Improving the Competency of Evidence-Based Nursing in China: Addressing Workforce Crisis and Inefficiencies in Leveraging the Potential of a Vast Healthcare Market

Improving the Competency of Evidence-Based Nursing in China: Addressing Workforce Crisis and Inefficiencies in Leveraging the Potential of a Vast Healthcare Market | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving the Competency of Evidence-Based Nursing in China: Addressing Workforce Crisis and Inefficiencies in Leveraging the Potential of a Vast Healthcare Market Xin Xiang, Yang Gao, Luping Dong, Yinshan Tang, Hongzhi Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7430762/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: Evidence-based nursing practice (EBNP) has the potential to enhance healthcare efficiency, ensure patient safety, improve patient satisfaction, advance healthcare services, and accelerate progress towards Universal Health Coverage. However, despite being the world’s most populous and rapidly aging country, China has not fully realized the benefits of EBNP. The primary factor contributing to the significant gap between the demand for and supply of EBNP is the inadequate capabilities within its nursing workforce. Identifying the core competencies required for EBNP implementation is crucial to address this unmet demand. Aims: This study aimed to identify the core competencies necessary for the nursing workforce and propose a competency framework to effectively implement EBNP in China. Methods: A qualitative study was conducted in two phases. In the first phase, in-depth, semi-structured interviews with 67 participants from 17 provinces across mainland China were conducted, followed by thematic analysis to develop an initial competency framework. The second phase involved the Delphi method, engaging 29 experts to validate the proposed framework for EBNP. Results: The proposed competency framework consists of five domains and 20 sub-components essential for nurses to implement EBNP effectively in China. These domains include personal traits, professional value, research ability, leadership and management, and implementation and assessment. Conclusion: The findings provide valuable insights that can contribute to evidence-based nursing education, supporting the development of professionals equipped to address healthcare service demands. The proposed framework has potential applications in guiding the assessment, recruitment, and training of the nursing workforce, which may alleviate workforce shortage. Future research could further refine and integrate this framework into interventions and assessments, evaluating its long-term impacts on nursing practice. Nursing Evidence-based nursing practice health workforce shortage competency framework nursing education nursing care Introduction The World Health Organization (WHO) and nations worldwide remain committed to achieving Universal Health Coverage (UHC), striving to deliver high-quality healthcare services and foster health equity [ 1 – 4 ]. The enhancement of health service coverage and the realization of the right to the highest attainable standard of health depend on the availability, accessibility, acceptability, and quality of the health workforce [ 5 ]. This necessitates evidence-based health workforce strategies to efficiently allocate limited resources across all healthcare system levels. However, policymakers and scholars widely recognize that health workforce shortages remain a significant challenge for countries at various socioeconomic development levels [ 6 ]. The WHO projects a health workforce gap of 10 million by 2030, with half of this deficit expected in the nursing sector [ 7 ]. Given their pivotal role in health promotion and disease prevention, especially in delivering services to the most vulnerable and hard-to-reach populations, nurses are indispensable for achieving UHC [ 8 ]. In response to nurse shortages, countries have implemented human resource strategies to optimize workforce availability and accessibility. For instance, China has introduced incentive policies to encourage individuals to pursue nursing, offering scholarships and allowances [ 9 ]. Nonetheless, nursing, as a highly specialized profession, requires more than a mere increase in quantity to meet healthcare needs aligned with Sustainable Development Goals (SDGs) and UHC. Indeed, inefficiencies in strategy implementation and unmet demand arise from the mismatched capacities of nurses, particularly evident in Evidence-Based Nursing Practices (EBNP) [ 10 ]. Research indicates lower satisfaction with implementing EBNP and insufficient nursing competency, underscoring the urgent need to enhance nurses’ competencies to effectively implement EBNP [ 11 , 12 ]. Identifying the characteristics of a capable health workforce for EBNP implementation is paramount to addressing the unmet demand. Therefore, this study aims to explore this question. EBNP, recognized as an effective strategy for enhancing healthcare quality, has garnered widespread acceptance among health policymakers, healthcare professionals, and researchers [ 13 , 14 ]. Previous studies have demonstrated the positive impact of EBNP on healthcare outcomes, patient satisfaction, resource efficiency, reduced hospital stays, and improved cost efficiency [ 15 , 16 ]. While EBNP is rapidly advancing in developed nations such as the U.S., U.K., Australia, and Spain, it is still in its early stages in low- and middle-income countries (LMICs) [ 10 ]. The escalating need for evidence in healthcare decision-making in LMICs, driven by a high burden of diseases and illnesses, has become increasingly apparent. China is one of the most populous countries globally and ranks among the countries with the highest elderly population. The large population, uneven distribution of healthcare resources, and significant regional disparities in healthcare services underscore the urgent need for EBNP in China to enhance healthcare quality and standards [ 17 , 18 ]. In response, China has actively adopted the evidence-based healthcare model proposed by the Joanna Briggs Institute (JBI) of Australia, which is the largest global organization promoting EBNP, to guide its national EBNP development. Recent scholarly evidence suggests that the significant potential of EBNP to enhance healthcare quality in China. For instance, Wang et al. [ 19 ] conducted a study on patients with coronary heart disease, demonstrating that a nurse-led biofeedback-assisted relaxation training program, rooted in EBNP, led to significant improvements in sleep quality and quality of life. The study employed a randomized design, assigning patients to morning, night, morning-night, or control groups, and outcomes were measured through self-reported sleep-related indicators and validated scales like the Pittsburgh Sleep Quality Index (PSQI) and Zung’s Self-rating Anxiety Scale (SAS), revealing enhanced physical activity and notable reductions in anxiety and depression symptoms. These outcomes underscore the capacity of EBNP to achieve tangible patient-centered results in specific clinical contexts, illustrating how integrating evidence-based interventions can elevate patient care. However, the implementation of EBNP in China faces substantial barriers, while limit its practical effectiveness and widespread adoption. Despite its theoretical promise, many nurses encounter significant challenges in translating EBNP principles into routine clinical practice [ 20 ]. Key obstacles include limited leadership support, insufficient understanding of EBNP methodologies and systemic gaps in professional training [ 12 ]. Among these challenges, the lack of adequate knowledge, skills, and competence among nursing staff stands out as one of the most fundamental issues [ 10 ]. These barriers have collectively contributed to the underutilization of EBNP, leaving it unable to meet the pressing demand for improved healthcare quality and standards in China. In response to the challenge of insufficient EBNP competence among nursing professionals, there is a call for increased research efforts dedicated to constructing a competence framework for EBNP, enabling more effective implementation. To date, there has been a scarcity of studies systematically proposing such a framework. This study, therefore, seeks to fill this gap by identifying the core competencies necessary for EBNP and proposing a competency framework for its effective implementation in China through a qualitative study employing semi-structured interviews and the Delphi method. Methods We adopted a two-phase approach to develop the core competencies for EBNP. Phase 1 consisted of qualitative interviews to draft an initial competency framework, followed by Phase 2, which employed the Delphi method to validate the competency framework for EBNP. Phase 1: Semi-structured interviews This phase utilized a qualitative descriptive study approach, employing semi-structured interviews with key stakeholders to investigate the essential competencies required for nurses to implement EBNP in clinical practice. Semi-structured interviews were chosen to enable a more in-depth exploration of specific topics. The interview outline was crafted following the framework of the evidence-based healthcare model of JBI. This study selectively engaged key stakeholders involved in, influencing, or researching EBNP, including directors of nursing, nurses, and experts from universities. Participants were chosen based on several criteria: (1) nurses with a minimum of 3 years of EBNP experience, defined as direct participation in evidence-based practice activities, such as implementing evidence-based interventions, contributing to EBNP related clinical decision making, or actively engaging in EBNP training and workshops; (2) directors of nursing with at least two years of leadership experience in nursing departments and holding an associate professional title or above; (3) university experts with a background in supervising EBNP training programs or relevant research experience in EBNP; (4) candidates with a geographical distribution covering regions with varying concentrations of health resources; and (5) an attempt to distribute the percentage of respondents from different organizations based on the actual situation. Initial participant recruitment utilized researchers’ personal networks or invitation emails sent to potential