, 2014). Moreover, the integration of EBP into nursing and midwifery curricula demonstrates the profession's commitment to evidence-based healthcare delivery while acknowledging the ongoing need to bridge theoretical knowledge with clinical practice (Kyriakoulis et al., 2016). This educational evolution ensures that future healthcare professionals are equipped with both practical skills and theoretical understanding, enabling them to provide high-quality, evidence-based care (Immonen et al., 2022). The implementation of EBP through andragogical approaches in academic settings enables healthcare professionals to develop research competencies and apply evidence-based methodologies in clinical practice (De Leo et al., 2021; Muraraneza & Mtshali, 2021). This educational framework represents a significant advancement from traditional apprenticeship models, where learning was primarily experiential rather than evidence-based. However, the transition presents notable challenges. Both educators and practitioners face difficulties in teaching and learning EBP methodologies (Cardoso et al., 2021;(Kyriakoulis et al., 2016). These challenges underscore the complexity of integrating theoretical knowledge with practical clinical skills in academic settings (Janes, Ekpenyong, Mbeah-Bankas, & Serrant, 2023). Modern teaching strategies such as Problem Based Learning (PBL) aim to promote cognitive skills and encourages active participation of learners (Millanzi & Kibusi, 2020). PBL is an educational approach that emphasizes active participation, problem-solving, and critical thinking(Sari, Utomo, & Astina, 2021). It encourages learners to identify their own knowledge and skills and apply them to novel situations or use them by combining prior knowledge or principles to achieve particular objectives (Fidan & Tuncel, 2019; Millanzi & Kibusi, 2020). PBL has increasingly replaced traditional nursing and midwifery education, primarily characterized by lecture-based, didactic teaching methods where instructors deliver standardized content through formal presentations, with learners as passive recipients of knowledge and limited opportunities for practical application (Burns & Weston,2022). Reviews examining PBL versus traditional pedagogical approaches in nursing and midwifery education have demonstrated PBL's efficacy in enhancing learning outcomes (Molina Montoya, 2013). Research indicates that PBL implementation has yielded multiple positive learning outcomes, including increased student motivation, enhanced interprofessional collaboration, developed problem-solving capabilities, and strengthened critical thinking skills among both student and practicing nurses and midwives (Burns & Weston, 2022). However, some studies have found no significant difference in learning outcomes or learning styles between students enrolled in traditional and PBL curricula. For example, a meta-analysis by Vernon and Blake (1993) concluded that PBL and traditional teaching methods yield comparable results in terms of student performance. Similarly, a study by Nandi et al. (2000) found no convincing evidence to suggest that PBL improves learning compared to conventional teaching methods. According to Sangestani and Khatiban (2013), in nursing and midwifery education, the lecture style was shown to be more successful than PBL. However, the study did not compare PBL for teaching EBP. A systematic review by Coomaraswamy and Khan compared stand-alone teaching methods to integrated clinical problem-solving strategies for postgraduate medical students. Results showed that clinically integrated courses improved students' knowledge, skills, attitudes, and behaviors; (Coomarasamy & Khan, 2004) Even though one may hypothesize that this advantage could be true for other student population, it has not shown for the midwives and nurses. Although, systematic reviews have been conducted on teaching EBP to postgraduate medical students (Bala et al., 2021; Ehrenbrusthoff, Braun, Bahns, Happe, & Kopkow, 2022a; Ramis, Chang, & Nissen, 2015), there’s no review available to date which has assessed the efficacy of PBL as a teaching approach for EBP in nursing and midwifery education. Therefore, this review aims to analyze, critically appraise, and synthesize evidence regarding the efficacy of PBL in training nursing and midwifery professionals on EBP. Methods This review adhered to a priori criterion. The review's title has been registered in PROSPERO (No: CRD42023390989). Cochrane Handbook guidelines were used to ensure robustness of the systematic review (Heggins et al., 2022), and reporting in accordance with the PRISMA 2020 statement. Research approach and design This study aimed to collect empirical data on the efficacy of the method for training midwifery and nursing professionals in the context of EBP The initial step involved conducting a scoping search to identify published, peer-reviewed articles related to the topic. The data collected from this review search was then used to develop and refine a search strategy, which was tailored for each database to extract relevant articles for the review. Definition of EBP Evidence-based practice is a systematic and methodological approach to professional decision-making that integrates three key components: the best available research evidence, practitioner expertise, and client/patient values and preferences(Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). This interdisciplinary framework emerged from evidence-based medicine but has since been adopted across various fields including nursing, psychology, education, and social work. Straus and Richardson (2011) define EBP as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." This definition emphasizes the deliberate nature of incorporating empirical research into practice decisions. The process of evidence-based practice typically involves five main steps (Melnyk & Fineout-Overholt, 2022). Formulating a clear clinical/practice question Systematically searching for relevant evidence Critically appraising the evidence Integrating the evidence with professional expertise and client factors Evaluating outcomes of the implemented decision It's important to note that EBP is not simply the application of research findings, but rather a dynamic integration of multiple knowledge sources. As it is emphasized, EBP requires practitioners to consider both internal evidence (clinical expertise, organizational data) and external evidence (research studies, systematic reviews) while accounting for contextual factors and stakeholder perspectives (Cleary-Holdforth, O’Mathúna, & Fineout‐Overholt, 2021) . Defining the research question and inclusion criteria The review was intended to answer the following questions: Primary Review Question: What is the proportion of midwifery and nursing professionals trained using PBL who apply EBP core competencies in clinical practice compared to those trained using other approaches? Secondary Review Questions : What EBP core competencies are applied in clinical practice by the nursing and midwifery professionals who were trained using PBL? What approaches other than PBL are used to train EBP to nursing and midwifery trainees and professionals? What are the factors associated with application of EBP core competencies in clinical practice by nursing and midwifery professionals and trainees trained using PBL? Conceptual framework for data synthesis Conceptual Framework PICOS Criteria What works? Intervention PBL as a method of teaching EBP Comparison or control Other teaching approaches in training nursing and midwifery professionals (Lecture-based, advanced lecture-based methods, seminars, self-directed learning, community-based education, lectures, small group work, clinical practicum projects, post clinical conferences, simulation-based learning. For whom? Population Nursing and midwifery trainees and professionals. Under which circumstances? Timing duration and type of study Cross-sectional, case-control, longitudinal, RCTs, observational studies from the year 2001 to 2024. To what end? Outcome EBP competency as measured by knowledge change, attitude and EBP Practice. Selection criteria Peer-reviewed, and empirical studies describing Problem Based Learning as a teaching approach for EBP teaching methodologies for nursing and midwifery professionals and trainees were included. Articles matching the following eligibility criteria were included in the review: (1) Articles published in peer-reviewed journals were preferred because they contain high-quality literature. (2) Articles published between 2001 and 2024 were selected since they include current information because EBP was implemented in nursing and midwifery in the 21st century. (3) Randomized controlled trials, controlled trials, or cohort studies (pre-post longitudinal studies). (4) Studies focusing on educational interventions (with no restrictions on mode of delivery or type) to increase EBP competences among nursing and midwifery professional and trainees. (5) Reports from grey literature that focus on PBL and other educational approaches that are used to teach EBP among nursing and midwifery professionals and trainees. Studies that did not meet these criteria were excluded, while those that did were included in the review. Searching the literature and identification of studies Data sources : Data sources: The articles for the review were obtained from the following databases: MEDLINE, CINAHL, PubMed, EMBASE, Web of Science, ERIC, PsycINFO, Cochrane CENTRAL, Google Scholar and Bibliography of the included studies. In addition, grey literature sources from websites of organizations such as Trove, World Health Organization (WHO) databases, International Confederation of Nurses (ICN) databases, International Confederation of Midwives (ICM) databases, and The New York Academy of Medicine were searched but these yielded no results. Search terms: The searches were conducted using the following search terms: ‘Evidence-based practice’, ‘Evidence-based education’, ‘Evidence based nursing’, ‘Evidence-based medicine’, ‘Evidence-based Midwifery’, ‘Undergraduate, Baccalaureate’, ‘Critical appraisal’, ‘Knowledge’, ‘Skills’, ‘Attitudes’, ‘Self-efficacy’, ‘Teaching’, ‘Learning’, ‘Education’, training’, ‘continuous medical education’, ‘Journal club’, ‘Nursing and Midwifery Education’, ‘Medicine’, ‘Occupational therapy’, ‘Core competences’, ‘Clinical ‘practice’, ‘Nurse, midwife’, ‘nursing professionals’, ‘midwifery professionals’, ‘. The search string was developed using Boolean operators "OR", and "AND". Search strategy Two reviewers, developed a comprehensive search strategy using key words, their corresponding synonyms, and medical subject headings (MeSH). Truncation was applied on terms with varying suffixes. The reviewers then identified relevant data bases and run the searches. The scope of the search was not restricted to scholarly publications that were published within the time frame of 2001 to 2023, and only articles written in the English language were included. In addition, grey literature sources were searched. The search was last updated in October, 2024. The complete search approach may be found in supplemental file1. All publications retrieved from the search of the corresponding electronic databases and websites were submitted for evaluation using Endnote, along with their citation. Articles from different databases were exported to EndNote Version 9 and duplicated were removed. Title/abstract screening of articles was done by two reviewers (GK and AK) with an EndNote software using a priori criteria. Any disagreements between the two reviewers were resolved through discussion and consensus. The articles that met the inclusion criteria were considered for full text screening. The selected articles for full text screening were reviewed in details for the data regarding population, methodology, BPL teaching strategy intervention and other teaching strategies for EBP for nursing and midwifery professions/ trainees and study outcomes were reviewed and entered in the excel sheet with their references. Moreover, the articles with irrelevant outcomes and those that lacked required data were not included. Selection of articles for inclusion in the review Two reviewers, GK and AK, independently screened all citations by examining their titles and abstracts to identify studies that could potentially be included in the systematic review. After this initial screening, the full texts of the studies considered relevant were evaluated further. The selection process involved comparing the decisions made by both reviewers, and any disagreements were resolved through discussion to reach a consensus. For a study to be included, both reviewers had to agree; studies could not be included based on the decision of just one reviewer. Data extraction and management Data extraction The data extraction process was carried out by two independent reviewers, GK and AK, who used the JBI-SUMARI standardized data extraction tool to collect information from the evaluated papers. The reviewers reached a unanimous agreement, with no points of contention that required further discussion or consensus. The extracted data included specific details on interventions, demographics, research methodologies, and results relevant to the review topic and objectives. Before starting the data extraction, a data extraction form was developed and tested. The reviewers extracted data from each included study, recording information such as the study reference, inclusion/exclusion criteria, number and type of participants, methodology (including the BPL teaching intervention and comparison), outcome measures, time points, and any conflicts of interest. Any disagreements between the reviewers were resolved through discussion and consensus. The full-text screening assessed whether the studies incorporated PBL as a teaching method for Evidence-Based Practice among nursing and midwifery professionals. The reviewers evaluated the implementation of the teaching method and its alignment with the core principles of PBL. They looked for clear documentation of participants’ competence in following the five steps of EBP: asking clinical questions, acquiring evidence, appraising evidence, applying evidence to practice, and assessing outcomes. The screening process also examined how the studies measured participants’ abilities to formulate focused clinical questions, conduct systematic literature searches, critically evaluate research evidence, integrate that evidence into clinical decision-making, and assess the impact of evidence-based interventions on patient outcomes. Additionally, the reviewers considered whether the studies evaluated participants’ skills in accessing electronic databases, interpreting statistical analyses, and translating research findings into practical recommendations for patient care. Quality assessment Before being included in the review, the publications that were selected for retrieval underwent methodological evaluation by two independent reviewers (GK and OM). This evaluation was conducted using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-SUMARI). Any inconsistencies among the reviewers were addressed through deliberation and by inviting a third reviewer to act as an arbitrator. Methodological quality The quality of the included studies was assessed using the risk of bias assessment criteria with the ROBINS-I tool (McGuinness & Higgins, 2021), as shown in Fig. 1. Three studies, Jamshidi et al. (2021), Nango and Tanaka (2010), and Son (2020), demonstrated a low risk of bias across all domains. Six studies, Ahmed (2014), Cheng et al. (2020), Dagne et al. (2021), Delaney et al. (2011), Gebresilassie et al. (2022), and Hauck et al. (2013), reported moderate bias, showing acceptable methodological quality despite some limitations. However, three studies, Adams (2009), Dagne and Beshah (2021), and Ehrenbrusthoff et al. (2022), were categorized as having serious bias, indicating substantial methodological concerns. Data Synthesis and Analysis Due to significant differences in study designs, educational interventions, outcome measures, and assessment methods across the included studies, conducting a meta-analysis was not feasible. Therefore, we conducted a narrative synthesis following the guidance of Popay et al. (2006). This synthesis specifically focused on analyzing how teaching approaches influenced the teaching and learning of EBP among nursing and midwifery professionals and, more specifically, the PBL. Results Description of Studies A total of 2,179 articles were retrieved from database searches: PubMed (593), EMBASE (534), Web of Science (WoS) (26), ERIC (976), and Google Scholar (50). Additionally, 3 articles were identified from other sources. A total of 1,791 duplicate articles were removed. During the title and abstract screening, 1,731 papers were excluded for various reasons, namely: 569 for irrelevant outcomes, 590 for irrelevant populations, 510 for irrelevant titles, 52 for reviews and protocols, and 10 for retraction. From the title and abstract screening, a total of 1791 articles were selected for full-text screening. Out of these 1791 articles, 60 underwent full-text screening, resulting in the inclusion of 18 articles for narrative synthesis while 42 were excluded due to irrelevant outcomes (see Fig. 2 ). General characteristics of the included studies The systematic review included 18 studies from a variety of geographical and economic contexts. A significant majority of the research originated from High-Income Countries (72.2%, n = 13), followed by Middle-Income Countries (16.7%, n = 3) and Lower-Income Countries (11.1%, n = 2). The United States was the leading contributor, accounting for four studies (Adams, 2009; Delaney et al., 2011; Hauck