candidates. Subsequently, a snowball sampling procedure was employed, encouraging participants to invite other qualified respondents. Semi-structured interviews were conducted with a total of 67 participants. The final sample size was determined by the concept of data saturation, which refers to the point at which no new themes or categories emerge from additional interviews, and the data collected adequately represents the phenomena under study. When the research team noted that no new information or themes were emerging, and that the data from subsequent interviews were consistently fitting into the pre-existing thematic categories, it was agreed that saturation had been reached. Specifically, the researchers reviewed transcripts after each interview, comparing the data to existing themes, and determined whether any new themes or perspectives had emerged. The decision to cease interviews was made after a thorough analysis of the data from the 67th participant, at which point no new themes were identified. This ensured that the sample size was adequate for capturing the diversity of perspectives with the target population, while also maintaining the rigor of the study. According to the evidence-based healthcare model of JBI, the interview guide comprised a set of primary questions and potential follow-up questions developed through a review of the literature and the collective expertise of the research team. The objective was to discern the fundamental competencies required for nurses to effectively implement EBNP in clinical settings. The semi-structured interview questions included: Please introduce yourself and your working background. Please elucidate your comprehension of EBNP, particularly the evidence-based healthcare model of JBI in the context of EBNP implementation. What are the essential competencies for implementing EBNP in clinical practice in China? Kindly offer suggestions for enhancing competencies in EBNP implementation. (For nurses specifically) Kindly share your experiences both successful and unsuccessful, in implementing ENBP. (For nurses specifically) What factors, in your opinion, influence your competencies?. These questions were designed to align with the group characteristics of the respondents and to explore the competencies needed for effective EBNP implementation. The interview guide served as a framework to ensure comprehensive and consistent data collection across participants. Individual interviews were conducted either at the participants’ workplaces in a conference setting or through video calls to accommodate geographical distances. The research team conducted 67 in-depth interviews between March and November 2022, with each interview lasting one to two hours. Recordings were made after obtaining prior oral informed consent and were transcribed within 24 hours of the interview. The ultimate count of participants was determined through saturation, signifying the point at which additional interviews did not yield new thematic insights. To uphold ethical standards, personal information and specific workplace locations were omitted from the data. The transcripts of audio recordings are transcribed and supplemented with field observation notes and interview transcripts to form comprehensive interview data. Each interview transcript undergoes member checking to validate the integrity and accuracy of the interviews. Thematic analysis, guided by the framework proposed by Braun and Clarke [ 21 ], was employed to analyze the data. Data coding and analysis were carried out using NVivo 12.0. The details of coding process were reported below: Initial coding: Two researchers independently reviewed the transcribed data and developed an inital set of codes related to the competencies necessary for implementing EBNP. These codes were derived inductively from the data, meaning that the researchers did not begin with a predefined set of codes but instead allowed themes and categories to emerge naturally from the interview transcripts. Codebook development: To ensure systematic analysis, a codebook was developed during the initial phase of coding. The codebook contained definitions of each code, along with illustrative examples from the transcripts. This process allowed for consistency in coding across all transcripts and facilitated transparent tracking of the evolving themes. Inter-coder reliability: After the initial coding phase, the two researchers compared their code data. Any discrepancies or differences in coding were discussed in detail, and a third researcher was consulted to help resolve disputes. A consensus approach was used to ensure that the final coding accurately reflected the data. The inter-coder reliability was assessed by calculating Cohen’s kappa coefficient for a randomly selected portion of the data, achieving a value of 0.75, indicating a high level of agreement between the coders. Pattern identification and theme development: The researchers examined the data for patterns, relationships, and contradictions in the coded responses. By grouping related codes together and analyzing their frequency and co-occurrence across different interviews, patterns were identified. These patterns informed the development of broader themes and sub-components related to competencies in EBNP. Additionally, the researchers focused on contradictions within the data, as these often provided valuable insights into complex or underexplored aspects of the competency domains. Refinement of themes and sub-components: The identified codes, sub-components, and themes were compared with the original data, ensuring that the analysis remained grounded in the actual interview transcripts. These discussions were iterative, involving continual dialogue among the researchers, ensuring that each theme accurately captured the nuances of the data. Themes were refined and redefined as necessary based on the emerging data. Validation and Consensus: Throughout the process, continual discussions were held among all authors to validate the themes and ensure that the interpretation of the data was consistent. This collaborative approach facilitated the development of a final set of competency domains and sub-components that were grounded in the experiences and perspectives of the interview participants. The detailed coding process allowed us to identify key competencies necessary for the successful implementation of EBNP in nursing practice. The final competency domains and sub-components in this phase were derived through a rigorous, transparent, and iterative process of analysis, ensuring the robustness and validity of the findings. Phase 2: Delphi process This phase utilized a Delphi study, a widely recognized consensus-building technique employed in the formulation of competency frameworks, to validate the initially proposed competency framework for the implementation of EBNP in China and to establish the content validity of the framework. The Delphi process consisted of three rounds, with the first round being qualitative and the subsequent rounds (2 and 3) involving quantitative assessments. To ensure the representativeness of the experts in the Delphi study, we assembled the panel using a purposive stratified sampling approach. This approach was chosen to ensure a balanced and comprehensive representation of diverse perspectives within the field of EBNP in China. Invitations were extended via email, including study details and an estimate of the time commitment expected for their participation. A total of 29 experts were selected, and the sampling strategy aimed to capture a range of expertise and experience across different dimensions relevant to EBNP. The characteristics and professional backgrounds of the selected experts ensured a balanced representation of perspectives, as outlined below: Clinical and academic expertise Experts were selected from both clinical practice and academic research backgrounds to ensure that the panel captured the full spectrum of perspectives on EBNP. Nursing directors, who bring valuable experience from clinical practice, were selected to provide insights on the practical implementation of EBNP in hospital settings. In contrast, nursing educators and researchers, with their focus on teaching and advancing the theoretical aspects of EBNP, were included to ensure the inclusion of scholarly perspectives and evidence-based knowledge dissemination. Geographic diversity Experts were recruited from both developed and underdeveloped regions of China to capture the differing stages of EBNP implementation across the country. Experts from more developed areas, where EBNP has been more established, provided insights into the challenges and successes of implementing evidence-based practices in well-resourced environments. Conversely, experts from less developed regions, where EBNP is still emerging, shared their perspectives on the barriers and opportunities for advancing EBNP in areas with fewer resources and infrastructure. This geographic diversity was essential to ensure that the findings of the study reflect the realities of EBNP across the entire country. International and domestic educational backgrounds To enhance the diversity of perspectives, the panel included experts with varying levels of international exposure to evidence-based nursing education. Some experts had received advanced training in countries with well-established EBNP systems, such as Australia and Canada, and brought with them international best practices and global perspectives on EBNP. Other experts had been trained within China, contributing valuable insights into how EBNP is being integrated within the local context, and highlighting the unique challenges and strengths of domestic EBNP practices. This mix of international and domestic educational backgrounds helped ensure that the panel was well-rounded and inclusive of different approaches to EBNP. Professional experience The selection of experts was also informed by their professional experience and position within the nursing community. Nursing directors were required to have a minimum of five years of leadership experience in nursing departments, defined as holding a managerial or supervisory position with responsibilities such as overseeing clinical nursing practices, developing and implementing nursing policies, coordinating team activities, and managing staff performance and professional development, ensuring that they had practical knowledge of managing and implementing EBNP in clinical settings. Nursing educators and researchers were selected based on their significant involvement in EBNP education and research, with at least three years of experience in these fields, and holding positions such as associate professors or higher. This level of expertise was critical to ensure that the panel was composed of individuals who could contribute valuable insights into both the theory and practice of EBNP. The 29 experts were deemed sufficient to provide a wide range of viewpoints while maintaining a manageable group size for effective discussion and consensus-building. Additionally, the sample size aligns with recommendations in Delphi methodology for obtaining reliable expert opinions, where 15–30 participants are typically considered optimal for balancing diversity and manageability of the panel. Three rounds were conducted from March 2023 to May 2023. In round 1, the initial template was sent to the panel to modify key themes and potential components of framework obtained from interviews. Experts were required to review and refine these competencies by identifying redundancies, integrating related concepts, and increasing the necessary competencies to drop. Two open-ended questions were established as follows: (1) Please kindly provide comments or modifications regarding the proposed theme and components of competency framework for EBNP implementation; (2) Please provide additional competencies that are crucial but missing from the proposed framework. The responses were collected and used to generate a comprehensive set of modified and newly proposed components encompassing all themes. Three rounds were conducted from March to May 2023. In the initial round, the preliminary template was distributed to the panel for the modification of key themes and potential components derived from interviews. Experts were tasked with reviewing and refining these competencies, which involved identifying redundancies, integrating related concepts, and suggesting necessary competencies for addition. Two open-ended questions were formulated as follows: (1) Kindly provide comments or modifications concerning the proposed themes and components of the competency framework for EBNP implementation; (2) Offer additional competencies deemed crucial but currently absent from the proposed framework. Responses were collected and utilized to generate a comprehensive set of modified and newly proposed components, spanning all themes. Subsequently, two additional rounds of the Delphi process were administered through self-administered questionnaires. Specifically, the second round questionnaire was developed based on the outcomes of the initial round and comprised three sections: (1) a cover letter introducing the study and providing instructions for completing the questionnaire; (2) sociodemographic information of experts and their familiarity with the field of EBNP; (3) the proposed competency framework for EBNP implementation, consisting of five domains and 20 components. The questionnaire utilized a five-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree) to enable experts to assess the extent of their agreement or disagreement with this competency framework. In the third round, feedback was disseminated regarding the outcomes derived from the second round. The identical questionnaire, along with a succinct statistical summary of responses from the second-round, was returned to the experts. Encouragement was extended to the experts to reevaluate and adjust their initial votes in light of the synthesized results. This process provided an opportunity for experts to revise their responses, taking into account the collective opinions within the panel. The experts were requested to complete the questionnaire within a two-week time-frame and scored based on their individual opinions, with anonymity assured. To analyze the ratings from the second and third rounds, the mean and content validity ratios (CVRs) for each item were calculated. The CVR is the appropriate technique for determining consensus among a panel of experts and is computed as (n e -N/2)/(N/2), where n e is the number of panel lists who indicated ‘agree or strongly agree’ and N is the total number of panel lists. If any item met the criteria of mean < 4 or CVR < 0.70, it was considered nonessential and subsequently removed from competency framework after discussing with the research team. Ethical considerations All participants involved in the interviews and the Delphi process provided informed consent in response to a letter that explicitly stated the voluntary nature of participation and guaranteed complete confidentiality. Ethical approval for this study was granted by the Research Ethics Committee of the Guangxi Academy of Medical Sciences (IIT−2023−79). Results The characteristics of participants and Delphi experts A total of 67 individuals from 17 provinces across mainland China were participated in the semi-structured interviews. Among these participants, 23 were affiliated with universities, while 44 were associated with tertiary hospitals. The majority of the participants (28 individuals, 41.79%) had more than 10 years of professional experience, and 77.61% (52 individuals) held a master's degree or above. Among the respondents, 40 (59.70%) had over three years of evidence-based nursing experience, 56 (83.58%) had participated in or instructed evidence-based nursing training programs, and 37 (55.22%) had been involved in related research activities. A detailed presentation of the demographic characteristics and EBNP-related experience of the participants is provided in Table 1 . Table 1 Demographic characteristics of participants Variable Number Proportion(%) Total Cases (N) 67 100% Gender Female 58 86.57% Male 9 13.43% Age Under 30 11 16.42% 30–40 31 46.27% 41–50 21 31.34% 51–60 4 5.97% Years of work experience 5 years or less 13 19.40% 6–10 years 26 38.81% More than 10 years 28 41.79% Educational degree Bachelor 15 22.39% Master 31 46.27% Ph.D 21 31.34% Profession Educator or researcher from university 23 34.33% Director of nursing department 31 46.27% EBNP nurses 13 19.40% Geographical location Eastern region 25 37.31% Central region 19 28.36% Western region 23 34.33% EBNP-related experience Years of EBNP experience ( > = 3 years) 40 59.70% Attended EBNP training programs (Yes) 56 83.58% Participated in EBNP research (Yes) 37 55.22% We invited 32 experts to participate in the Delphi process, of whom 29 (90.63%) responded in the first round. The respondent rate in the second and third round was 100%. Table 2 presents the demographic characteristics of the expert panel involved in the Delphi method. Female experts constituted the largest proportion (25 individuals, 86.21%). The majority of experts (20 individuals, 68.97%) were affiliated with universities, including 9 professors and 11 associate professors. Most of these university-based experts had over six years of experience in EBNP education (14 individuals, 70%). Additionally, nine experts were nursing supervisors from hospitals, of whom five had 5–10 years of experience managing nursing departments, while four had over 10 years of management experience. Table 2 Demographic characteristics of Delphi study Variable Number Proportion(%) Total Cases (N) 29 100% Gender Female/Woman 25 86.21% Male/Man 4 13.79% Degree type Master 10 34.48% Ph.D 19 65.52% Age 30–40 13 44.83% 41–50 10 34.48% 51–60 6 20.69% Affiliation University 20 68.97% Hospital 9 31.03% Position Professor 9 31.03% Associate professor 11 37.94% Director of nursing 9 31.03% Years of leadership experience (for Director of nursing) (n = 9) 5–10 years 5 55.56% More than 10 years 4 44.44% Years of EBNP education (for Associate professor and professor) (n = 20) 1–5 years 6 30.00% 6–10 years 10 50.00% More than 10 years 4 20.00% Competency dimensions of EBNP The thematic analysis of the interview data revealed five distinct competency domains essential for effective evidence-based nursing implementation. These domains include personal traits, professional value, research ability, leadership and management, and implementation and mentoring. Additionally, a total of 24 sub-component were identified, providing a comprehensive framework that outlines the multifaceted nature of nursing competence in the context of EBNP, as detailed in Table 3 . Table 3 Initial competency framework from interview Themes Items Personal traits Self-reflection Self improvement Responsibility Courage Professional value Empathy Care for others Ethical practice Legal practice Equality and respect Promoting professional development Research ability Identification clinical issues Evidence search ability Literature quality assessment Solving clinical problem with scientific thinking Leadership and management Communication with other colleges and patients Teamwork Health education skills Risk management Patient safety management Implementation and mentoring Clinical nursing practical skills Evidence application scenario assessment ability EBNP program construction ability EBNP program implementation ability Ability to evaluate the effect of EBNP program The valuable feedback received in the first round of Delphi experts promoted the renaming and consolidation of several themes and components from the initial template. Specifically, three items were renamed: “implementation and mentoring” was changed to “implementation and assessment,” “evidence search ability” was revised to “literature search ability,” and “communication” was updated to “communication with other colleagues and patients”. Additionally, several items were merged: “legal practice” and “ethical practice” were combined into “legal/ethical practice,” “EBNP program implementation ability” was consolidated into “EBNP program construction,” and “risk management” and “patient safety management” were consolidated into “risk and safety management”. Furthermore, “care for others” was combined into the broader concept of “empathy”. Following the first round’s outcomes, the framework for evidence-based nursing competency underwent expert validation using a 5-level scale in the second and third rounds. A consensus on the core competencies for evidence-based nursing was achieved through three rounds of Delphi, with all items demonstrating 100% content validity. Table 4 presents the