et al., 2013; Harper et al., 2017). Ethiopia (Dagne & Beshah, 2021; Dagne et al., 2021) and Iran (Jamshidi, Hemmati Maslakpak et al., 2021; Jamshidi, Parizad, & Maslakpak, 2021) each contributed two studies. Other countries, including Australia (Fry & Attawet, 2018; Malik et al., 2017), Germany (Ehrenbrusthoff et al., 2022), Israel (Mashiach Eizenberg, 2011), Japan (Nango & Tanaka, 2010), South Korea (Son, 2020), Taiwan (Cheng et al., 2020), and Iraq (Ahmed, 2014), each contributed one study, providing a broad international perspective. The professional focus of the studies revealed a distinct pattern: the majority concentrated on nursing professionals (66.7%, n = 12), while 22.2% (n = 4) included both nurses and midwives, and 11.1% (n = 2) specifically examined midwifery practice. This distribution reflects the dominant representation of nursing research in healthcare literature and highlights the relative scarcity of studies focused solely on midwifery. Methodologically, the studies employed a range of approaches: Cross-sectional designs were most common (38.1%, n = 8), which included studies by Adams (2009) and Ahmed (2014). Qualitative studies represented 14.3% (n = 3), including those by Dagne and Beshah (2021). Randomized controlled trials accounted for 9.5% (n = 2), including those by Jamshidi, Hemmati Maslakpak et al. (2021) and Nango and Tanaka (2010). Mixed methods studies comprised 19.1% (n = 4). Other designs included quasi-experimental studies (Cheng et al., 2020; Son, 2020) and one Delphi study (Harper et al., 2017). The studies varied greatly in sample sizes, ranging from 20 participants in a Japanese randomized controlled trial (Nango & Tanaka, 2010) to 3,397 participants in a U.S. Delphi study (Harper et al., 2017). Response rates also varied widely, from 7.4–100%, with several studies achieving full participation from their targeted populations. Regarding participant characteristics, the overwhelming majority of studies (16 out of 18) included undergraduate student trainees. Four studies incorporated graduate professional trainees, and some included both undergraduate and postgraduate participants. Educational levels varied, with some studies specifically documenting the distribution (e.g., Adams (2009): 105 Bachelor's and 126 postgraduate participants). The sampling techniques reflected a balance between probability (57.1%, n = 12) and non-probability (52.9%, n = 11) approaches, indicating considerations of both representativeness and practical sampling constraints. Several studies included specific interventional components, such as experiential learning programs (Cheng et al., 2020), problem-based learning sessions (Jamshidi, Hemmati Maslakpak et al., 2021), and evidence-based practice implementation programs (Mashiach Eizenberg, 2011). (Table.1) Table 1 General characteristics of the included studies S/N Author/Year Country Economic class Study design Participants (Intervention and Control) Undergraduate Student trainees (Yes/No) Graduate professional Trainees (Yes/No) Study population Sample size (n) Response rate (%) Level professional training (no’s) Sampling technique 1. Adams (2009) USA HIC CS None?? Yes Yes nurses 247 20.6 Bachelor (105) Post graduate (126) probability 2. Ahmed (2014) Iraq MIC CS None Yes No midwives 53 100 Bachelor (53) probability 3. (Cheng, Huang, Yang, & Chang, 2020) Taiwan HIC QE Intervention : (experiential learning program) Control : (response before intervention) Yes No Nurses 103 100 1st Yr. Bachelor students (103) probability 4. (Dagne & Beshah, 2021) Ethiopia LIC Qual None Yes Yes Nurses, midwives 86 100 Nur. BSc. (29) Post grad (3) BSc. Mid-41. Post. Grad (5) probability 5. (Dagne, Beshah, Kassa, & Dagnaw, 2021) Ethiopia LIC CS None Yes No Nurses and midwives 790 95.64 Not indicated probability 6. (Delaney, Apostolidis, Lachapelle, & Fortinsky, 2011) USA HIC CS None Yes No Nurses 57.60 Not indicated Probability 7. (Ehrenbrusthoff, Braun, Bahns, Happe, & Kopkow, 2022b) Germany HIC CS None Yes No Midwives and nurses 889 13.40 Not indicated Probability 8. (Mashiach Eizenberg, 2011) Israel HIC CS Intervention : (EBP implementation) Control : (non- EBP implementers) Yes No Nurses 243 100 Not indicated Convinience 9. (Fry & Attawet, 2018) Australia HIC CS None Yes No Nurses and Midwives 204 92 Not indicated Convinience 10 (Gebresilassie, Baraki, Kassie, & Wami, 2022) Ethiopia LIC CS None Yes No Midwives 314 93.70 Probability 11 (Hauck, Winsett, & Kuric, 2013) USA HIC CS Intervention : (EBP implementation) Control : (Baseline response) Yes No Nurses 427 63 (2008) 57 (2010) Not indicated probability 12 (Jamshidi, Hemmati Maslakpak, & Parizad, 2021) Iran MIC RCT Intervention : (PBL learning) Control : (routine lectures) Yes No Nurses 78 100 Not indicated probability 13 (Jamshidi, Parizad, & Maslakpak, 2021) Iran MIC QE Intervention : (PBL sessions) Control : (no education session) Yes No Nurses 78 100 Not indicated Probability 14 (Nango & Tanaka, 2010) Japan HIC RCT Intervention : (PBL learning) Control : (baseline) Yes No Nurses 20 100 Not indicated Probability 16 (Son, 2020) South Korea HIC QE Intervention : (simulation problem-based learning) Control : (traditional maternity nursing clinical practicum) Yes No Nurses 78 100 Not indicated Probability 17. (Harper et al., 2017) USA HIC Delp. None Yes Yes Nurses 3,397 7.4 75% Post grad. 25% Bachelor Convience 18. Gulzar MALIK (2016) Australia HIC Qual. Gr.Thr None No Yes Nurses and midwives 23 100 100% post grad Purporsive Table 2 Summary of the study findings S/N Author name Mean age Age group. Resp. rate (%) Applied EBP (Y/N) Steps of EBP (Y/N) Ask a clin.qn Acquire Appraise Apply Eval. Prev. Nur. Pract. EBP Prev. Mid. Pract. EBP Findings 1. (Adams, 2009) Not indicated Not indicated 20.6 Y Y Y Y Y N Not indicated none Required resources for EBP practice, networking opportunities, predeveloped EBP guidelines, and education on outcome evaluation. source of information on EBP (awareness): conferences (87.3%) continuing education, classes (87.0%), colleagues (81.6%) article publications (27.3%) and institutional websites (24.9%). most preferred information sources were internet (65.5%) and textbooks (48.0%). 2. (Ahmed, 2014) 37.79 23–57 100 Y N N N N N Not indicated Not indicated reasons for performing episiotomy by midwives include: macrosomia/large fetus (38, 71.7%), breech delivery (31, 58.5%), shoulder dystocia (29, 54.7%), anticipated perineal tear (27, 50.9%) and fetal distress (27, 50.9%). There was a significant association between the frequency of these reasons and midwives’ total experience in delivery rooms as well as their levels of education 3. (Cheng et al., 2020) 18 Not indicated 100 Y N N N Y Y 100 none there were significant differences between the pre-test and post-test scores in the three domains: behaviour, thoughts, and feelings. In addition, there were significant differences between the pre-test and post-test scores in the four domains: systematicity/analyticity, open-mindedness, inquisitiveness, and reflective thinking. 4. (Dagne & Beshah, 2021) 31 21–50 100 Y N N N N N 37.2 53.5 none 5. (Dagne, Beshah, Kassa, & Dagnaw, 2021) 28 25–29 95.6 Y Y Y N N N 65.4 34.6 This study revealed that 34.7% of participants implemented EBP moderately or desirably. Age of participants, the attitude, nursing/midwifery work index, self-efficacy of EBP and knowledge level of participants were statistically significant factors associated with implementation of EBP 6. (Delaney, Apostolidis, Lachapelle, & Fortinsky, 2011) 47.3 Not indicated 57.4 Y Y Y Y Y Y 57.6 None Home care nurses’ scores demonstrated a 78.9% knowledge level in overall HF education principles. Nurses requested further information on all HF topics addressed in the survey as well as on psychosocial issues, research evidence, and more information from other healthcare providers. 7. (Ehrenbrusthoff, Braun, Bahns, Happe, & Kopkow, 2022) 37.4 18–69 13.4 Y Y Y Y Y Y 13.4 8.2 70% of the participants demonstrated a positive attitude towards EBP and believed that it was useful in clinical practice. Broadly, 80% of the respondents evaluated themselves as being able to enact EBP behaviour in clinical practice. In contrast, less than 70% preferred to use quantitative information instead of their intuition to inform their habitual clinical behaviour. Still, 20 to 30% reported that EBP did not sufficiently account for their clinical experience and differences between patients. 8. (Mashiach Eizenberg, 2011) 36.9 22–57 100 Y Y Y Y Y Y Not indicated Not indicated The self-reported professional behaviour of nurses with a degree was more evidence-based than that of those without a degree. EBP was more likely where there was access to a rich library with nursing and medical journals, and opportunities for working with a computer and for searching the Internet in the workplace 9. (Fry & Attawet, 2018) 46.6 Not indicated 92 Y Y Y Y Y Y 2.4 97.5 The findings showed that evidence for EBP was mostly obtained from clinical practice guidelines followed by article publications. There was a statistical difference when comparing leadership positions and other registered practitioner groups in the frequency of searching for evidence 10. (Gebresilassie et al., 2022) 27 18–50 years 93.70 Y Y Y Y Y Y none 100 Among the midwives, one hundred seventy-two (54.8%) (95% CI: 49.08%, 60.37) had good skill on conducting research. 11 (Hauck et al., 2013) 2008(43.3) 2010(43.1) Not indicated 2008(63) 2010(57) Y Y Y Y Y Y Not specified none With the interventions in place, the total group scores for beliefs and organizational readiness to implement EBP improved significantly. 12 (Jamshidi, Hemmati Maslakpak, et al., 2021) Control (23.26) Interventional group (22.95) Not indicated 100 Y Y Y Y Y Y 100 None The results indicated that the difference in the mean scores of knowledges, attitudes, and perceptions of the nursing students about patient safety was statistically significant between the two groups after the PBL education (p = 0.001). The mean scores of students’ knowledge, attitude, and perceptions of patient safety increased significantly in the intervention group. 13 (Jamshidi, Parizad, & Maslakpak, 2021) Control (23.26) Interventional group (22.9) Not indicated 100 Y Y Y Y Y Y 100 none No significant difference was observed in the mean score of patient safety-based communication skills in the control groups after the intervention (P = 0.162). However, the intervention groups had significantly higher scores after the educational sessions (P = 0.001) 14 (Nango & Tanaka, 2010) 30 Not indicated 100 Y Y Y Y Y Y 45 none scores at baseline and post-program were not significantly different After the program, the Visual Analog Scale for clinical decision making was significantly different, although pre-program values for both groups were similar 15 (Son, 2020) Experimental(n = 22.06) Control(n = 22.1) Not indicated 100 Y Y Y Y Y Y Not indicated Not indicated Compared with the control group, the pre-post difference in learning attitude and critical thinking increased significantly (p < 0.01) in the experimental group. S-PBL was found to be an effective strategy for improving nursing students’ learning transfer 16 (Kara, Arikan, & Kahyaoglu, 2021) 20.9 Not indicated 108 Y Y Y Y Y Y 100 none The overall mean score for knowledge on pressure injury prevention was 49.9% (11.7/26). in the instrument’s subthemes, nutrition scored highest followed by aetiology and development. The overall mean attitude score was 42.20 ± 2.40, although a statistically significant difference among grades was found (P < .001). The highest mean scores showed agreement among students that pressure injury prevention should be a priority (10.50 ± 1.43). A significant difference was found in the competence subscale according to the number of dressing changes observed and sense of competence in pressure injury care (P = .003). A weak but statistically significant positive relationship was found between knowledge and attitude scores 17 (Harper et al., 2017) 54 Not indicated 7.4 Y Y Y Y Y Y Not indicated Not indicated The self-reported professional behaviour of nurses with a degree was more evidence-based than that of those without a degree. EBP was more likely where there was access to a rich library with nursing and medical journals, and opportunities for working with a computer and for searching the Internet in the workplace 18. (Malik, McKenna, & Griffiths, 2017) 23 Not indicated Not indicate Y N N N N N Not indicated Not indicated Nurse academics have incorporated various pedagogical approaches to influence evidence -based practice education. However, desired to be aware of the most engaging and effective methods. • Students were introduced with the evidence -based practice process, but literature searching and critical appraisal skills were emphasised to a large extent. • Participants encountered challenges such as limited time, insufficient resources, heavy workload, students’ disengagement and limited awareness of effective teaching strategies. The analysis of the review findings revealed several key themes and patterns across the included studies: Demographic Characteristics The mean age of participants across studies showed considerable variation, ranging from 18 to 54 years. The majority of studies reported mean ages between 25–45 years. Notable exceptions included Cheng (2020) with a mean age of 18 years and Harper (2017) with a mean age of 54 years. Response rates varied substantially across studies, from as low as 7.4% (Harper, 2017) to 100% (reported in multiple studies). Theme 1: EBP competency The systematic review reveals a multifaceted understanding of EBP competency among nursing and midwifery professionals, with measurement across three primary domains: knowledge acquisition, attitudinal shifts, and practice implementation. Of the 18 studies included in the review, 12 focused on student nurses and midwives and demonstrated adherence to all the essential competencies of EBP. In contrast, participants in the remaining studies failed to follow the foundational steps of EBP. The EBP process encompasses several critical stages. Step 1 involves formulating a clinical question that can be effectively researched. Step 2 requires collecting relevant scientific data from credible sources. Step 3 entails critically appraising the outcomes of the search. Step 4 focuses on applying the evidence in clinical practice, while Step 5 evaluates the quality of care delivered (Law & MacDermid, 2024). Notably, three studies included in the review did not comply with any of the phases of EBP (Ahmed, 2014; Dagne & Beshah, 2021; Janes et al., 2023). Knowledge Knowledge transformation emerged as a fundamental indicator of EBP competency development. Jamshidi (2021) documented statistically significant improvements in knowledge scores following PBL interventions (p = 0.001), demonstrating that structured educational approaches effectively enhance EBP knowledge. Similarly, Hauck (2008) reported significant improvements in baseline knowledge following targeted interventions. The studies consistently reveal that EBP knowledge encompasses understanding research methodologies, critical appraisal skills, and familiarity with implementation frameworks. Knowledge deficiencies were also identified, particularly in specialized clinical areas. For instance, Akese (2014) found that 73% of nurses demonstrated a low level of knowledge regarding pressure ulcer identification and staging, highlighting the need for targeted EBP education in specialty domains. This finding suggests that EBP competency development must account for practice-specific knowledge requirements beyond general EBP principles. Attitudes The systematic review consistently identified attitudes toward EBP as a critical mediator of implementation success. Ehrenbrusthof (2022) reported that 70% of participants demonstrated positive attitudes toward EBP, believing it useful in clinical practice. This finding underscores the importance of fostering receptive mindsets toward evidence integration. Moreover, Dagne (2021) established that attitudes toward EBP were statistically significant factors associated with implementation, suggesting that attitudinal assessment provides valuable predictive information regarding practice patterns. Educational interventions showed promising effects on attitudinal development. Kara (2021) found a weak but statistically significant positive relationship between knowledge and attitude scores, suggesting that cognitive understanding influences affective responses to EBP. Additionally, Cheng (2020) documented significant improvements in the affective domains of behavior, thoughts, and feelings following experiential learning interventions, highlighting the malleability of EBP attitudes through appropriate educational strategies. Theme 2: The prevalence of EBP From the data presented, the prevalence of EBP implementation varies significantly across studies and settings: 1. Overall EBP Implementation Rates: Dagne (2021) found that 34.7% of participants implemented EBP at moderate and desirable levels. In addition, Ehrenbrusthof (2022) reported that 70% of participants had positive attitudes toward EBP, with 80% self-reporting ability to implement it. Moreover, Fry (2017) indicated that EBP implementation rates differed between leadership positions and other practitioners. 