proposed evidence-based nursing competency framework, comprising 5 domains and 20 sub-components, and includes a statistical description of the results from the second and third rounds (with the second round's results shown in parentheses). Additionally, t-tests were utilized to determine the significance of differences between the statistical descriptions across the two rounds. Table 4 Competency framework for evidence-based nursing in China It reports the mean values in Round 3 first and those in Round 2 in brackets; a t test was used to test whether the means of competencies of Round 3 have statistical significance compared with Round 2. *** denotes that the mean value is different between rounds with statistical significance level of 1%. Themes Items Mean Personal traits Self-reflection 4.45 *** (4.38) Self improvement 4.48 *** (4.41) Responsibility 4.66 *** (4.66) Courage 4.34 *** (4.34) Professional value Empathy 4.21 *** (4.14) Legal/ethical practice 4.31 *** (4.24) Equality and respect 4.51 *** (4.51) Promoting professional development 4.24 *** (4.24) Research ability Identification clinical issues 4.66 *** (4.66) Literature search ability 4.76 *** (4.76) Literature quality assessment 4.55 *** (4.55) Solving clinical problem with scientific thinking 4.62 *** (4.62) Leadership and management Communication with other colleges and patients 4.66 *** (4.66) Teamwork 4.41 *** (4.41) Health education skills 4.34 *** (4.27) Risk and safety management 4.24 *** (4.24) Implementation and assessment Clinical nursing practical skills 4.55 *** (4.55) Evidence application scenario assessment ability 4.59 *** (4.48) EBNP program construction ability 4.45 *** (4.38) Ability to evaluate the effect of EBNP program 4.55 *** (4.52) Competency framework for EBNP The proposed competency framework consists of 5 domains and 20 sub-components, representing core competencies crucial for nurses to effectively implement evidence-based nursing practices in China. We then provide a detailed analysis of these competencies within the context of evidence-based nursing in China. Personal traits The personal traits domain reflects the attitudes and motivations that drive individuals to actively engage in EBNP. This confirmed prior study highlighting personal traits as a crucial determinant affecting nursing performance [ 22 ]. As one respondent noted, “The ability to engage with EBNP from a personal commitment to continuous learning and improvement. It’s about staying updated and reflecting on your own practice to be better every day”. EBNP, as an ongoing process of learning, emphasizes the use of the latest and most reliable clinical evidence when making nursing decisions and and formulating practices. Respondents highlighted the need for nurses to possess key personal traits to ensure that they continuously reflect on and summarize their clinical practice. One participant explained, “We can’t just do the job; we need to keep improving ourselves, especially by staying informed about the latest research and adapting our practice accordingly”. Therefore, nursing professionals must maintain a constant focus on new clinical research, guidelines, and practical experiences to improve patient outcomes and their own professional growth. The four core sub-competencies identified in this domain are self-reflection, self-improvement, responsibility, and courage. Self-reflection emphasizes the capacity of individuals to engage actively in a thorough and systematic analysis of their thoughts, actions, experiences, and emotions. In the context of EBNP, nurses are expected o constantly assess their practices, and reflect deeply on their actions, decisions, and clinical judgments. Observable behaviors that exemplify this competency include regularly keeping a reflective journal to document and analyze clinical experiences, seeking feedback from colleagues to identify areas for improvement, and critically evaluating clinical decisions after patient interactions to assess whether evidence-based practices were properly applied. One participant stated, “Through self-reflection, I am able to identify where I may have made decisions based on assumptions rather than evidence, which helps me to improve my nursing competencies.” Another respondent emphasized, “Self-reflection allows me to see my own biases and knowledge gaps, which is crucial for my professional growth in EBNP”. Self-improvement denotes the ongoing learning, development, and enhancement of one’s abilities within a professional sphere, aiming for excellence and continuous progress. In EBNP, nurses are encouraged to maintain a learning mindset and update their knowledge and skills by actively seeking the latest research findings, clinical guidelines, and best practices to deliver optimal nursing care. Observable behaviors demonstrating this competency include attending relevant workshops and training sessions on new evidence-based practices, reading and applying the latest research articles to clinical settings, and engaging in peer discussions to share knowledge and reflect on new developments in nursing. One nurse explained, “In my daily practice, I regularly look for the newest guidelines and research to improve my care. It’s not just about keeping up; it’s about being proactive in applying new evidence to improve patient outcomes.” Responsibility refers to the sense of accountability individuals hold when undertaking specific tasks, roles, or responsibilities, and the willingness to take responsibility for their actions and decisions. In the realm of EBNP, nurses have a significant responsibility to ensure that the care provided is based on the latest evidence, thereby maximizing patient treatment outcomes and satisfaction. Observable behaviors include ensuring that care plans are based on current, evidence-based guidelines, consistently reviewing clinical guidelines to ensure they are integrated into practice, and taking ownership of patient care outcomes by actively seeking evidence to address any gaps in practice. A respondent highlighted, “As a nurse, he/she should feel a strong responsibility to ensure that the treatments he/she provide are evidence-based, as it directly affects patient outcomes. They should always make sure to check if the latest evidence is applied in the care plans”. Courage represents the quality demonstrated by individuals when facing difficulties, challenges, uncertainty, or risks, involving displaying confidence, decisiveness, and determination in decision-making and action, even in the face of pressure or potential negative consequences. Observable behaviors reflecting this competency include proposing evidence-based changes to clinical practices despite resistance from colleagues or institutional norms, actively advocating for patient safety even in difficult or uncomfortable situations, and being willing to challenge outdated practices that may compromise care quality. One participant shared, “At times, challenging the status quo is essential. In EBNP, suggesting changes to established practices is not always easy, but it’s necessary for improving patient safety and care quality.” Another respondent emphasized, “It takes courage to speak up and advocate for evidence-based changes, especially when the traditional ways of doing things are deeply entrenched in the culture of the institution”. Professional value Professional value involves a set of principles and values that govern the behavior of nurses within EBNP, aiming to assist them in navigating ethical and moral challenges inherent in their profession, ensuring that their actions align with societal expectations, legal regulations, and professional standards. One respondent emphasized, “Professional values serve as the moral and ethical cornerstone for nurses practicing, empowering nurses to uphold the highest standards of professionalism in clinical care and ensuring that patients receive comprehensive, compassionate, and safe care”. This domain contained four key aspects: empathy, legal/ethical practice, equality and respect, and promoting professional development. Those findings align with previous studies, but they also expand beyond the traditional focus on promoting professional development and legal/ethical practice [ 23 , 24 ]. Empathy refers to the nurse’s ability to understand and share the emotions, experiences, and perspectives of patients. In the context of EBNP, it is crucial for nurses to connect with patients on an emotional level, resonate with their needs, and respond accordingly to provide compassionate, personalized care. Observable behaviors that exemplify this competency include actively listening to patients’ concerns, using empathetic language to acknowledge patients’ feelings, and demonstrating attentiveness to non-verbal cues, such as body language or facial expressions, to assess emotional states. One respondents stated, “Empathy plays as a pivotal role in forming strong nurse-patient relationships. It builds patient trust and facilitates better participation in treatment decisions, which is key to improve patient outcomes”. Empathy fosters patient trust, enhances engagement in care, and ensures better adherence to treatment plans. Legal/ethical practice underscores the necessity for nurses to uphold ethical principles and adhere to legal regulations in their professional responsibilities. In EBNP, nurses must consistently navigate ethical challenges while complying with relevant laws and regulations. This include ensuring informed consent, maintaining patient confidentiality, and adhering to professional guidelines. Observable behaviors in this area include consistently discussing treatment options with patients to ensure informed consent, safeguarding patient information and ensuring it is shared only with appropriate healthcare professionals, and upholding ethical standards by addressing any conflicts of interest or ethical dilemmas in a timely manner. A respondents noted, “Legal/ethical practice is foundational in safeguarding patients’ rights and ensuring that the healthcare professionals operate within acceptable ethical and legal frameworks”. Ethical practice not only protects patients but also ensures that all members of the healthcare team uphold high standards of conduct. Equality and respect are fundamental principles guiding nurses’ interactions with patients, colleagues, and other healthcare professionals. These principles advocate for the eradication of discrimination in healthcare settings, ensuring that every individual receives fair and dignified treatment. Observable behaviors reflecting equality and respect include treating all patients, regardless of background, with the same level of care and respect, being culturally sensitive in communication, and ensuring that all team members are equally heard in collaborative decision-making. One respondent noted, “In EBNP, equality and respect are critical. Nurses must be sensitive to cultural, religious, and personal differences among patients to provide culturally competent care”. Additionally, these values also apply to collaborative work with colleagues, fostering an inclusive environment where all perspectives are valued. “In an interdisciplinary team, respect for each team member’s contributions enhances collaboration and drives the team towards common goals,” another respondent added. Promoting professional development refers to the ongoing pursuit of knowledge and skills to advance both individual and disciplinary growth. Nurses practicing EBNP are expected to stay abreast of latest developments in medical and nursing knowledge to meet increasingly complex needs of patients and improve healthcare delivery. Observable behaviors in this area include attending continuing education courses, participating in professional conferences, engaging in self-directed learning, and applying new knowledge and skills in clinical practice. Respondents emphasize that, as professionals, EBNP nurses not only aim for personal growth but also contribut to the advancement of nursing science and evidence-based practice in China. One participant noted, “Nurses in China have an immense potential to drive the development of evidence-based practice. This responsibility is not just to improve our own skills but to contribute to the growth of the entire profession.” Research ability Research ability refers to the capacity of nursing professionals to engage in academic thinking, master scholarly skills, and design and implement scientific research projects. In the context of EBNP, nurses must continually engage in academic research and knowledge innovation to refine and enhance clinical practice continually. Previous research has acknowledged the importance of research skills for nursing professionals [ 25 ], but it has not specifically explored how research skills mainfest in the implementation of EBNP in China. This gap is largely attributed to differences between China and the Western countries in the characteristics of evidence-based nursing practitioners. Most Chinese evidence-based nursing practitioners have only received undergraduate education, which often lacks formal training in academic research skills. However, evidence-based nursing practice requires nurses to explore and apply the latest scientific evidence, much of which is published in English-language international journals. As such, proficiency in academic research skills is essential for accessing these cutting-edge scholarly resources. This study specifically identified several key components of research ability, including identification of clinical issues, literature search ability, literature quality assessment, and solving clinical problems with scientific thinking. Identification of clinical issues refers to the ability to recognize problems within clinical practice. EBNP emphasizes guiding clinical practices based on the most current scientific evidence. To implement EBNP effectively, nurses must first accurately identify existing problems in clinical practice, which enables targeted literature searchers, evidence evaluation, and evidence-based decision-making. Observable behaviors that exemplify this competency include actively observing patient care processes, discussing and identifying challenges in clinical team meetings, conducting regular audits to spot gaps in patient care, and documenting observed problems for further analysis. As one respondent explained, “Identifying clinical problems is the first crucial step to ensuring that nursing interventions are both effective and appropriate”. Literature search ability is the proficiency of nurses in navigating various literature databases and accurately accessing sources of evidence. Effective literature retrieval provides a wealth of evidence to guide clinical practice. Observable behaviors related to this competency include using multiple sources, such as academic journals, medical databases, and online platforms, to retrieve evidence, performing advanced search strategies using keywords, filters, and Boolean operators; and demonstrating the ability to organize and synthesize retrieved data into relevant clinical topics. However, many respondents highlighted hat nurses in China often lack awareness of existing academic databases, particularly international ones, and tend to rely on limited and single channels for literature retrieval. As noted in previous studies, this lack of familiarity with international databases has been a barrier to evidence-based practice in China [ 26 ]. One respondent pointed out, “This limited access to international databases restricts our ability to obtain the most up-to-date clinical clinical evidence”. This lack of awareness hampers their ability to access the latest research, making it imperative to improve literature retrieval skills in the context of EBNP in China. Literature quality assessment refers to the skills required to evaluate and interpret evidence, identifying the most appropriate sources of evidence for clinical practice. Given the diversity of available evidence, nurses must be able to evaluate its relevance and quality to ensure it is suitable for addressing clinical needs. Observable behaviors in this area include assessing the credibility of the source of evidence (e.g., peer-reviewed journals, reputable institutions), applying critical appraisal tools to assess the methodology of studies, and comparing evidence from multiple sources to ensure consistency and reliability. Respondents emphasized the importance of discerning high-quality evidence. As one participant noted, “For EBNP to be effective, we must be able to find and apply the evidence most relevant to patient needs. This requires the ability to critically evaluate the quality of the available evidence”. Solving clinical problem with scientific thinking refers to the ability to systematically analyze, evaluate, and resolve clinical problems based on the latest scientific evidence and theoretical knowledge. Scientific thinking enables nurses to engage in independent reasoning and adopt a methodical approach to solving clinical issues. Observable behaviors that exemplify this competency include using structured frameworks for problem-solving (e.g., PICO method), analyzing patient cases using evidence-based guidelines, testing hypotheses to verify clinical assumptions, and utilizing decision-making models to guide the implementation of interventions. Respondents emphasized the importance of approaching clinical problems from a scientific perspective. One respondent noted, “By analyzing clinical issues through the lens of scientific thinking, nurses can systematically identify the root causes of problems and develop evidence-based solutions”. This ability not only improves clinical practice but also strengthens the overall quality of care provided to patients. Leadership and management The leadership and management domain focuses on the efficient collaboration of nurses with other healthcare stakeholders to ensure the delivery of high-quality patient care. EBNP often requires teamwork and coordination among various stakeholders, including nurses, physicians, and patients. Nurses who possess strong leadership and management skills can efficiently organize and coordinate team members to provide optimal nursing services, enhance patient satisfaction, and promote the development of evidence-based medicine. In contrast to previous research, which primarily emphasized management aspects [ 25 , 27 ], this domain highlights the critical leadership role of nurses in advancing evidence-based scientific development among stakeholders, as well as their managerial responsibilities in implementing evidence-based nursing practice. Communication with other colleagues and patients is the ability to promptly and clearly convey information and share knowledge with colleagues and patients, thereby reducing information asymmetry. Proficient communication skills facilitate collaboration among team members, ensuring smooth information flow and mutual understanding. Observable behaviors that exemplify this competency include actively listening to colleagues during handoff discussions, using clear and concise language to explain complex medical terms to patients, providing timely updates on patient conditions during team meetings, and tailoring communication to suit the needs of different audiences (e.g., using simple language for patients with limited medical knowledge). One respondent noted, “Positive communication with patients helps nurses more personalized care, addressing not only their physiological needs but also their psychological and emotional concerns”. Teamwork ability refers to the capacity for interdisciplinary collaboration, where team members leverage their respective expertise and skills to deliver comprehensive care. In healthcare settings with limited resources, effective teamwork ensures better coordination in the allocation and utilization of resources, ultimately benefiting patient care. Observable behaviors that demonstrate this competency include actively participating in team meetings, offering constructive feedback to colleagues, sharing relevant research or evidence during discussions, and respecting each team member’s contributions. Nurses should also demonstrate flexibility by adjusting their roles to accommodate the needs of the team. As one respondent stated, “Through collaboration, team members can exchange ideas, share experience, and jointly develop problem-solving methods, thereby enhancing the overall proficiency and capability of the healthcare team”. Health education skills are crucial for nursing professionals to effectively impart knowledge and strategies that help patients understand and manage their conditions while adopting proactive health behaviors. Nurses engaging in health education foster patient