2. Professional Variation: Nursing EBP prevalence varied from 13.4–100% across studies, while Midwifery EBP prevalence varied from 8.2–100%. Theme 3: Implementation of Evidence-Based Practice The review revealed varying levels of EBP implementation across different healthcare settings and professional groups. The majority of studies (> 75%) reported active implementation of EBP, with different degrees of adherence to the five fundamental steps of evidence-based practice: asking clinical questions, acquiring evidence, appraising evidence, applying evidence and evaluating outcomes. Implementation rates varied significantly between nursing professionals (13.4–100%) and midwifery professionals (34.6–100%), suggesting potential differences in EBP adoption between these professional groups. Implementation rates showed considerable variation: For nursing professionals: ranging from 13.4% (Ehrenbrusthof, 2022) to 100% (multiple studies), for midwifery professionals: ranging from 34.6% (Dagne, 2021) to 100% (Gebresilassie, 2022). Of the 20 studies included in this systematic review, three explored the use of Problem-Based Learning (PBL) as a training approach for Evidence-Based Practice (EBP) among undergraduate nursing students (Jamshidi, Hemmati Maslakpak, et al., 2021; Nango & Tanaka, 2010; Son, 2020). Two of these studies were conducted in Iran (Jamshidi, Hemmati Maslakpak, et al., 2021; Jamshidi, Parizad, et al., 2021), while the third was carried out in Japan (Nango & Tanaka, 2010). Among the Iranian studies, one was a randomized controlled trial (RCT) comparing PBL with traditional lecture-based teaching methods (Jamshidi, Hemmati Maslakpak, et al., 2021; Jamshidi, Parizad, et al., 2021). The second study was a quasi-experimental design comparing PBL to no educational intervention but rather a clinical practicum placement. Both studies utilized a sample of 78 undergraduate nursing students. The Japanese study, involving a sample of 20 undergraduate nurses, was an RCT that compared PBL with a baseline condition. Findings from these studies demonstrated that PBL was associated with significant improvements in students' knowledge, attitudes, and behaviours toward implementing EBP when compared to traditional lecture methods or baseline conditions. Theme 4: Impact on Knowledge and Practice Several studies have demonstrated positive outcomes of PBL on EBP knowledge and application: 1. Jamshidi (2021) found that the PBL intervention group had significantly higher scores in knowledge, attitudes, and perceptions related to patient safety compared to the control group. 2. Son (2020) reported that simulation-based PBL significantly improved learning transfer among nursing students. 3. Consistently, studies have shown that professionals with higher education levels, particularly those holding degrees, exhibited more evidence-based behaviors (Eizenberg, 2010; Harper, 2017). Theme 5: Enhancement of Learning Attitudes and Critical Thinking PBL approaches have demonstrated positive effects on students' learning attitudes and critical thinking skills. Cheng (2020) found significant improvements in key areas such as systematic thinking, analytical skills, open-mindedness, inquisitiveness, and reflective thinking following PBL interventions. Similarly, Son (2020) showed that students in the experimental PBL group experienced notable increases in their learning attitudes and critical thinking abilities when compared to those taught using traditional methods. Additionally, research by Nango and Tanaka (2010) indicated that PBL contributes to improved clinical decision-making skills. Theme 6: Challenges in Curriculum Integration and Implementation Several common challenges and considerations for integrating Project-Based Learning (PBL) into Evidence-Based Practice (EBP) curriculum were identified: Malik (2016) highlighted several barriers, including limited time, insufficient resources, heavy workloads, and student disengagement. Additionally, infrastructure requirements were emphasized, particularly the need for access to libraries, computers, and internet resources (Mashiach Eizenberg, 2011). Furthermore, the importance of proper preparation and support for both staff and students were underscored (Janes et al., 2023). Theme 6: Curriculum Integration and Implementation Challenges Several common challenges and considerations for integrating PBL into EBP curriculum have emerged. Malik (2016) identified significant barriers such as limited time, insufficient resources, heavy workloads, and student disengagement. Additionally, infrastructure requirements were highlighted, including access to libraries, computers, and internet resources (Mashiach Eizenberg, 2011). The importance of adequate preparation and support for both staff and students were also emphasized (Janes, Ekpenyong, Mbeah-Bankas, & Serrant, 2023); kpenyong, Mbeah-Bankas, & Serrant, 2023). Theme 7: Evidence of Curriculum Orientation Toward EBP The studies revealed a clear trend in incorporating EBP into curricula. Several studies emphasized the importance of systematic approaches for evaluating and implementing evidence. There was a consistent focus on integrating practical skills with theoretical knowledge. Additionally, the development of critical appraisal skills and research literacy was evident across the studies. Theme 8: Key findings from educational interventions and their impact Several studies have evaluated specific educational interventions, with a particular focus on PBL approaches. Jamshidi et al. (2021) demonstrated significant improvements in knowledge, attitudes, and perceptions of patient safety following the implementation of PBL. Similarly, Son et al. (2020) reported notable enhancements in learning attitudes and critical thinking skills through simulation-based PBL compared to traditional teaching methods. The effectiveness of these educational interventions is influenced by several factors: 1. Professional Education Level : Studies consistently show that practitioners with higher degrees exhibit more evidence-based professional behaviour (Mashiach Eizenberg, 2011). This finding suggests that educational level is crucial for the successful implementation of EBP. 2. Resource Availability : Resource access is critical for successful EBP implementation. Studies have highlighted the importance of access to digital libraries, networking opportunities, predeveloped evidence-based guidelines, and computers and the internet in the workplace. 3. Organizational Support : Research emphasizes the significance of organizational factors in EBP implementation, including Leadership support, allocated time for EBP activities, opportunities for professional development, and a supportive workplace culture. Barriers and Facilitators The review identified several consistent barriers to EBP implementation, including: Limited access to resources and libraries (Malik et al., 2017) Time constraints and heavy workloads (reported across multiple studies) Knowledge and skill deficits (Valerie, 2017) Limited organizational support Conversely, several facilitating factors were identified: Access to digital resources and libraries (Eizenberg, 2010) Higher educational qualifications Strong organizational leadership (Hauck, 2013) Opportunities for continuing education Supportive professional networks Discussion Evidence-based practice (EBP) has become a cornerstone of quality healthcare delivery, requiring practitioners to integrate the best available research evidence with clinical expertise and patient values (Sackett et al., 1996). However, practical methods for teaching and implementing EBP among nursing and midwifery professionals remain an ongoing investigation. This systematic review focuses explicitly on the efficacy of PBL approaches for teaching EBP to nursing and midwifery professionals, examining implementation rates, learning outcomes, and factors influencing the success of this pedagogical strategy. Effective learning of EBP requires consideration of cognitive, affective, behavioural, and environmental elements, which is where the PBL teaching approach could be of value. However, this review found only three studies where PBL interventions, combined with different teaching and learning approaches, were effective in teaching EBP in nursing and midwifery (Jamshidi, Hemmati Maslakpak, et al., 2021; Nango & Tanaka, 2010; Son, 2020). Due to the heterogeneity in the reported teaching methodologies, populations, and interventions, it was difficult to determine which EBP teaching and learning approach was most effective in improving learners' EBP competencies, as most teaching methods proved effective. The studies that examined the effectiveness of teaching EBP included blended learning, experiential learning, and simulation-based learning, all of which also appeared effective in applying the steps of the EBP process and in clinical judgment and practice (Janes et al., 2023; Son, 2020). This review identified three studies specifically investigating PBL approaches (Jamshidi, Hemmati Maslakpak, et al., 2021; Nango & Tanaka, 2010; Son, 2020) that demonstrated significant improvements in students' knowledge, attitudes, and behaviours toward implementing EBP compared to traditional teaching methods. These findings align with previous systematic reviews in the broader healthcare education literature. For instance, Kong et al. (2014) systematically reviewed PBL in nursing education. Similarly, they found that PBL was superior to traditional lecture-based approaches for developing critical thinking skills, though they did not specifically focus on EBP education. In contrast, Cant and Cooper's (2017) systematic review of active learning strategies in nursing education found mixed results regarding PBL's superiority over other active learning strategies, suggesting that while PBL shows promise, its relative advantage over other student-centered approaches remains unclear. Our findings extend this understanding specifically within the context of EBP education, demonstrating more consistent positive outcomes than reported in some broader educational reviews. In our 2023–2024 review, we also found that the quality of methodologies and the use of psychometrically validated tools to assess learner competency in EBP varied. These results are consistent with the latest overview of systematic reviews, which concluded that the current evidence on this topic is of poor quality, characterized by heterogeneity of interventions and outcome measures (Bala et al., 2021). Although the research utilized different teaching approaches with distinct focuses, several common themes were identified. Studies employing small groups and evidence implementation methodologies indicated the influence of social and environmental factors in clinical practice (Janes et al., 2023; Khan & Coomarasamy, 2006). These techniques are aligned with the principles of constructivist pedagogy and PBL methodology (Ramis, Chang, & Nissen, 2015). These factors warrant further investigation. Problem-Based Learning (PBL) may enhance learners' education by teaching them to apply theory to clinical practice and fostering the development of their problem-solving abilities. However, two studies conducted by Jamshidi et al. (2021) found no significant difference in EBP behaviour between teaching methods compared to traditional methods, nor between curricula with and without EBM integration. Moreover, the research also found that student nurses who experienced PBL had higher scores in indicators of EBP behaviour compared to those who received traditional lectures (Jamshidi, Hemmati Maslakpak, et al., 2021). Our finding that PBL approaches notably enhanced critical thinking skills (Cheng, 2020; Son, 2020) and clinical decision-making capabilities (Nango & Tanaka, 2010) is consistent with meta-analyses by Shin and Kim (2013), who found moderate positive effects of PBL on critical thinking development in nursing education(Shin & Kim, 2013). However, our review specifically connects these cognitive improvements to EBP implementation, which Shin and Kim did not explore in depth. These findings also align with Salinitri et al.'s (2015) systematic review of active learning strategies in pharmacy education, which found that PBL specifically enhanced evidence appraisal skills compared to other active learning approaches(Salinitri, Wilhelm, & Crabtree, 2015). This suggests that the benefits of PBL for critical thinking development may be particularly relevant for EBP education across healthcare disciplines. Our finding that 12 of 18 studies demonstrated adherence to all essential EBP competencies following educational interventions, including PBL approaches, provides more comprehensive evidence than previous reviews. For instance, Young et al.'s (2014) systematic review of EBP teaching strategies found limited evidence for comprehensive competency development across the five EBP steps, focusing primarily on knowledge and appraisal skills rather than application and evaluation. Our review's identification of three studies that did not comply with any phases of EBP (Ahmed, 2014; Dagne & Beshah, 2021; Janes et al., 2023)(Janes et al., 2023) highlights implementation quality issues that have received limited attention in previous reviews. This finding extends upon Maggio et al.'s (2013) systematic review of EBP curricula, which identified variability in EBP teaching approaches but did not specifically analyze implementation fidelity or competency development across the complete EBP process(Maggio, Tannery, Chen, ten Cate, & O’Brien, 2013). Conclusion Current data does not provide sufficient support for the efficacy of PBL in teaching EBP, as there is limited research to substantiate this issue. Moreover, no single teaching approach has been shown to surpass others in enhancing learner competency in EBP, regardless of their nursing and midwifery status whether they are students or professionals, undergraduates or postgraduates. The substandard quality and diversity of interventions and outcome measures restricted the synthesis of findings. Future research should prioritize the development of rigorous studies and the use of psychometrically validated instruments to further examine the effectiveness of PBL as a teaching strategy for EBP and its impact on the EBP competencies of nurses and midwives. Additionally, it is essential to investigate the ongoing monitoring of learner proficiency in EBP as they progress from beginner to more advanced levels, including nursing and midwifery trainees and professionals actively applying EBP in clinical practice. Declarations Contribution of the Authors The design of the systematic review, including the formulation of the PICO question, was collaboratively undertaken by all authors. G.K (Grace Komuhangi), A.K(Alison Annet Kyinengyere), and O.M (Ocan Moses) devised the search strategy, which A.K executed. G.K and A.K evaluated citations for potential inclusion in the review after analysing both abstracts and complete texts. G.K and A.K conducted the data extraction session. F.N(Florian Neuhann), J.W (Jürgen Wacker), and GK assessed the potential for bias in the included studies. G.K prepared Figure 1. G.K and A.K prepared Figure 2 G.K, O.M and F.N prepared tables 1 and 2. Funding The review did not receive any funding. Conflicts of interest : The authors declare no known conflicts of interest. References Adams, S. (2009). Use of evidence-based practice in school nursing: Survey of school nurses at a national conference. The Journal of School Nursing, 25 (4), 302–313. Ahmed, H. M. (2014). Midwives’ clinical reasons for performing episiotomies in the Kurdistan Region: are they evidence-based? Sultan Qaboos University Medical Journal, 14 (3), e369. Burns, P., & Weston, K. M. (2022). Evidence-Based Practice in Medical Education: Mapping a Research and Critical Analysis Program Against the Sicily Statement. Medical Science Educator, 32 (4), 779–783. Cheng, Y.-C., Huang, L.-C., Yang, C.-H., & Chang, H.-C. (2020). Experiential learning program to strengthen self-reflection and critical thinking in freshmen nursing students during COVID-19: a quasi-experimental study. International Journal of Environmental Research and Public Health, 17 (15), 5442. Cleary-Holdforth, J., O’Mathúna, D., & Fineout‐Overholt, E. (2021). Evidence‐based practice beliefs, implementation, and organizational culture and readiness for EBP among nurses, midwives, educators, and students in the Republic of Ireland. Worldviews on Evidence‐Based Nursing, 18 (6), 379–388. Coomarasamy, A., & Khan, K. S. (2004). What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. Bmj, 329 (7473), 1017. Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. PloS one, 16 (8), e0256600. Dagne, A. H., Beshah, M. H., Kassa, B. G., & Dagnaw, E. H. (2021). Implementation of evidence-based practice and associated factors among nurses and midwives working in Amhara Region government hospitals: a cross-sectional study. Reproductive health, 18 , 1–10. Delaney, C., Apostolidis, B., Lachapelle, L., & Fortinsky, R. (2011). Home care nurses’ knowledge of evidence-based education topics for management of heart failure. Heart & Lung, 40 (4), 285–292. Ehrenbrusthoff, K., Braun, T., Bahns, C., Happe, L., & Kopkow, C. (2022). Adherence to evidence-based practice across healthcare professionals in Germany: results from a cross-sectional, nationwide survey. BMC Health Services Research, 22 (1), 1285. Fidan, M., & Tuncel, M. (2019). Integrating augmented reality into problem based learning: The effects on learning achievement and attitude in physics education. Computers & Education, 142 , 103635. Fry, M., & Attawet, J. (2018). Nursing and midwifery use, perceptions and barriers to evidence-based practice: a cross-sectional survey. JBI Evidence Implementation, 16 (1), 47–54. Gebresilassie, K. Y., Baraki, A. G., Kassie, B. A., & Wami, S. D. (2022). Midwifery-led researches for evidence-based practice: Clinical midwives engagement in research in Ethiopia, 2021. PloS one, 17 (6), e0268697. Harper, M. G., Gallagher-Ford, L., Warren, J. I., Troseth, M., Sinnott, L. T., & Thomas, B. K. (2017). Evidence-based practice and US healthcare outcomes: Findings from a national survey with nursing professional development practitioners. Journal for Nurses in Professional Development, 33 (4), 170–179. Hauck, S., Winsett, R. P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. Journal of advanced nursing, 69 (3), 664–674. Immonen, K., Tuomikoski, A.-M., Kääriäinen, M., Oikarinen, A., Holopainen, A., Kuivila, H.,. .. Vesterinen, S. (2022). Evidence-based healthcare competence of social and healthcare educators: A systematic review of mixed methods. Nurse education today, 108 , 105190. Jamshidi, H., Hemmati Maslakpak, M., & Parizad, N. (2021). Does problem-based learning education improve knowledge, attitude, and perception toward patient safety among nursing students? A randomized controlled trial. BMC nursing, 20 (1), 70. Jamshidi, H., Parizad, N., & Maslakpak, M. H. (2021). Problem-based learning; a new pathway towards improving patient safety-based communication skills in nursing students. Journal of Preventive Epidemiology, 6 (2), e25-e25. Janes, G., Ekpenyong, M. S., Mbeah-Bankas, H., & Serrant, L. (2023). An international exploration of blended learning use in pre-registration nursing and midwifery education. Nurse Education in Practice, 66 , 103514. Kara, H., Arikan, F., & Kahyaoglu, A. (2021). Student nurse knowledge of and attitudes toward pressure injury prevention: how sufficient is undergraduate education? Advances in Skin & Wound Care, 34 (9), 473–480. Kyriakoulis, K., Patelarou, A., Laliotis, A., Wan, A. C., Matalliotakis, M., Tsiou, C., & Patelarou, E. (2016). Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review. Journal of educational evaluation for health professions, 13 . Maggio, L. A., Tannery, N. H., Chen, H. C., ten Cate, O., & O’Brien, B. (2013). Evidence-based medicine training in undergraduate medical education: a review and critique of the literature published 2006–2011. Academic Medicine, 88 (7), 1022–1028. Malik, G., McKenna, L., & Griffiths, D. (2017). Using pedagogical approaches to influence evidence-based practice integration–processes and recommendations: findings from a grounded theory study. Journal of advanced nursing, 73 (4), 883–893. Mashiach Eizenberg, M. (2011). Implementation of evidence-based nursing practice: nurses’ personal and professional factors? Journal of advanced nursing, 67 (1), 33–42. McGuinness, L. A., & Higgins, J. P. (2021). Risk-of‐bias VISualization (robvis): an R package and Shiny web app for visualizing risk‐of‐bias assessments. Research synthesis methods, 12 (1), 55–61. Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing & healthcare: A guide to best practice : Lippincott Williams & Wilkins. Millanzi, W. C., & Kibusi, S. M. (2020). Exploring the effect of problem-based facilitatory teaching approach on metacognition in nursing education: a quasi‐experimental study of nurse students in Tanzania. Nursing Open, 7 (5), 1431–1445. Molina Montoya, N. P. (2013). Problem-Based Learning as Teaching Strategy. Nango, E., & Tanaka, Y. (2010). Problem-based learning in a multidisciplinary group enhances clinical decision making by medical students: a randomized controlled trial. Journal of medical and dental sciences, 57 (1), 109–118. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D.,. .. Brennan, S. E. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj, 372 . Ramis, M.-A., Chang, A., & Nissen, L. (2015). Strategies for teaching evidence-based practice to undergraduate health students: a systematic review protocol. JBI Evidence Synthesis, 13 (2), 12–25. Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine. BMJ: British Medical Journal, 313 (7050), 170. Salinitri, F. D., Wilhelm, S. M., & Crabtree, B. L. (2015). Facilitating facilitators: Enhancing PBL through a structured facilitator development program. Interdisciplinary Journal of Problem-Based Learning, 9 (1), 11. Sari, Y. I., Utomo, D. H., & Astina, I. K. (2021). The Effect of Problem Based Learning on Problem Solving and Scientific Writing Skills. International Journal of Instruction, 14 (2), 11–26. Shin, I.-S., & Kim, J.-H. (2013). The effect of problem-based learning in nursing education: a meta-analysis. Advances in Health Sciences Education, 18 , 1103–1120. Son, H. K. (2020). Effects of S-PBL in maternity nursing clinical practicum on learning attitude, metacognition, and critical thinking in nursing students: a quasi-experimental design. International Journal of Environmental Research and Public Health, 17 (21), 7866. Young, T., Rohwer, A., Volmink, J., & Clarke, M. (2014). What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PloS one, 9 (1), e86706. Additional Declarations The authors declare no competing interests. Supplementary Files SEARCHSTRATEGY2023.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6120932","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":421780430,"identity":"2bc45e21-4bcf-4305-8140-5439bc8b4812","order_by":0,"name":"Grace Komuhangi","email":"data:image/png;base64,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","orcid":"","institution":"University of Heidelberg, Institute of Global HealthGermany","correspondingAuthor":true,"prefix":"","firstName":"Grace","middleName":"","lastName":"Komuhangi","suffix":""},{"id":421780431,"identity":"3792798f-1980-4aa4-a3c7-afe16a279ebd","order_by":1,"name":"Valerie Louis","email":"","orcid":"","institution":"Heidelberg University, Institute of Global Health,Germany","correspondingAuthor":false,"prefix":"","firstName":"Valerie","middleName":"","lastName":"Louis","suffix":""},{"id":421780432,"identity":"f7636704-0f1a-4c73-b846-6693fb004a6a","order_by":2,"name":"Florian Neuhann","email":"","orcid":"","institution":"Heidelberg University, Institute of Global Health,Germany","correspondingAuthor":false,"prefix":"","firstName":"Florian","middleName":"","lastName":"Neuhann","suffix":""},{"id":421780433,"identity":"b1cf5a78-4d87-4587-8345-c689816a4ba5","order_by":3,"name":"Alison Annet Kyinengyere","email":"","orcid":"","institution":"Makerere University, Medical school, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Alison","middleName":"Annet","lastName":"Kyinengyere","suffix":""},{"id":421780434,"identity":"e5a09e45-5a74-4f6f-9c48-88887c3d77dc","order_by":4,"name":"Jürgen Wacker","email":"","orcid":"","institution":"Heidelberg University, Medical Faculty,Germany","correspondingAuthor":false,"prefix":"","firstName":"Jürgen","middleName":"","lastName":"Wacker","suffix":""},{"id":421780435,"identity":"b271e876-f57d-4379-aa88-11ac00b8a30f","order_by":5,"name":"Moses Ocan","email":"","orcid":"","institution":"Makerere University, Department of Pharmacology, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Moses","middleName":"","lastName":"Ocan","suffix":""}],"badges":[],"createdAt":"2025-02-27 12:24:55","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6120932/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6120932/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78423216,"identity":"20c7004b-ecff-40a6-b8ae-1ea85bcdb758","added_by":"auto","created_at":"2025-03-13 06:05:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":284016,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of bias summary. Review authors' judgements about each risk of bias item for each included study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMcGuinness, LA, Higgins, JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2020; 1- 7. https://doi.org/10.1002/jrsm.1411\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6120932/v1/41aa5a5f9e1fdc78f4893be6.png"},{"id":78423214,"identity":"a06ad544-bfb4-472f-8b25-7f041ae37574","added_by":"auto","created_at":"2025-03-13 06:05:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33216,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA flowchart (Page et al., 2021)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6120932/v1/cacb061cc2184e47fc30fc3d.png"},{"id":78426274,"identity":"fdb7cf7c-efbd-45ca-b012-e7229e07e8d5","added_by":"auto","created_at":"2025-03-13 06:29:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2179488,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6120932/v1/9424019f-4ff1-49fa-8cc0-9a96628ca035.pdf"},{"id":78423215,"identity":"30f7b74e-9581-4d04-9c61-1a96784704f4","added_by":"auto","created_at":"2025-03-13 06:05:03","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":124380,"visible":true,"origin":"","legend":"","description":"","filename":"SEARCHSTRATEGY2023.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6120932/v1/38cbae737bab6a80cb5e9558.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEfficacy of Problem Based Learning approach for teaching Evidence Based Practice for midwifery and nursing professionals: a systematic review.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe evolution of nursing and midwifery education from apprenticeship models to academic institutions marks a crucial transformation in healthcare professional development. This shift, occurring predominantly in the latter half of the 20th century, fundamentally changed how Evidence-Based Practice (EBP) is integrated into educational curricula (Dagne \u0026amp; Beshah, 2021).\u003c/p\u003e \u003cp\u003eThe transition to higher education institutions addresses several key objectives:\u003c/p\u003e \u003cp\u003eIntegration of scientific principles and research methodology into clinical practice. Development of advanced clinical reasoning and decision-making skills. Enhancement of professional judgment through evidence-based approaches(Young, Rohwer, Volmink, \u0026amp; Clarke, 2014). Moreover, the integration of EBP into nursing and midwifery curricula demonstrates the profession's commitment to evidence-based healthcare delivery while acknowledging the ongoing need to bridge theoretical knowledge with clinical practice (Kyriakoulis et al., 2016). This educational evolution ensures that future healthcare professionals are equipped with both practical skills and theoretical understanding, enabling them to provide high-quality, evidence-based care (Immonen et al., 2022).\u003c/p\u003e \u003cp\u003eThe implementation of EBP through andragogical approaches in academic settings enables healthcare professionals to develop research competencies and apply evidence-based methodologies in clinical practice (De Leo et al., 2021; Muraraneza \u0026amp; Mtshali, 2021). This educational framework represents a significant advancement from traditional apprenticeship models, where learning was primarily experiential rather than evidence-based.\u003c/p\u003e \u003cp\u003eHowever, the transition presents notable challenges. Both educators and practitioners face difficulties in teaching and learning EBP methodologies (Cardoso et al., 2021;(Kyriakoulis et al., 2016). These challenges underscore the complexity of integrating theoretical knowledge with practical clinical skills in academic settings (Janes, Ekpenyong, Mbeah-Bankas, \u0026amp; Serrant, 2023).\u003c/p\u003e \u003cp\u003eModern teaching strategies such as Problem Based Learning (PBL) aim to promote cognitive skills and encourages active participation of learners (Millanzi \u0026amp; Kibusi, 2020). PBL is an educational approach that emphasizes active participation, problem-solving, and critical thinking(Sari, Utomo, \u0026amp; Astina, 2021). It encourages learners to identify their own knowledge and skills and apply them to novel situations or use them by combining prior knowledge or principles to achieve particular objectives (Fidan \u0026amp; Tuncel, 2019; Millanzi \u0026amp; Kibusi, 2020).\u003c/p\u003e \u003cp\u003ePBL has increasingly replaced traditional nursing and midwifery education, primarily characterized by lecture-based, didactic teaching methods where instructors deliver standardized content through formal presentations, with learners as passive recipients of knowledge and limited opportunities for practical application (Burns \u0026amp; Weston,2022).\u003c/p\u003e \u003cp\u003eReviews examining PBL versus traditional pedagogical approaches in nursing and midwifery education have demonstrated PBL's efficacy in enhancing learning outcomes (Molina Montoya, 2013). Research indicates that PBL implementation has yielded multiple positive learning outcomes, including increased student motivation, enhanced interprofessional collaboration, developed problem-solving capabilities, and strengthened critical thinking skills among both student and practicing nurses and midwives (Burns \u0026amp; Weston, 2022).\u003c/p\u003e \u003cp\u003eHowever, some studies have found no significant difference in learning outcomes or learning styles between students enrolled in traditional and PBL curricula. For example, a meta-analysis by Vernon and Blake (1993) concluded that PBL and traditional teaching methods yield comparable results in terms of student performance. Similarly, a study by Nandi et al. (2000) found no convincing evidence to suggest that PBL improves learning compared to conventional teaching methods. According to Sangestani and Khatiban (2013), in nursing and midwifery education, the lecture style was shown to be more successful than PBL. However, the study did not compare PBL for teaching EBP.\u003c/p\u003e \u003cp\u003eA systematic review by Coomaraswamy and Khan compared stand-alone teaching methods to integrated clinical problem-solving strategies for postgraduate medical students. Results showed that clinically integrated courses improved students' knowledge, skills, attitudes, and behaviors; (Coomarasamy \u0026amp; Khan, 2004) Even though one may hypothesize that this advantage could be true for other student population, it has not shown for the midwives and nurses.\u003c/p\u003e \u003cp\u003eAlthough, systematic reviews have been conducted on teaching EBP to postgraduate medical students (Bala et al., 2021; Ehrenbrusthoff, Braun, Bahns, Happe, \u0026amp; Kopkow, 2022a; Ramis, Chang, \u0026amp; Nissen, 2015), there\u0026rsquo;s no review available to date which has assessed the efficacy of PBL as a teaching approach for EBP in nursing and midwifery education.\u003c/p\u003e \u003cp\u003eTherefore, this review aims to analyze, critically appraise, and synthesize evidence regarding the efficacy of PBL in training nursing and midwifery professionals on EBP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis review adhered to a priori criterion. The review's title has been registered in PROSPERO (No: CRD42023390989). Cochrane Handbook guidelines were used to ensure robustness of the systematic review (Heggins et al., 2022), and reporting in accordance with the PRISMA 2020 statement.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch approach and design\u003c/h2\u003e \u003cp\u003eThis study aimed to collect empirical data on the efficacy of the method for training midwifery and nursing professionals in the context of EBP The initial step involved conducting a scoping search to identify published, peer-reviewed articles related to the topic. The data collected from this review search was then used to develop and refine a search strategy, which was tailored for each database to extract relevant articles for the review.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDefinition of EBP\u003c/h3\u003e\n\u003cp\u003eEvidence-based practice is a systematic and methodological approach to professional decision-making that integrates three key components: the best available research evidence, practitioner expertise, and client/patient values and preferences(Sackett, Rosenberg, Gray, Haynes, \u0026amp; Richardson, 1996). This interdisciplinary framework emerged from evidence-based medicine but has since been adopted across various fields including nursing, psychology, education, and social work.\u003c/p\u003e \u003cp\u003eStraus and Richardson (2011) define EBP as \"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.\" This definition emphasizes the deliberate nature of incorporating empirical research into practice decisions.\u003c/p\u003e \u003cp\u003eThe process of evidence-based practice typically involves five main steps (Melnyk \u0026amp; Fineout-Overholt, 2022).\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFormulating a clear clinical/practice question\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSystematically searching for relevant evidence\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCritically appraising the evidence\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIntegrating the evidence with professional expertise and client factors\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEvaluating outcomes of the implemented decision\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eIt's important to note that EBP is not simply the application of research findings, but rather a dynamic integration of multiple knowledge sources. As it is emphasized, EBP requires practitioners to consider both internal evidence (clinical expertise, organizational data) and external evidence (research studies, systematic reviews) while accounting for contextual factors and stakeholder perspectives (Cleary-Holdforth, O\u0026rsquo;Math\u0026uacute;na, \u0026amp; Fineout‐Overholt, 2021) .\u003c/p\u003e\n\u003ch3\u003eDefining the research question and inclusion criteria\u003c/h3\u003e\n\u003cp\u003eThe review was intended to answer the following questions:\u003c/p\u003e\n\u003ch3\u003ePrimary Review Question:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWhat is the proportion of midwifery and nursing professionals trained using PBL who apply EBP core competencies in clinical practice compared to those trained using other approaches?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSecondary Review Questions\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat EBP core competencies are applied in clinical practice by the nursing and midwifery professionals who were trained using PBL?