empowerment, leading to improved self-management and self-care. Observable behaviors in this area include explaining treatment plans and health risks in a way that patients understand, using visual aids or printed materials to enhance patient comprehension, regularly checking in with patients to assess their understanding of health instructions, and encouraging patients to ask questions about their care. As one respondent noted, “EBNP emphasizes the prevention and management of chronic diseases, and health education plays a key role in empowering patients to adopt healthy lifestyle changes, including dietary, exercise, and medication management”. Risk and safety management ability involves nurses’ ability to mitigate medical risks, ensure patient safety, and deliver high-quality care. EBNP emphasizes the reduction of health risks and the enhancement of patient safety through the use of scientific evidence and best practices. Observable behaviors that exemplify this competency include regularly performing risk assessments for patients (e.g., fall risk, infection control), checking for potential medication interactions before administering drugs, following established protocols for infection prevention, and reporting safety concerns immediately to the appropriate authorities. Nurses should also actively engage in patient safety training sessions and encourage colleagues to adhere to safety guidelines.. One respondent emphasized, “Proficient risk and safety management helps prevent medical errors, ensuring that patients receive the right treatment at the right time, thereby avoiding adverse outcomes”. Implementation and assessment Implementation and assessment domain refers to the ability to integrate evidence-based knowledge with clinical practice, develop clinical practice protocols, and access the outcomes of EBNP. This competency domain enables nurses to effectively translate evidence-based nursing principles into practical actions and ensure their execution aligns with the standards and quality expectations of best practices. Respondents frequently mentioned the importance of ongoing evaluation, with one stating, “We must constantly check whether what we’re doing aligns with evidence-based guidelines; it’s not enough just to implement, evaluation is key to improvement”. Additionally, nursing professionals need to regularly access the effectiveness of evidence-based nursing strategies and adjust practices based on these evaluations to continuously improve the quality of care. As one respondent emphasized, “It’s not just about applying evidence; we have to review the results and refine our strategies based on what works best for the patients”. This domain highlights both the application of evidence and the continuous assessment of its effects to drive the development of evidence-based medicine. Nursing practice skills encompass the essential clinical knowledge, experience, and abilities that nurses acquire, allowing them to convert evidence-based theoretical knowledge into practical application. Proficiency in these skills enables nurses to perform nursing tasks effectively, improving work efficiency, reducing errors, and enhancing the safety and quality of care. Observable behaviors that exemplify this competency include accurately assessing patient conditions based on physical exams, interpreting lab results to guide clinical decisions, applying evidence-based protocols during routine care, and using appropriate nursing techniques to ensure patient comfort and safety. One respondent reflected, “Without solid clinical practice skills, even the best evidence can’t be applied effectively. The skills are the bridge between theory and real-world care”. Evidence application scenario assessment ability involves evaluating the specific circumstances of patients and integrating the latest evidence to guide clinical decisions and actions. Effective practice requires an in-depth understanding of clinical contexts, such as patient medical histories, symptoms, and diagnostic results. Observable behaviors demonstrating this competency include conducting thorough patient assessments, considering both the latest evidence and the unique aspects of each patient’s condition, modifying evidence-based protocols based on patient preferences and available resources, and continuously updating care plans in response to new clinical information. One nurse elaborated, “Every patient is different, and EBNP needs to be flexible. It’s about knowing the research, but also knowing the patient in front of you”. Another respondent added, “You can’t just follow a guideline blindly; you have to adapt it to the reality of the situation, considering everything from the patient’s condition to available resources”. Nurses must therefore blend scientific evidence with clinical experience and individual patient differences to create the most appropriate care plans. Ability to construct EBNP program refers to the ability to plan, design, and establish projects within EBNP. Clear planning and careful design ensure that the goals of these projects are feasible and that resources are allocated appropriately. Observable behaviors include developing clear objectives and timelines for EBNP projects, identifying necessary resources (e.g., staff, equipment, funding), and ensuring that all project components are aligned with evidence-based guidelines. Additionally, nurses must ensure the sustainability of programs by planning for ongoing monitoring and adaptation. One nurse explained, “You can’t expect good results from evidence-based projects if they’re not carefully planned from the start, clear goals and the right resources are crucial”. Another participant stressed, “It’s important to know that every project should be sustainable and adaptable, ensuring that we can meet patients’ needs without overextending resources”. Ability to evaluate the effect of EBNP programs refers to the capacity to evaluate the outcome and effects of EBNP and engage in retrospective reflection on the entire process. Reflecting on the outcomes allows nursing professionals to identify shortcomings and adjust practices to enhance care quality. Observable behaviors that demonstrate this competency include systematically collecting data on patient outcomes (e.g., patient satisfaction, health improvements), analyzing the effectiveness of implemented EBNP programs, seeking feedback from patients and colleagues to identify areas for improvement, and revising care strategies based on evaluation findings. Respondents emphasized the importance of continuous evaluation in ensuring the ongoing improvement of nursing services. One respondent noted, “If we don’t evaluate the outcomes, we miss opportunities to refine and improve our practices. It’s through evaluation that we can find gaps and make changes”. Another nurse highlighted, “Evaluation is where new knowledge emerges. By assessing our practice, we contribute to evidence that can be shared and used to further develop the field”. In this way, the evaluation process not only improves current practice but also contributes to the advancement of evidence-based medicine. Discussion EBNP holds great potential for enhancing medical efficiency, ensuring patient safety, improving patient satisfaction, advancing healthcare services, and accelerating progress towards UHC. Despite China’s position as the world’s most populous and rapidly aging country, it has yet to fully harness the extensive benefits of EBNP, primarily due to the insufficient capabilities among its nursing workforce. This gap underscores the critical need for a scientifically robust and systematic EBNP competency framework in China. This study proposed a core competency framework comprising five domains and 20 items essential for nurses implementing evidence-based nursing in China, aiming to foster a health workforce dedicated to advancing evidence-based medicine and global health. To our knowledge, this study marks the first attempt to develop a national-scale competency framework for EBNP in China, expected to significantly contribute to the competency maturation in mainland China. This study, based on the JBI model, proposes a competency framework for EBNP consisting of five core domains and twenty sub-components. The JBI model provides a solid foundation for evidence-based healthcare, emphasizing interdisciplinary competencies such as evidence generation, synthesis, translation, and implementation. In contrast, the competency framework presented in this study further delineates these competencies, focusing on how nursing professionals can effectively apply EBNP in their clinical settings, thereby offering a more structured and practice-oriented framework. Furthermore, these domains are closely linked to established theoretical frameworks, enhancing the framework’s scientific rigor and theoretical value. Specifically, the personal traits domain is crucial in shaping EBNP, with traits like self-reflection and self-improvement aligning with Bandura’s social cognitive theory [ 28 ], which highlights the role of self-efficacy and persistence in motivating challenging yet achievable behaviors. These traits support the adoption of evidence-based practices and professional development. The professional values domain, including empathy, ethics, equality, and respect, is essential for patient-centered care. These values resonate with Kohlberg’s theory of moral development [ 29 ], which emphasizes moral reasoning driven by principles of justice and respect, fostering ethical decision-making in nursing practice. The research ability domain bridges theory and practice by enabling nurses to critically appraise and apply the best available evidence to improve patient outcomes. This aligns with evidence-based medicine [ 30 ], which integrates research, clinical expertise, and patient values to optimize care. The leadership and management domain is vital for implementing systemic changes in healthcare. Nurses with strong leadership skills drive organizational change, promote interdisciplinary collaboration, and integrate evidence-based practices into clinical care. This aligns with Lewin’s change management theory [ 31 ], providing a framework for facilitating organizational change. The implementation and assessment domain ensures EBNP’s successful integration into clinical practice, promoting continuous improvement. This domain is linked to quality