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat approaches other than PBL are used to train EBP to nursing and midwifery trainees and professionals?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat are the factors associated with application of EBP core competencies in clinical practice by nursing and midwifery professionals and trainees trained using PBL?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eConceptual framework for data synthesis\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConceptual Framework\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePICOS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCriteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat works?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePBL as a method of teaching EBP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparison or control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther teaching approaches in training nursing and midwifery professionals (Lecture-based, advanced lecture-based methods, seminars, self-directed learning, community-based education, lectures, small group work, clinical practicum projects, post clinical conferences, simulation-based learning.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFor whom?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing and midwifery trainees and professionals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder which circumstances?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTiming duration and type of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional, case-control, longitudinal, RCTs, observational studies from the year 2001 to 2024.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo what end?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEBP competency as measured by knowledge change, attitude and EBP Practice.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSelection criteria\u003c/h2\u003e \u003cp\u003ePeer-reviewed, and empirical studies describing Problem Based Learning as a teaching approach for EBP teaching methodologies for nursing and midwifery professionals and trainees were included.\u003c/p\u003e \u003cp\u003eArticles matching the following eligibility criteria were included in the review:\u003c/p\u003e \u003cp\u003e(1) Articles published in peer-reviewed journals were preferred because they contain high-quality literature.\u003c/p\u003e \u003cp\u003e(2) Articles published between 2001 and 2024 were selected since they include current information because EBP was implemented in nursing and midwifery in the 21st century.\u003c/p\u003e \u003cp\u003e(3) Randomized controlled trials, controlled trials, or cohort studies (pre-post longitudinal studies).\u003c/p\u003e \u003cp\u003e(4) Studies focusing on educational interventions (with no restrictions on mode of delivery or type) to increase EBP competences among nursing and midwifery professional and trainees.\u003c/p\u003e \u003cp\u003e(5) Reports from grey literature that focus on PBL and other educational approaches that are used to teach EBP among nursing and midwifery professionals and trainees.\u003c/p\u003e \u003cp\u003eStudies that did not meet these criteria were excluded, while those that did were included in the review.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearching the literature and identification of studies\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eData sources\u003c/b\u003e: Data sources: The articles for the review were obtained from the following databases: MEDLINE, CINAHL, PubMed, EMBASE, Web of Science, ERIC, PsycINFO, Cochrane CENTRAL, Google Scholar and Bibliography of the included studies. In addition, grey literature sources from websites of organizations such as Trove, World Health Organization (WHO) databases, International Confederation of Nurses (ICN) databases, International Confederation of Midwives (ICM) databases, and The New York Academy of Medicine were searched but these yielded no results.\u003c/p\u003e\n\u003ch3\u003eSearch terms:\u003c/h3\u003e\n\u003cp\u003eThe searches were conducted using the following search terms: \u003cem\u003e\u0026lsquo;Evidence-based practice\u0026rsquo;, \u0026lsquo;Evidence-based education\u0026rsquo;, \u0026lsquo;Evidence based nursing\u0026rsquo;, \u0026lsquo;Evidence-based medicine\u0026rsquo;, \u0026lsquo;Evidence-based Midwifery\u0026rsquo;, \u0026lsquo;Undergraduate, Baccalaureate\u0026rsquo;, \u0026lsquo;Critical appraisal\u0026rsquo;, \u0026lsquo;Knowledge\u0026rsquo;, \u0026lsquo;Skills\u0026rsquo;, \u0026lsquo;Attitudes\u0026rsquo;, \u0026lsquo;Self-efficacy\u0026rsquo;, \u0026lsquo;Teaching\u0026rsquo;, \u0026lsquo;Learning\u0026rsquo;, \u0026lsquo;Education\u0026rsquo;, training\u0026rsquo;, \u0026lsquo;continuous medical education\u0026rsquo;, \u0026lsquo;Journal club\u0026rsquo;, \u0026lsquo;Nursing and Midwifery Education\u0026rsquo;, \u0026lsquo;Medicine\u0026rsquo;, \u0026lsquo;Occupational therapy\u0026rsquo;, \u0026lsquo;Core competences\u0026rsquo;, \u0026lsquo;Clinical \u0026lsquo;practice\u0026rsquo;, \u0026lsquo;Nurse, midwife\u0026rsquo;, \u0026lsquo;nursing professionals\u0026rsquo;, \u0026lsquo;midwifery professionals\u0026rsquo;, \u0026lsquo;.\u003c/em\u003e The search string was developed using Boolean operators \"OR\", and \"AND\".\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy\u003c/h2\u003e \u003cp\u003eTwo reviewers, developed a comprehensive search strategy using key words, their corresponding synonyms, and medical subject headings (MeSH). Truncation was applied on terms with varying suffixes. The reviewers then identified relevant data bases and run the searches. The scope of the search was not restricted to scholarly publications that were published within the time frame of 2001 to 2023, and only articles written in the English language were included. In addition, grey literature sources were searched.\u003c/p\u003e \u003cp\u003eThe search was last updated in October, 2024. The complete search approach may be found in supplemental file1. All publications retrieved from the search of the corresponding electronic databases and websites were submitted for evaluation using Endnote, along with their citation. Articles from different databases were exported to EndNote Version 9 and duplicated were removed. Title/abstract screening of articles was done by two reviewers (GK and AK) with an EndNote software using a priori criteria. Any disagreements between the two reviewers were resolved through discussion and consensus.\u003c/p\u003e \u003cp\u003eThe articles that met the inclusion criteria were considered for full text screening. The selected articles for full text screening were reviewed in details for the data regarding population, methodology, BPL teaching strategy intervention and other teaching strategies for EBP for nursing and midwifery professions/ trainees and study outcomes were reviewed and entered in the excel sheet with their references. Moreover, the articles with irrelevant outcomes and those that lacked required data were not included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSelection of articles for inclusion in the review\u003c/h2\u003e \u003cp\u003eTwo reviewers, GK and AK, independently screened all citations by examining their titles and abstracts to identify studies that could potentially be included in the systematic review. After this initial screening, the full texts of the studies considered relevant were evaluated further. The selection process involved comparing the decisions made by both reviewers, and any disagreements were resolved through discussion to reach a consensus. For a study to be included, both reviewers had to agree; studies could not be included based on the decision of just one reviewer.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData extraction and management\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eData extraction\u003c/h2\u003e \u003cp\u003eThe data extraction process was carried out by two independent reviewers, GK and AK, who used the JBI-SUMARI standardized data extraction tool to collect information from the evaluated papers. The reviewers reached a unanimous agreement, with no points of contention that required further discussion or consensus. The extracted data included specific details on interventions, demographics, research methodologies, and results relevant to the review topic and objectives.\u003c/p\u003e \u003cp\u003eBefore starting the data extraction, a data extraction form was developed and tested. The reviewers extracted data from each included study, recording information such as the study reference, inclusion/exclusion criteria, number and type of participants, methodology (including the BPL teaching intervention and comparison), outcome measures, time points, and any conflicts of interest. Any disagreements between the reviewers were resolved through discussion and consensus.\u003c/p\u003e \u003cp\u003eThe full-text screening assessed whether the studies incorporated PBL as a teaching method for Evidence-Based Practice among nursing and midwifery professionals. The reviewers evaluated the implementation of the teaching method and its alignment with the core principles of PBL. They looked for clear documentation of participants\u0026rsquo; competence in following the five steps of EBP: asking clinical questions, acquiring evidence, appraising evidence, applying evidence to practice, and assessing outcomes.\u003c/p\u003e \u003cp\u003eThe screening process also examined how the studies measured participants\u0026rsquo; abilities to formulate focused clinical questions, conduct systematic literature searches, critically evaluate research evidence, integrate that evidence into clinical decision-making, and assess the impact of evidence-based interventions on patient outcomes. Additionally, the reviewers considered whether the studies evaluated participants\u0026rsquo; skills in accessing electronic databases, interpreting statistical analyses, and translating research findings into practical recommendations for patient care.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eQuality assessment\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eBefore being included in the review, the publications that were selected for retrieval underwent methodological evaluation by two independent reviewers (GK and OM). This evaluation was conducted using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-SUMARI). Any inconsistencies among the reviewers were addressed through deliberation and by inviting a third reviewer to act as an arbitrator.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eMethodological quality\u003c/h2\u003e \u003cp\u003eThe quality of the included studies was assessed using the risk of bias assessment criteria with the ROBINS-I tool (McGuinness \u0026amp; Higgins, 2021), as shown in Fig.\u0026nbsp;1. Three studies, Jamshidi et al. (2021), Nango and Tanaka (2010), and Son (2020), demonstrated a low risk of bias across all domains. Six studies, Ahmed (2014), Cheng et al. (2020), Dagne et al. (2021), Delaney et al. (2011), Gebresilassie et al. (2022), and Hauck et al. (2013), reported moderate bias, showing acceptable methodological quality despite some limitations. However, three studies, Adams (2009), Dagne and Beshah (2021), and Ehrenbrusthoff et al. (2022), were categorized as having serious bias, indicating substantial methodological concerns.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eData Synthesis and Analysis\u003c/h2\u003e \u003cp\u003eDue to significant differences in study designs, educational interventions, outcome measures, and assessment methods across the included studies, conducting a meta-analysis was not feasible. Therefore, we conducted a narrative synthesis following the guidance of Popay et al. (2006). This synthesis specifically focused on analyzing how teaching approaches influenced the teaching and learning of EBP among nursing and midwifery professionals and, more specifically, the PBL.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eDescription of Studies\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA total of 2,179 articles were retrieved from database searches: PubMed (593), EMBASE (534), Web of Science (WoS) (26), ERIC (976), and Google Scholar (50). Additionally, 3 articles were identified from other sources. A total of 1,791 duplicate articles were removed. During the title and abstract screening, 1,731 papers were excluded for various reasons, namely: 569 for irrelevant outcomes, 590 for irrelevant populations, 510 for irrelevant titles, 52 for reviews and protocols, and 10 for retraction. From the title and abstract screening, a total of 1791 articles were selected for full-text screening. Out of these 1791 articles, 60 underwent full-text screening, resulting in the inclusion of 18 articles for narrative synthesis while 42 were excluded due to irrelevant outcomes (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003ch2\u003eGeneral characteristics of the included studies\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe systematic review included 18 studies from a variety of geographical and economic contexts. A significant majority of the research originated from High-Income Countries (72.2%, n\u0026thinsp;=\u0026thinsp;13), followed by Middle-Income Countries (16.7%, n\u0026thinsp;=\u0026thinsp;3) and Lower-Income Countries (11.1%, n\u0026thinsp;=\u0026thinsp;2). The United States was the leading contributor, accounting for four studies (Adams, 2009; Delaney et al., 2011; Hauck et al., 2013; Harper et al., 2017). Ethiopia (Dagne \u0026amp; Beshah, 2021; Dagne et al., 2021) and Iran (Jamshidi, Hemmati Maslakpak et al., 2021; Jamshidi, Parizad, \u0026amp; Maslakpak, 2021) each contributed two studies. Other countries, including Australia (Fry \u0026amp; Attawet, 2018; Malik et al., 2017), Germany (Ehrenbrusthoff et al., 2022), Israel (Mashiach Eizenberg, 2011), Japan (Nango \u0026amp; Tanaka, 2010), South Korea (Son, 2020), Taiwan (Cheng et al., 2020), and Iraq (Ahmed, 2014), each contributed one study, providing a broad international perspective. The professional focus of the studies revealed a distinct pattern: the majority concentrated on nursing professionals (66.7%, n\u0026thinsp;=\u0026thinsp;12), while 22.2% (n\u0026thinsp;=\u0026thinsp;4) included both nurses and midwives, and 11.1% (n\u0026thinsp;=\u0026thinsp;2) specifically examined midwifery practice. This distribution reflects the dominant representation of nursing research in healthcare literature and highlights the relative scarcity of studies focused solely on midwifery.\u003c/p\u003e \u003cp\u003eMethodologically, the studies employed a range of approaches: Cross-sectional designs were most common (38.1%, n\u0026thinsp;=\u0026thinsp;8), which included studies by Adams (2009) and Ahmed (2014). Qualitative studies represented 14.3% (n\u0026thinsp;=\u0026thinsp;3), including those by Dagne and Beshah (2021). Randomized controlled trials accounted for 9.5% (n\u0026thinsp;=\u0026thinsp;2), including those by Jamshidi, Hemmati Maslakpak et al. (2021) and Nango and Tanaka (2010). Mixed methods studies comprised 19.1% (n\u0026thinsp;=\u0026thinsp;4). Other designs included quasi-experimental studies (Cheng et al., 2020; Son, 2020) and one Delphi study (Harper et al., 2017).\u003c/p\u003e \u003cp\u003eThe studies varied greatly in sample sizes, ranging from 20 participants in a Japanese randomized controlled trial (Nango \u0026amp; Tanaka, 2010) to 3,397 participants in a U.S. Delphi study (Harper et al., 2017).\u003c/p\u003e \u003cp\u003eResponse rates also varied widely, from 7.4\u0026ndash;100%, with several studies achieving full participation from their targeted populations.\u003c/p\u003e \u003cp\u003eRegarding participant characteristics, the overwhelming majority of studies (16 out of 18) included undergraduate student trainees. Four studies incorporated graduate professional trainees, and some included both undergraduate and postgraduate participants. Educational levels varied, with some studies specifically documenting the distribution (e.g., Adams (2009): 105 Bachelor's and 126 postgraduate participants).\u003c/p\u003e \u003cp\u003eThe sampling techniques reflected a balance between probability (57.1%, n\u0026thinsp;=\u0026thinsp;12) and non-probability (52.9%, n\u0026thinsp;=\u0026thinsp;11) approaches, indicating considerations of both representativeness and practical sampling constraints.\u003c/p\u003e \u003cp\u003eSeveral studies included specific interventional components, such as experiential learning programs (Cheng et al., 2020), problem-based learning sessions (Jamshidi, Hemmati Maslakpak et al., 2021), and evidence-based practice implementation programs (Mashiach Eizenberg, 2011). (Table.1)\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characteristics of the included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthor/Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEconomic class\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003e(Intervention and Control)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUndergraduate Student trainees\u003c/p\u003e \u003cp\u003e(Yes/No)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGraduate professional Trainees\u003c/p\u003e \u003cp\u003e(Yes/No)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStudy population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eResponse rate (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLevel professional training (no\u0026rsquo;s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eSampling technique\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdams (2009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone??\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003enurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e20.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eBachelor (105)\u003c/p\u003e \u003cp\u003ePost graduate\u003c/p\u003e \u003cp\u003e(126)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eprobability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAhmed\u003c/p\u003e \u003cp\u003e(2014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIraq\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003emidwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003cp\u003e(53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eprobability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Cheng, Huang, Yang, \u0026amp; Chang, 2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTaiwan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e: (experiential learning program)\u003c/p\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e: (response before intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1st Yr. Bachelor\u003c/p\u003e \u003cp\u003estudents\u003c/p\u003e \u003cp\u003e(103)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eprobability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Dagne \u0026amp; Beshah, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses, midwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNur. BSc. (29)\u003c/p\u003e \u003cp\u003ePost grad (3)\u003c/p\u003e \u003cp\u003eBSc. Mid-41.\u003c/p\u003e \u003cp\u003ePost. Grad (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eprobability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Dagne, Beshah, Kassa, \u0026amp; Dagnaw, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses and midwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e95.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eprobability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Delaney, Apostolidis, Lachapelle, \u0026amp; Fortinsky, 2011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e57.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eProbability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Ehrenbrusthoff, Braun, Bahns, Happe, \u0026amp; Kopkow, 2022b)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMidwives and nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eProbability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Mashiach Eizenberg, 2011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIsrael\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e: (EBP implementation)\u003c/p\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e: (non- EBP implementers)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eConvinience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Fry \u0026amp; Attawet, 2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses and Midwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eConvinience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Gebresilassie, Baraki, Kassie, \u0026amp; Wami, 2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMidwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e93.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eProbability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Hauck, Winsett, \u0026amp; Kuric, 2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e: (EBP implementation)\u003c/p\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e: (Baseline response)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e63 (2008)\u003c/p\u003e \u003cp\u003e57 (2010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eprobability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Jamshidi, Hemmati Maslakpak, \u0026amp; Parizad, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e: (PBL learning)\u003c/p\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e: (routine lectures)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eprobability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Jamshidi, Parizad, \u0026amp; Maslakpak, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e: (PBL sessions)\u003c/p\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e: (no education session)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eProbability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Nango \u0026amp; Tanaka, 2010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e: (PBL learning)\u003c/p\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e: (baseline)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eProbability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Son, 2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSouth Korea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e: (simulation problem-based learning)\u003c/p\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e: (traditional maternity nursing clinical practicum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eProbability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Harper et al., 2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDelp.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3,397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e75% Post grad.\u003c/p\u003e \u003cp\u003e25% Bachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eConvience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGulzar MALIK (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQual.\u003c/p\u003e \u003cp\u003eGr.Thr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNurses and midwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100% post grad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003ePurporsive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of the study findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthor name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge group.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResp. rate\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eApplied EBP\u003c/p\u003e \u003cp\u003e(Y/N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e \u003cp\u003eSteps of EBP (Y/N)\u003c/p\u003e \u003cp\u003eAsk a\u003c/p\u003e \u003cp\u003eclin.qn Acquire Appraise Apply Eval.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePrev. Nur.\u003c/p\u003e \u003cp\u003ePract.\u003c/p\u003e \u003cp\u003eEBP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003ePrev.\u003c/p\u003e \u003cp\u003eMid.\u003c/p\u003e \u003cp\u003ePract.\u003c/p\u003e \u003cp\u003eEBP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eFindings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Adams, 2009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eRequired resources for EBP practice, networking opportunities, predeveloped EBP guidelines, and education on outcome evaluation. source of information on EBP (awareness): conferences (87.3%) continuing education, classes (87.0%), colleagues (81.6%) article publications (27.3%) and institutional websites (24.9%). most preferred information sources were internet (65.5%) and textbooks (48.0%).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Ahmed, 2014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u0026ndash;57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003ereasons for performing episiotomy by midwives include: macrosomia/large fetus (38, 71.7%), breech delivery (31, 58.5%), shoulder dystocia (29, 54.7%), anticipated perineal tear (27, 50.9%) and fetal distress (27, 50.9%). There was a significant association between the frequency of these reasons and midwives\u0026rsquo; total experience in delivery rooms as well as their levels of education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Cheng et al., 2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003ethere were significant differences between the pre-test and post-test scores in the three domains: behaviour, thoughts, and feelings. In addition, there were significant differences between the pre-test and post-test scores in the four domains: systematicity/analyticity, open-mindedness, inquisitiveness, and reflective thinking.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Dagne \u0026amp; Beshah, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e53.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Dagne, Beshah, Kassa, \u0026amp; Dagnaw, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eThis study revealed that 34.7% of participants implemented EBP moderately or desirably. Age of participants, the attitude, nursing/midwifery work index, self-efficacy of EBP and knowledge level of participants were statistically significant factors associated with implementation of EBP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Delaney, Apostolidis, Lachapelle, \u0026amp; Fortinsky, 2011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome care nurses\u0026rsquo; scores demonstrated a 78.9% knowledge level in overall HF education principles. Nurses requested further information on all HF topics addressed in the survey as well as on psychosocial issues, research evidence, and more information from other healthcare providers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Ehrenbrusthoff, Braun, Bahns, Happe, \u0026amp; Kopkow, 2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e70% of the participants demonstrated a positive attitude towards EBP and believed that it was useful in clinical practice. Broadly, 80% of the respondents evaluated themselves as being able to enact EBP behaviour in clinical practice. In contrast, less than 70% preferred to use quantitative information instead of their intuition to inform their habitual clinical behaviour. Still, 20 to 30% reported that EBP did not sufficiently account for their clinical experience and differences between patients.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Mashiach Eizenberg, 2011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u0026ndash;57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eThe self-reported professional behaviour of nurses with a degree was more\u003c/p\u003e \u003cp\u003eevidence-based than that of those without a degree. EBP was more likely where there was access to a rich library with nursing and medical journals, and opportunities for working with a computer and\u003c/p\u003e \u003cp\u003efor searching the Internet in the workplace\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Fry \u0026amp; Attawet, 2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e97.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eThe findings showed that evidence for EBP was mostly obtained from clinical practice guidelines followed by article publications. There was a statistical difference when comparing leadership positions and other registered practitioner groups in the frequency of searching for evidence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Gebresilassie et al., 2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u0026ndash;50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eAmong the midwives, one hundred seventy-two (54.8%) (95% CI: 49.08%, 60.37) had good skill on conducting research.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Hauck et al., 2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2008(43.3)\u003c/p\u003e \u003cp\u003e2010(43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2008(63)\u003c/p\u003e \u003cp\u003e2010(57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eWith the interventions in place, the total group scores for beliefs and organizational readiness to implement EBP improved significantly.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Jamshidi, Hemmati Maslakpak, et al., 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl (23.26)\u003c/p\u003e \u003cp\u003eInterventional group (22.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eThe results indicated that the difference in the mean scores of knowledges, attitudes, and perceptions of the nursing students about patient safety was statistically significant between the two groups after the PBL education (p\u0026thinsp;=\u0026thinsp;0.001). The mean scores of students\u0026rsquo; knowledge, attitude, and perceptions of patient safety increased significantly in the intervention group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Jamshidi, Parizad, \u0026amp; Maslakpak, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl (23.26)\u003c/p\u003e \u003cp\u003eInterventional group (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo significant difference was observed in the mean score of patient safety-based communication\u003c/p\u003e \u003cp\u003eskills in the control groups after the intervention (P\u0026thinsp;=\u0026thinsp;0.162). However, the intervention groups had\u003c/p\u003e \u003cp\u003esignificantly higher scores after the educational sessions (P\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Nango \u0026amp; Tanaka, 2010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003escores at baseline and post-program were not significantly different After the program, the Visual Analog Scale for clinical decision making was significantly different, although pre-program values for both groups were similar\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Son, 2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;22.06)\u003c/p\u003e \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eCompared with the control group, the pre-post difference in learning attitude and critical thinking increased significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) in the experimental group. S-PBL was found to be an effective strategy for improving nursing students\u0026rsquo; learning transfer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Kara, Arikan, \u0026amp; Kahyaoglu, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eThe overall mean score for knowledge on pressure injury prevention was 49.9% (11.7/26). in the instrument\u0026rsquo;s subthemes, nutrition scored highest followed by aetiology and development. The overall mean attitude score was 42.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40, although a statistically significant difference among grades was found (P\u0026thinsp;\u0026lt;\u0026thinsp;.001). The highest mean scores showed agreement among students that pressure injury prevention should be a priority (10.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43). A significant difference was found in the competence subscale according to the number of dressing changes observed and sense of competence in pressure injury care (P\u0026thinsp;=\u0026thinsp;.003). A weak but statistically significant positive relationship was found between knowledge and attitude scores\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Harper et al., 2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eThe self-reported professional behaviour of nurses with a degree was more\u003c/p\u003e \u003cp\u003eevidence-based than that of those without a degree. EBP was more likely where there was access to a rich library with nursing and medical journals, and opportunities for working with a computer and\u003c/p\u003e \u003cp\u003efor searching the Internet in the workplace\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Malik, McKenna, \u0026amp; Griffiths, 2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot indicate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNot indicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNurse academics have incorporated various pedagogical approaches to influence\u003c/p\u003e \u003cp\u003eevidence\u003c/p\u003e \u003cp\u003e-based practice education. However, desired to be aware of the most\u003c/p\u003e \u003cp\u003eengaging and effective methods.\u003c/p\u003e \u003cp\u003e\u0026bull; Students were introduced with the evidence\u003c/p\u003e \u003cp\u003e-based practice process, but literature\u003c/p\u003e \u003cp\u003esearching and critical appraisal skills were emphasised to a large extent.\u003c/p\u003e \u003cp\u003e\u0026bull; Participants encountered challenges such as limited time, insufficient resources, heavy\u003c/p\u003e \u003cp\u003eworkload, students\u0026rsquo; disengagement and limited awareness of effective teaching\u003c/p\u003e \u003cp\u003estrategies.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe analysis of the review findings revealed several key themes and patterns across the included studies:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe mean age of participants across studies showed considerable variation, ranging from 18 to 54 years. The majority of studies reported mean ages between 25\u0026ndash;45 years. Notable exceptions included Cheng (2020) with a mean age of 18 years and Harper (2017) with a mean age of 54 years. Response rates varied substantially across studies, from as low as 7.4% (Harper, 2017) to 100% (reported in multiple studies).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eTheme 1: EBP competency\u003c/h2\u003e \u003cp\u003eThe systematic review reveals a multifaceted understanding of EBP competency among nursing and midwifery professionals, with measurement across three primary domains: knowledge acquisition, attitudinal shifts, and practice implementation. Of the 18 studies included in the review, 12 focused on student nurses and midwives and demonstrated adherence to all the essential competencies of EBP. In contrast, participants in the remaining studies failed to follow the foundational steps of EBP. The EBP process encompasses several critical stages. Step 1 involves formulating a clinical question that can be effectively researched. Step 2 requires collecting relevant scientific data from credible sources. Step 3 entails critically appraising the outcomes of the search. Step 4 focuses on applying the evidence in clinical practice, while Step 5 evaluates the quality of care delivered (Law \u0026amp; MacDermid, 2024). Notably, three studies included in the review did not comply with any of the phases of EBP (Ahmed, 2014; Dagne \u0026amp; Beshah, 2021; Janes et al., 2023).