improvement theories [ 32 ], particularly the Plan-Do-Study-Act (PDSA) cycle, which supports iterative practice refinement through systematic evaluation. This study provided several new insights on developing workforce for EBNP. First, personal traits and professional value are two core domains of competency, highlighting personal internal driving force is one of the decisive factors for nurses’ competency in evidence-based nursing. The professional value of nurses is essential to nursing practice. Research indicated that nurses’ sense of responsibility and innate mission towards their job duties drive them to contribute the advancement of nursing science and the maintenance of health equity, while striving for high-quality nursing outcomes [ 22 ]. Evidence-based nursing is committed to global health which places a priority on improving health and achieving health equity for all people worldwide. Hence, this requires courage, responsibility, equal and respect, and other internal trait to drive nurses to actively implement this concept. Professional education of evidence-based nursing should be strengthened in China. Prior study has demonstrated that evidence-based nursing training can effectively enhance the knowledge and self-efficacy of nurses and nursing students, thereby further promoting implementation practices [ 33 ]. With the implementation of evidence-based nursing in China, although some universities have started offering evidence-based nursing programs, they are mainly focused on the postgraduate level, with very few offering undergraduate programs in this field. This has resulted in an inadequate supply of professionally trained talent to meet the market demand in clinical practice. Such domains identified in this study as research ability. However, the competencies proposed in this study require specialized development and the optimal stage of intervention is undergraduate education. Additionally, there is a need to strengthen continuing education in evidence-based nursing, providing more opportunities for in-service nurses to undergo retraining, thus meeting the demand of nursing professionals who have not received specialized education but wish to actively participate in evidence-based nursing practice. The diversification of disciplines is crucial for conducting evidence-based nursing education. Incorporating evidence-based nursing-related courses comprehensively into undergraduate nursing education is the first step in assisting nursing students to systematically master the foundational skills and knowledge of evidence-based nursing to assume professional roles in evidence-based nursing practice [ 34 ]. Currently, nursing education in China primarily focuses on medical knowledge and clinical teaching, with other courses often presented as electives, leading to insufficient emphasis on these aspects in education. The proposed competency framework refers to various disciplines such as academic research, team management, legal regulations, and clinical practice. Therefore, specialized education needs to involve these interdisciplinary aspects to provide an optimized training pattern. The formation of an evidence-based nursing team is essential for the effective implementation of evidence-based nursing practices. Teamwork has long been advocated as an effective approach in the field of nursing, aiding in the reduction of medical and nursing error, thereby enhancing patient satisfaction and improving healthcare delivery [ 35 ]. Most evidence-based nursing professionals in China are often required by their leaders to engage in evidence-based nursing practices during their spare time, leading to a passive approach and nearly independent completion of the entire process. This significantly affects the effectiveness of evidence-based nursing practices. The implementation of evidence-based nursing involves multiple processes, and the competencies it emphasizes cover various domains, such as leadership and management, research ability, implementation and mentoring. Under the current nursing education system in China, it is challenging for an individual to possess all these core competencies simultaneously, and more often, individuals excel in specific domain. Therefore, an effective practice strategy is a collaborative team approach, integrating individuals with expertise in different core competencies to collectively carry out evidence-based nursing practices. Implementation barriers and cultural factors Despite the potential of the proposed competency framework, its implementation in China faces several challenges. A major barrier is the resource disparity between urban and rural regions. Rural healthcare institutions often lack access to evidence-based resources, such as academic databases and updated clinical guidelines, making it difficult for nurses to apply EBNP effectively. Smaller hospitals, in particular, may have limited opportunities for professional development, hindering nurses’ ability to stay current with the latest research. Another challenge is nurse turnover, which remains high across many healthcare settings. Frequent staff changes disrupt continuous professional development and the consistent application of evidence-based practices, as newly hired nurses may not receive proper training in EBNP. Regional differences in nursing education also contribute to uneven competency levels. Urban areas typically offer more advanced training and resources, while rural areas often lack such opportunities, leading to disparities in readiness to implement the framework. Finally, institutional support is essential for EBNP implementation. Without strong backing from hospital management, nurses may struggle to integrate evidence-based practices into their routines, especially when they conflict with traditional practices or policies. To successfully integrate EBNP, healthcare institutions must foster an environment that supports professional development and aligns policies with evidence-based practices. In China’s healthcare environment, the authoritative culture and hierarchical structure can indeed influence nurses’ acceptance of EBNP. Within the traditional hierarchical system in Chinese hospitals, decision-making is often top-down, with hospital management and senior physicians holding a dominant role in medical decisions. Their opinions and experiences are frequently regarded as highly authoritative. For example, when establishing clinical nursing protocols, decisions are often based on the management experience of hospital leadership or the clinical judgments of senior physicians, rather than on scientific evidence underpinning EBNP. Furthermore, nurses typically occupy a subordinate position within the healthcare team. This hierarchical relationship can deter nurses from voicing dissent when their views differ from those of management or senior physicians. For instance, when EBNP suggest adopting a new nursing technique, but senior physicians, based on traditional practices, deem the old methods more reliable, nurses may feel compelled to follow the physicians’ opinions due to concerns about challenging their authority or jeopardizing their professional standing within the team, rather than proactively adopting EBNP. This situation can hinder the implementation and development of EBNP in China. To promote the advancement of EBNP in China, it is essential to enhance the education and training of nurses in EBN, improving their competence and awareness. Policy implication These findings also provides several implication for policymakers seeking to enhance the competency of the nursing workforce in EBNP in China, aiming to address the nursing shortage and improve the effectiveness of EBNP implementation. First, policymakers should provide both financial and policy support to encourage universities to establish undergraduate programs in EBNP. This would equip nursing students with the foundational knowledge and skills necessary to build a talent pool for the future implementation of EBNP. Second, universities should regularly offer evidence-based nursing training programs to provide ongoing professional development opportunities for practicing nurses, thereby strengthening their capacity to implement EBNP. Third, hospitals should establish dedicated EBNP teams guided by the proposed competency framework. These teams would foster collaborative teamwork, enabling the effective integration of EBNP into clinical practice. Additionally, there is a need to reform the traditional hierarchical structure and authoritative culture in healthcare, establishing a more egalitarian and open model of team collaboration. This would encourage nurses to actively engage in medical decision-making and practice, thereby facilitating the implementation and growth of EBNP. Strength and limitations This study has significant theoretical and practical contributions. Firstly, by constructing a Chinese competency framework for EBNP guided by the JBI model, it substantially broadens the scope of research in the field of EBNP in China. The framework provides a comprehensive and systematic analysis of the competencies required for EBNP, offering new directions for refining EBNP theory. Secondly, the study provides empirical evidence to support the development of China’s evidence-based nursing workforce. The competency framework, based on rigorous research, clearly defines the essential competencies for evidence-based nurses, strengthening the theoretical foundation of the field. Thirdly, the framework serves as a blueprint for individuals pursuing a career in EBNP, offering clear guidance on the necessary knowledge, skills, and attitudes for professional development. Fourthly, it supports healthcare institutions in talent development, recruitment, assessment, and evaluation. By aligning with the framework, healthcare institutions can define training goals, select qualified staff, and establish indicators to ensure high-quality evidence-based nursing. Fifthly, it offers insights for universities to enhance their curricula for EBNP, ensuring they better meet the needs of the healthcare sector. Lastly, the research provides a valuable reference for countries in the early stages of EBNP, helping them avoid unnecessary trial-and-error and contributing to the global development of evidence-based medicine. Despite significant efforts in this study to comprehensively explore the competency