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge\u003c/h2\u003e \u003cp\u003eKnowledge transformation emerged as a fundamental indicator of EBP competency development. Jamshidi (2021) documented statistically significant improvements in knowledge scores following PBL interventions (p\u0026thinsp;=\u0026thinsp;0.001), demonstrating that structured educational approaches effectively enhance EBP knowledge. Similarly, Hauck (2008) reported significant improvements in baseline knowledge following targeted interventions. The studies consistently reveal that EBP knowledge encompasses understanding research methodologies, critical appraisal skills, and familiarity with implementation frameworks.\u003c/p\u003e \u003cp\u003eKnowledge deficiencies were also identified, particularly in specialized clinical areas. For instance, Akese (2014) found that 73% of nurses demonstrated a low level of knowledge regarding pressure ulcer identification and staging, highlighting the need for targeted EBP education in specialty domains. This finding suggests that EBP competency development must account for practice-specific knowledge requirements beyond general EBP principles.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eAttitudes\u003c/h2\u003e \u003cp\u003eThe systematic review consistently identified attitudes toward EBP as a critical mediator of implementation success. Ehrenbrusthof (2022) reported that 70% of participants demonstrated positive attitudes toward EBP, believing it useful in clinical practice. This finding underscores the importance of fostering receptive mindsets toward evidence integration. Moreover, Dagne (2021) established that attitudes toward EBP were statistically significant factors associated with implementation, suggesting that attitudinal assessment provides valuable predictive information regarding practice patterns.\u003c/p\u003e \u003cp\u003eEducational interventions showed promising effects on attitudinal development. Kara (2021) found a weak but statistically significant positive relationship between knowledge and attitude scores, suggesting that cognitive understanding influences affective responses to EBP. Additionally, Cheng (2020) documented significant improvements in the affective domains of behavior, thoughts, and feelings following experiential learning interventions, highlighting the malleability of EBP attitudes through appropriate educational strategies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eTheme 2: The prevalence of EBP\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFrom the data presented, the prevalence of EBP implementation varies significantly across studies and settings:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003e1. Overall EBP Implementation Rates:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDagne (2021) found that 34.7% of participants implemented EBP at moderate and desirable levels. In addition, Ehrenbrusthof (2022) reported that 70% of participants had positive attitudes toward EBP, with 80% self-reporting ability to implement it. Moreover, Fry (2017) indicated that EBP implementation rates differed between leadership positions and other practitioners.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e2. Professional Variation:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eNursing EBP prevalence varied from 13.4\u0026ndash;100% across studies, while Midwifery EBP prevalence varied from 8.2\u0026ndash;100%.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Implementation of Evidence-Based Practice\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe review revealed varying levels of EBP implementation across different healthcare settings and professional groups. The majority of studies (\u0026gt;\u0026thinsp;75%) reported active implementation of EBP, with different degrees of adherence to the five fundamental steps of evidence-based practice: asking clinical questions, acquiring evidence, appraising evidence, applying evidence and evaluating outcomes.\u003c/p\u003e \u003cp\u003eImplementation rates varied significantly between nursing professionals (13.4\u0026ndash;100%) and midwifery professionals (34.6\u0026ndash;100%), suggesting potential differences in EBP adoption between these professional groups. Implementation rates showed considerable variation: For nursing professionals: ranging from 13.4% (Ehrenbrusthof, 2022) to 100% (multiple studies), for midwifery professionals: ranging from 34.6% (Dagne, 2021) to 100% (Gebresilassie, 2022).\u003c/p\u003e \u003cp\u003eOf the 20 studies included in this systematic review, three explored the use of Problem-Based Learning (PBL) as a training approach for Evidence-Based Practice (EBP) among undergraduate nursing students (Jamshidi, Hemmati Maslakpak, et al., 2021; Nango \u0026amp; Tanaka, 2010; Son, 2020). Two of these studies were conducted in Iran (Jamshidi, Hemmati Maslakpak, et al., 2021; Jamshidi, Parizad, et al., 2021), while the third was carried out in Japan (Nango \u0026amp; Tanaka, 2010).\u003c/p\u003e \u003cp\u003eAmong the Iranian studies, one was a randomized controlled trial (RCT) comparing PBL with traditional lecture-based teaching methods (Jamshidi, Hemmati Maslakpak, et al., 2021; Jamshidi, Parizad, et al., 2021). The second study was a quasi-experimental design comparing PBL to no educational intervention but rather a clinical practicum placement. Both studies utilized a sample of 78 undergraduate nursing students. The Japanese study, involving a sample of 20 undergraduate nurses, was an RCT that compared PBL with a baseline condition.\u003c/p\u003e \u003cp\u003eFindings from these studies demonstrated that PBL was associated with significant improvements in students' knowledge, attitudes, and behaviours toward implementing EBP when compared to traditional lecture methods or baseline conditions.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTheme 4: Impact on Knowledge and Practice\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eSeveral studies have demonstrated positive outcomes of PBL on EBP knowledge and application:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e1. Jamshidi (2021) found that the PBL intervention group had significantly higher scores in knowledge, attitudes, and perceptions related to patient safety compared to the control group.\u003c/p\u003e \u003cp\u003e2. Son (2020) reported that simulation-based PBL significantly improved learning transfer among nursing students.\u003c/p\u003e\u003cp\u003e3. Consistently, studies have shown that professionals with higher education levels, particularly those holding degrees, exhibited more evidence-based behaviors (Eizenberg, 2010; Harper, 2017).\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Enhancement of Learning Attitudes and Critical Thinking\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003ePBL approaches have demonstrated positive effects on students' learning attitudes and critical thinking skills. Cheng (2020) found significant improvements in key areas such as systematic thinking, analytical skills, open-mindedness, inquisitiveness, and reflective thinking following PBL interventions. Similarly, Son (2020) showed that students in the experimental PBL group experienced notable increases in their learning attitudes and critical thinking abilities when compared to those taught using traditional methods. Additionally, research by Nango and Tanaka (2010) indicated that PBL contributes to improved clinical decision-making skills.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eTheme 6: Challenges in Curriculum Integration and Implementation\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eSeveral common challenges and considerations for integrating Project-Based Learning (PBL) into Evidence-Based Practice (EBP) curriculum were identified:\u003c/p\u003e \u003cp\u003eMalik (2016) highlighted several barriers, including limited time, insufficient resources, heavy workloads, and student disengagement. Additionally, infrastructure requirements were emphasized, particularly the need for access to libraries, computers, and internet resources (Mashiach Eizenberg, 2011).\u003c/p\u003e \u003cp\u003eFurthermore, the importance of proper preparation and support for both staff and students were underscored (Janes et al., 2023).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 6: Curriculum Integration and Implementation Challenges\u003c/b\u003eSeveral common challenges and considerations for integrating PBL into EBP curriculum have emerged. Malik (2016) identified significant barriers such as limited time, insufficient resources, heavy workloads, and student disengagement. Additionally, infrastructure requirements were highlighted, including access to libraries, computers, and internet resources (Mashiach Eizenberg, 2011). The importance of adequate preparation and support for both staff and students were also emphasized (Janes, Ekpenyong, Mbeah-Bankas, \u0026amp; Serrant, 2023); kpenyong, Mbeah-Bankas, \u0026amp; Serrant, 2023).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003eTheme 7: Evidence of Curriculum Orientation Toward EBP\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe studies revealed a clear trend in incorporating EBP into curricula. Several studies emphasized the importance of systematic approaches for evaluating and implementing evidence. There was a consistent focus on integrating practical skills with theoretical knowledge. Additionally, the development of critical appraisal skills and research literacy was evident across the studies.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003eTheme 8: Key findings from educational interventions and their impact\u003c/h2\u003e \u003cp\u003eSeveral studies have evaluated specific educational interventions, with a particular focus on PBL approaches. Jamshidi et al. (2021) demonstrated significant improvements in knowledge, attitudes, and perceptions of patient safety following the implementation of PBL. Similarly, Son et al. (2020) reported notable enhancements in learning attitudes and critical thinking skills through simulation-based PBL compared to traditional teaching methods.\u003c/p\u003e \u003cp\u003eThe effectiveness of these educational interventions is influenced by several factors:\u003c/p\u003e \u003cp\u003e \u003cp\u003e \u003cb\u003e1. Professional Education Level\u003c/b\u003e: Studies consistently show that practitioners with higher degrees exhibit more evidence-based professional behaviour (Mashiach Eizenberg, 2011). This finding suggests that educational level is crucial for the successful implementation of EBP.\u003c/p\u003e\u003cp\u003e \u003cb\u003e2. Resource Availability\u003c/b\u003e: Resource access is critical for successful EBP implementation. Studies have highlighted the importance of access to digital libraries, networking opportunities, predeveloped evidence-based guidelines, and computers and the internet in the workplace.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3. Organizational Support\u003c/b\u003e: Research emphasizes the significance of organizational factors in EBP implementation, including Leadership support, allocated time for EBP activities, opportunities for professional development, and a supportive workplace culture.\u003c/p\u003e\u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eBarriers and Facilitators\u003c/h3\u003e\n\u003cp\u003eThe review identified several consistent barriers to EBP implementation, including:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eLimited access to resources and libraries (Malik et al., 2017)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTime constraints and heavy workloads (reported across multiple studies)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eKnowledge and skill deficits (Valerie, 2017)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLimited organizational support\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eConversely, several facilitating factors were identified:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAccess to digital resources and libraries (Eizenberg, 2010)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHigher educational qualifications\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStrong organizational leadership (Hauck, 2013)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOpportunities for continuing education\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSupportive professional networks\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEvidence-based practice (EBP) has become a cornerstone of quality healthcare delivery, requiring practitioners to integrate the best available research evidence with clinical expertise and patient values (Sackett et al., 1996). However, practical methods for teaching and implementing EBP among nursing and midwifery professionals remain an ongoing investigation. This systematic review focuses explicitly on the efficacy of PBL approaches for teaching EBP to nursing and midwifery professionals, examining implementation rates, learning outcomes, and factors influencing the success of this pedagogical strategy.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eEffective learning of EBP requires consideration of cognitive, affective, behavioural, and environmental elements, which is where the PBL teaching approach could be of value. However, this review found only three studies where PBL interventions, combined with different teaching and learning approaches, were effective in teaching EBP in nursing and midwifery (Jamshidi, Hemmati Maslakpak, et al., 2021; Nango \u0026amp; Tanaka, 2010; Son, 2020). Due to the heterogeneity in the reported teaching methodologies, populations, and interventions, it was difficult to determine which EBP teaching and learning approach was most effective in improving learners' EBP competencies, as most teaching methods proved effective. The studies that examined the effectiveness of teaching EBP included blended learning, experiential learning, and simulation-based learning, all of which also appeared effective in applying the steps of the EBP process and in clinical judgment and practice (Janes et al., 2023; Son, 2020).\u003c/p\u003e\u003cp\u003eThis review identified three studies specifically investigating PBL approaches (Jamshidi, Hemmati Maslakpak, et al., 2021; Nango \u0026amp; Tanaka, 2010; Son, 2020) that demonstrated significant improvements in students' knowledge, attitudes, and behaviours toward implementing EBP compared to traditional teaching methods. These findings align with previous systematic reviews in the broader healthcare education literature. For instance, Kong et al. (2014) systematically reviewed PBL in nursing education. Similarly, they found that PBL was superior to traditional lecture-based approaches for developing critical thinking skills, though they did not specifically focus on EBP education.\u003c/p\u003e\u003cp\u003eIn contrast, Cant and Cooper's (2017) systematic review of active learning strategies in nursing education found mixed results regarding PBL's superiority over other active learning strategies, suggesting that while PBL shows promise, its relative advantage over other student-centered approaches remains unclear. Our findings extend this understanding specifically within the context of EBP education, demonstrating more consistent positive outcomes than reported in some broader educational reviews.\u003c/p\u003e\u003cp\u003eIn our 2023\u0026ndash;2024 review, we also found that the quality of methodologies and the use of psychometrically validated tools to assess learner competency in EBP varied. These results are consistent with the latest overview of systematic reviews, which concluded that the current evidence on this topic is of poor quality, characterized by heterogeneity of interventions and outcome measures (Bala et al., 2021). Although the research utilized different teaching approaches with distinct focuses, several common themes were identified. Studies employing small groups and evidence implementation methodologies indicated the influence of social and environmental factors in clinical practice (Janes et al., 2023; Khan \u0026amp; Coomarasamy, 2006). These techniques are aligned with the principles of constructivist pedagogy and PBL methodology (Ramis, Chang, \u0026amp; Nissen, 2015). These factors warrant further investigation. Problem-Based Learning (PBL) may enhance learners' education by teaching them to apply theory to clinical practice and fostering the development of their problem-solving abilities. However, two studies conducted by Jamshidi et al. (2021) found no significant difference in EBP behaviour between teaching methods compared to traditional methods, nor between curricula with and without EBM integration. Moreover, the research also found that student nurses who experienced PBL had higher scores in indicators of EBP behaviour compared to those who received traditional lectures (Jamshidi, Hemmati Maslakpak, et al., 2021).\u003c/p\u003e\u003cp\u003eOur finding that PBL approaches notably enhanced critical thinking skills (Cheng, 2020; Son, 2020) and clinical decision-making capabilities (Nango \u0026amp; Tanaka, 2010) is consistent with meta-analyses by Shin and Kim (2013), who found moderate positive effects of PBL on critical thinking development in nursing education(Shin \u0026amp; Kim, 2013). However, our review specifically connects these cognitive improvements to EBP implementation, which Shin and Kim did not explore in depth.\u003c/p\u003e\u003cp\u003eThese findings also align with Salinitri et al.'s (2015) systematic review of active learning strategies in pharmacy education, which found that PBL specifically enhanced evidence appraisal skills compared to other active learning approaches(Salinitri, Wilhelm, \u0026amp; Crabtree, 2015). This suggests that the benefits of PBL for critical thinking development may be particularly relevant for EBP education across healthcare disciplines.\u003c/p\u003e\u003cp\u003eOur finding that 12 of 18 studies demonstrated adherence to all essential EBP competencies following educational interventions, including PBL approaches, provides more comprehensive evidence than previous reviews. For instance, Young et al.'s (2014) systematic review of EBP teaching strategies found limited evidence for comprehensive competency development across the five EBP steps, focusing primarily on knowledge and appraisal skills rather than application and evaluation. Our review's identification of three studies that did not comply with any phases of EBP (Ahmed, 2014; Dagne \u0026amp; Beshah, 2021; Janes et al., 2023)(Janes et al., 2023) highlights implementation quality issues that have received limited attention in previous reviews. This finding extends upon Maggio et al.'s (2013) systematic review of EBP curricula, which identified variability in EBP teaching approaches but did not specifically analyze implementation fidelity or competency development across the complete EBP process(Maggio, Tannery, Chen, ten Cate, \u0026amp; O\u0026rsquo;Brien, 2013).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCurrent data does not provide sufficient support for the efficacy of PBL in teaching EBP, as there is limited research to substantiate this issue. Moreover, no single teaching approach has been shown to surpass others in enhancing learner competency in EBP, regardless of their nursing and midwifery status whether they are students or professionals, undergraduates or postgraduates. The substandard quality and diversity of interventions and outcome measures restricted the synthesis of findings. Future research should prioritize the development of rigorous studies and the use of psychometrically validated instruments to further examine the effectiveness of PBL as a teaching strategy for EBP and its impact on the EBP competencies of nurses and midwives. Additionally, it is essential to investigate the ongoing monitoring of learner proficiency in EBP as they progress from beginner to more advanced levels, including nursing and midwifery trainees and professionals actively applying EBP in clinical practice.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContribution of the Authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe design of the systematic review, including the formulation of the PICO question, was collaboratively undertaken by all authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eG.K (Grace Komuhangi), A.K(Alison Annet Kyinengyere), and O.M (Ocan Moses) devised the search strategy,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ewhich A.K executed. G.K and A.K evaluated citations for potential inclusion in the review after analysing both abstracts and complete texts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eG.K and A.K conducted the data extraction session.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;F.N(Florian Neuhann), J.W (J\u0026uuml;rgen Wacker), and GK assessed the potential for bias in the included studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eG.K prepared Figure 1. G.K and A.K prepared Figure 2\u003c/p\u003e\n\u003cp\u003eG.K, O.M and F.N prepared tables 1 and 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe review did not receive any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no known conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdams, S. (2009). Use of evidence-based practice in school nursing: Survey of school nurses at a national conference. \u003cem\u003eThe Journal of School Nursing, 25\u003c/em\u003e(4), 302\u0026ndash;313.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed, H. M. (2014). Midwives\u0026rsquo; clinical reasons for performing episiotomies in the Kurdistan Region: are they evidence-based? \u003cem\u003eSultan Qaboos University Medical Journal, 14\u003c/em\u003e(3), e369.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurns, P., \u0026amp; Weston, K. M. (2022). Evidence-Based Practice in Medical Education: Mapping a Research and Critical Analysis Program Against the Sicily Statement. \u003cem\u003eMedical Science Educator, 32\u003c/em\u003e(4), 779\u0026ndash;783.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng, Y.-C., Huang, L.-C., Yang, C.-H., \u0026amp; Chang, H.-C. (2020). Experiential learning program to strengthen self-reflection and critical thinking in freshmen nursing students during COVID-19: a quasi-experimental study. \u003cem\u003eInternational Journal of Environmental Research and Public Health, 17\u003c/em\u003e(15), 5442.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCleary-Holdforth, J., O\u0026rsquo;Math\u0026uacute;na, D., \u0026amp; Fineout‐Overholt, E. (2021). Evidence‐based practice beliefs, implementation, and organizational culture and readiness for EBP among nurses, midwives, educators, and students in the Republic of Ireland. \u003cem\u003eWorldviews on Evidence‐Based Nursing, 18\u003c/em\u003e(6), 379\u0026ndash;388.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoomarasamy, A., \u0026amp; Khan, K. S. (2004). What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. \u003cem\u003eBmj, 329\u003c/em\u003e(7473), 1017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDagne, A. H., \u0026amp; Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. \u003cem\u003ePloS one, 16\u003c/em\u003e(8), e0256600.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDagne, A. H., Beshah, M. H., Kassa, B. G., \u0026amp; Dagnaw, E. H. (2021). Implementation of evidence-based practice and associated factors among nurses and midwives working in Amhara Region government hospitals: a cross-sectional study. \u003cem\u003eReproductive health, 18\u003c/em\u003e, 1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelaney, C., Apostolidis, B., Lachapelle, L., \u0026amp; Fortinsky, R. (2011). Home care nurses\u0026rsquo; knowledge of evidence-based education topics for management of heart failure. \u003cem\u003eHeart \u0026amp; Lung, 40\u003c/em\u003e(4), 285\u0026ndash;292.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEhrenbrusthoff, K., Braun, T., Bahns, C., Happe, L., \u0026amp; Kopkow, C. (2022). Adherence to evidence-based practice across healthcare professionals in Germany: results from a cross-sectional, nationwide survey. \u003cem\u003eBMC Health Services Research, 22\u003c/em\u003e(1), 1285.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFidan, M., \u0026amp; Tuncel, M. (2019). Integrating augmented reality into problem based learning: The effects on learning achievement and attitude in physics education. \u003cem\u003eComputers \u0026amp; Education, 142\u003c/em\u003e, 103635.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFry, M., \u0026amp; Attawet, J. (2018). Nursing and midwifery use, perceptions and barriers to evidence-based practice: a cross-sectional survey. \u003cem\u003eJBI Evidence Implementation, 16\u003c/em\u003e(1), 47\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebresilassie, K. Y., Baraki, A. G., Kassie, B. A., \u0026amp; Wami, S. D. (2022). Midwifery-led researches for evidence-based practice: Clinical midwives engagement in research in Ethiopia, 2021. \u003cem\u003ePloS one, 17\u003c/em\u003e(6), e0268697.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarper, M. G., Gallagher-Ford, L., Warren, J. I., Troseth, M., Sinnott, L. T., \u0026amp; Thomas, B. K. (2017). Evidence-based practice and US healthcare outcomes: Findings from a national survey with nursing professional development practitioners. \u003cem\u003eJournal for Nurses in Professional Development, 33\u003c/em\u003e(4), 170\u0026ndash;179.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHauck, S., Winsett, R. P., \u0026amp; Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. \u003cem\u003eJournal of advanced nursing, 69\u003c/em\u003e(3), 664\u0026ndash;674.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImmonen, K., Tuomikoski, A.-M., K\u0026auml;\u0026auml;ri\u0026auml;inen, M., Oikarinen, A., Holopainen, A., Kuivila, H.,. .. Vesterinen, S. (2022). Evidence-based healthcare competence of social and healthcare educators: A systematic review of mixed methods. \u003cem\u003eNurse education today, 108\u003c/em\u003e, 105190.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJamshidi, H., Hemmati Maslakpak, M., \u0026amp; Parizad, N. (2021). Does problem-based learning education improve knowledge, attitude, and perception toward patient safety among nursing students? A randomized controlled trial. \u003cem\u003eBMC nursing, 20\u003c/em\u003e(1), 70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJamshidi, H., Parizad, N., \u0026amp; Maslakpak, M. H. (2021). Problem-based learning; a new pathway towards improving patient safety-based communication skills in nursing students. \u003cem\u003eJournal of Preventive Epidemiology, 6\u003c/em\u003e(2), e25-e25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanes, G., Ekpenyong, M. S., Mbeah-Bankas, H., \u0026amp; Serrant, L. (2023). An international exploration of blended learning use in pre-registration nursing and midwifery education. \u003cem\u003eNurse Education in Practice, 66\u003c/em\u003e, 103514.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKara, H., Arikan, F., \u0026amp; Kahyaoglu, A. (2021). Student nurse knowledge of and attitudes toward pressure injury prevention: how sufficient is undergraduate education? \u003cem\u003eAdvances in Skin \u0026amp; Wound Care, 34\u003c/em\u003e(9), 473\u0026ndash;480.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKyriakoulis, K., Patelarou, A., Laliotis, A., Wan, A. C., Matalliotakis, M., Tsiou, C., \u0026amp; Patelarou, E. (2016). Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review. \u003cem\u003eJournal of educational evaluation for health professions, 13\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaggio, L. A., Tannery, N. H., Chen, H. C., ten Cate, O., \u0026amp; O\u0026rsquo;Brien, B. (2013). Evidence-based medicine training in undergraduate medical education: a review and critique of the literature published 2006\u0026ndash;2011. \u003cem\u003eAcademic Medicine, 88\u003c/em\u003e(7), 1022\u0026ndash;1028.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalik, G., McKenna, L., \u0026amp; Griffiths, D. (2017). Using pedagogical approaches to influence evidence-based practice integration\u0026ndash;processes and recommendations: findings from a grounded theory study. \u003cem\u003eJournal of advanced nursing, 73\u003c/em\u003e(4), 883\u0026ndash;893.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMashiach Eizenberg, M. (2011). Implementation of evidence-based nursing practice: nurses\u0026rsquo; personal and professional factors? \u003cem\u003eJournal of advanced nursing, 67\u003c/em\u003e(1), 33\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGuinness, L. A., \u0026amp; Higgins, J. P. (2021). Risk-of‐bias VISualization (robvis): an R package and Shiny web app for visualizing risk‐of‐bias assessments. \u003cem\u003eResearch synthesis methods, 12\u003c/em\u003e(1), 55\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelnyk, B. M., \u0026amp; Fineout-Overholt, E. (2022). \u003cem\u003eEvidence-based practice in nursing \u0026amp; healthcare: A guide to best practice\u003c/em\u003e: Lippincott Williams \u0026amp; Wilkins.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMillanzi, W. C., \u0026amp; Kibusi, S. M. (2020). Exploring the effect of problem-based facilitatory teaching approach on metacognition in nursing education: a quasi‐experimental study of nurse students in Tanzania. \u003cem\u003eNursing Open, 7\u003c/em\u003e(5), 1431\u0026ndash;1445.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolina Montoya, N. P. (2013). Problem-Based Learning as Teaching Strategy.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNango, E., \u0026amp; Tanaka, Y. (2010). Problem-based learning in a multidisciplinary group enhances clinical decision making by medical students: a randomized controlled trial. \u003cem\u003eJournal of medical and dental sciences, 57\u003c/em\u003e(1), 109\u0026ndash;118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D.,. .. Brennan, S. E. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. \u003cem\u003ebmj, 372\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamis, M.-A., Chang, A., \u0026amp; Nissen, L. (2015). Strategies for teaching evidence-based practice to undergraduate health students: a systematic review protocol. \u003cem\u003eJBI Evidence Synthesis, 13\u003c/em\u003e(2), 12\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., \u0026amp; Richardson, W. S. (1996). Evidence based medicine. \u003cem\u003eBMJ: British Medical Journal, 313\u003c/em\u003e(7050), 170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalinitri, F. D., Wilhelm, S. M., \u0026amp; Crabtree, B. L. (2015). Facilitating facilitators: Enhancing PBL through a structured facilitator development program. \u003cem\u003eInterdisciplinary Journal of Problem-Based Learning, 9\u003c/em\u003e(1), 11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSari, Y. I., Utomo, D. H., \u0026amp; Astina, I. K. (2021). The Effect of Problem Based Learning on Problem Solving and Scientific Writing Skills. \u003cem\u003eInternational Journal of Instruction, 14\u003c/em\u003e(2), 11\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin, I.-S., \u0026amp; Kim, J.-H. (2013). The effect of problem-based learning in nursing education: a meta-analysis. \u003cem\u003eAdvances in Health Sciences Education, 18\u003c/em\u003e, 1103\u0026ndash;1120.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSon, H. K. (2020). Effects of S-PBL in maternity nursing clinical practicum on learning attitude, metacognition, and critical thinking in nursing students: a quasi-experimental design. \u003cem\u003eInternational Journal of Environmental Research and Public Health, 17\u003c/em\u003e(21), 7866.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoung, T., Rohwer, A., Volmink, J., \u0026amp; Clarke, M. (2014). What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. \u003cem\u003ePloS one, 9\u003c/em\u003e(1), e86706.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Problem-Based Learning, Evidence-Based Practice, Nursing Education, Midwifery Education, Systematic Review, Healthcare Education","lastPublishedDoi":"10.21203/rs.3.rs-6120932/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6120932/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eProblem-Based Learning (PBL) has emerged as a potential educational strategy for teaching Evidence-Based Practice (EBP) to nursing and midwifery professionals. However, the effectiveness of this approach remains inadequately synthesized in the literature.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo systematically review and evaluate the efficacy of Problem-Based Learning approaches in teaching Evidence-Based Practice to nursing and midwifery professionals.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic review was conducted across multiple databases. 18 studies met the inclusion criteria, representing diverse geographical locations and methodological approaches. Studies were analyzed for their methodological quality, implementation strategies, and outcomes related to EBP competencies.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThree studies specifically explored PBL as a training approach for EBP among nursing students. PBL demonstrated significant improvements in students' knowledge, attitudes, and behaviors toward implementing EBP compared to traditional teaching methods. Studies showed enhanced critical thinking, systematicity, analyticity, and open-mindedness among participants. Implementation challenges included limited time, insufficient resources, and the need for proper infrastructure. Higher education levels consistently correlated with improved evidence-based behaviors. The review identified substantial heterogeneity in teaching methodologies, populations, and interventions, making it challenging to determine the most effective EBP teaching approach.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWhile PBL shows promise in teaching EBP to nursing and midwifery professionals, the current evidence base is characterized by methodological heterogeneity and varying quality. PBL may enhance learners' ability to apply theory to clinical practice and develop problem-solving skills. However, successful implementation requires adequate organizational support, resources, and infrastructure. Future research should focus on standardizing outcome measures and conducting more rigorous comparative studies to establish the optimal approach for EBP education in nursing and midwifery.\u003c/p\u003e","manuscriptTitle":"Efficacy of Problem Based Learning approach for teaching Evidence Based Practice for midwifery and nursing professionals: a systematic review.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-13 06:04:59","doi":"10.21203/rs.3.rs-6120932/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bab8b7a6-0a00-42e1-a712-556a252c1433","owner":[],"postedDate":"March 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44957772,"name":"Nursing"}],"tags":[],"updatedAt":"2025-03-13T06:04:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-13 06:04:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6120932","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6120932","identity":"rs-6120932","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}