framework required for EBNP in China, enhance nursing professionals’ competencies, and contribute more Chinese evidence to the global development of evidence-based medicine, several limitations inevitably exist, which provide opportunities for future research. First, during the research process, we included key stakeholders such as educators, researchers, managers, and nurses to gather a diverse range of perspectives. However, due to the inherent nature of the nursing profession, the gender distribution among respondents was imbalanced. This imbalance may have influenced the study’s findings, as gender differences may shape diverse experiences and viewpoints in EBNP. The disproportionate gender distribution may have led to the omission of certain perspectives or a lack of representation. Secondly, this study primarily focused on EBNP within tertiary hospitals, as EBNP in China is still in its nascent stages and primarily implemented in top-tier hospitals. However, this focus has limited our exploration of EBNP in primary or community healthcare settings. Primary and community healthcare institutions differ significantly from tertiary hospitals in terms of service population, resource allocation, and service models. As a result, the competency needs and challenges these institutions face in implementing EBNP may differ. Future research should consider primary and community healthcare settings as independent research subjects, investigating their unique needs in EBNP. Thirdly, the thematic analysis used to develop the initial competency framework is inherently subjective. While measures were taken to ensure rigor, such as independent coding by multiple researchers, some bias in interpreting qualitative data cannot be ruled out. Fourly, while this study proposes a competency framework for EBNP, the practical application of these theoretical constructs in real-world nursing practice remains a challenge. Future research should focus on the implementation of this framework in various healthcare settings, considering the practical effectiveness of its application. For instance, strategies such as training programs and policy support could be employed to enhance nursing professionals’ evidence-based competencies, and the effectiveness of these interventions should be evaluated. Additionally, this study primarily addresses the construction of the competency framework for EBNP, while the quantifiable assessment of its implementation outcomes has been somewhat neglected. Future studies should emphasize the actual impact of EBNP on patient health outcomes and nursing quality, exploring specific evaluation indicators and methods to more comprehensively and accurately measure the value of EBNP. Finally, the competency framework was developed and validated within the context of the Chinese healthcare system. While the findings may have implications for other settings, the framework’s applicability to different cultural or organizational contexts remains uncertain without further adaptation and validation. Conclusion The EBNP workforce plays a vital role in delivering high-quality nursing services, enhancing health equity, and promoting UHC. Given China’s potential to contribute significantly to global evidence-based medicine, the development of a competent nursing workforce to support the effective implementation of EBNP is both important and timely. This study identified five core competency domains essential for EBNP. The proposed competency framework offers a foundation for EBNP education, with the potential to guild the development qualified nursing professionals who can address healthcare service demands. Additionally, it provides a basis for improving the assessment, recruitment, and training of the nursing workforce, which may contribute to mitigating current workforce shortages. However, further research is needed to evaluate the framework’s practical application and long-term impacts on nursing practice. Declarations Ethics approval and consent to participate This study was conducted with the approval of the Ethics Committee of Guangxi Academy of Medical Sciences (IIT-2023-79). Participation in this study was fully anonymous and voluntary, and all participants signed a written informed consent form. All interviews were performed in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials The data are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions X.X. contributes to write and critical review the manuscript, and code the results. Y.G. contributes to methodology and code the results. L.D. contributes to write the manuscript and code the results. Y.T. contributes to extract the results and invite the participants. H.W. contributes to conceptualization and design this study. All authors read and approved the final manuscript. Authors’ information Dr Xin Xiang is currently a senior researcher at the Institute of Fiscal and Finance, Shandong Academy of Social Sciences. Xin gained a PhD from Henley Business School, University of Reading. Her research primarily focuses on medical leadership, human resource management, implementation sciences, health system, organizational studies and talent management. Dr Yang Gao is associate professor of Management at the the Institute of Fiscal and Finance, Shandong Academy of Social Sciences. His research focuses on organization study, policy study, and implementation sciences. Ms Luping Dong is attending doctor in Department of Neurology, The People’s Hospital of Guangxi Zhuang Autonomous Region. She is interested in neurology and qualitative research. Professor Yinshan Tang is a professor in Management at Henley Business School, University of Reading and also is Vice Dean of HBS. His research mainly refers to management, organization study and qualitative research. Dr Hongzhi Wang is a senior researcher working at Research Center of Hospital Management and Medical Prevention, Guangxi Academy of Medical Sciences. Dr Wang gained a PhD from Henley Business School, University of Reading. His main research areas include implementation sciences, health policy, health system management, competency development, hospital management, and talent management. References Yip W, Fu H, Jian W, Liu J, Pan J, Xu D, Zhai T (2023) Universal health coverage in China part 1: progress and gaps. Lancet Public Health 8(12):e1025–e1034 Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Achadi EL, Taher A, Khusun H (2019) Universal health coverage in Indonesia: concept, progress, and challenges. Lancet 393(10166):75–102 Lal A, Abdalla SM, Chattu VK, Erondu NA, Lee TL, Singh S, Phelan A (2022) Pandemic preparedness and response: exploring the role of universal health coverage within the global health security architecture. Lancet Global Health 10(11):e1675–e1683 Li W, Gillies RM, Liu C, Wu C, Chen J, Zhang X, Sun H (2023) Specialty preferences of studying-abroad medical students from low-and middle-income countries. BMC Med Educ 23(1):158 Szabo S, Nove A, Matthews Z, Bajracharya A, Dhillon I, Singh DR, Campbell J (2020) Health workforce demography: a framework to improve understanding of the health workforce and support achievement of the Sustainable Development Goals. Hum Resour Health 18:1–10 Lee ACK, Morling JR (2024) The looming global workforce crisis in primary care. Public Health 229:63–64 World Health Organization (2016) Global strategy on human resources for health: workforce 2030 Asamani JA, Amertil NP, Ismaila H, Akugri FA, Nabyonga-Orem J (2020) The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana. Hum Resour health 18(1):16 Li H, Sun D, Wan Z, Chen J, Sun J (2020) The perceptions of older nurses regarding continuing to work in a nursing career after retirement: A qualitative study in two Chinese hospitals of different levels. Int J Nurs Stud 105:103554 Lai J, Brettle A, Zhang Y, Zhou C, Li C, Fu J, Wu Y (2022) Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study. Nurse Educ Today 116:105436 Labrague LJ, McEnroe-Pettite D, Tsaras K, D’Souza MS, Fronda DC, Mirafuentes EC, Graham MM (2019) Predictors of evidence‐based practice knowledge, skills, and attitudes among nursing students. In Nursing forum (Vol. 54, No. 2, pp. 238–245) Fu Y, Wang C, Hu Y, Muir-Cochrane E (2020) The barriers to evidence‐based nursing implementation in mainland China: A qualitative content analysis. Nurs Health Sci 22(4):1038–1046 Arsenault Knudsen ÉN, Mundt MP, Steege LM Describing nurses' communication about evidence-based practice change: A social network analysis of hospital nurses. Worldviews on Evidence‐Based Nursing Cheng L, Feng S, Hu Y (2017) Evidence-based nursing implementation in Mainland China: A scoping review. Nurs Outlook 65(1):27–35 Boswell C, Ashcraft A, Long J, Cannon S, DiVito-Thomas P, Delaney T (2020) Self‐efficacy: changing the tide of evidence‐based practice. Worldviews Evidence‐Based Nurs 17(2):129–135 Kim SC, Stichler JF, Ecoff L, Brown CE, Gallo AM, Davidson JE (2016) Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews Evidence‐Based Nurs 13(5):340–348 Li Y, Zhang C, Zhan P, Fu H, Yip W (2023) Trends and projections of universal health coverage indicators in China, 1993–2030: An analysis of data from four nationwide household surveys. The Lancet Regional Health–Western Pacific, p 31 Zhou S, Dong X, Liu F, Zhang Y, Yue D, Zhou Q, Zheng ZJ (2021) A stepped wedge cluster randomized control trial to evaluate the implementation and effectiveness of optimized initiatives in improving quality of care for ST segment elevation myocardial infarction in response to the COVID-19 outbreak. Implement Sci 16:1–15 Wang LN, Tao H, Zhao Y, Zhou YQ, Jiang XR (2014) Optimal timing for initiation of biofeedback-assisted relaxation training in hospitalized coronary heart disease patients with sleep disturbances. J Cardiovasc Nurs 29(4):367–376 Zhao J, Liu X, Zhang W, Xing Y, Cho SW, Hao Y (2018) Evidence-based nursing outputs and hot spot analysis of the last 5 years in mainland China: Results of a bibliometric analysis. Int J Nurs Pract, 24(2), e12628 Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Res Psychol 3(2):77–101 Ma H, Lin L, Zhang S, Lei L, Huang J, Lu F, Luo Y (2021) Exploring competencies of military nurses in general hospitals in China: a qualitative content analysis. BMC Nurs 20:1–8 Finnbakk E, Wangensteen S, Skovdahl K, Fagerström L (2015) The Professional Nurse Self-Assessment Scale: Psychometric testing in Norwegian long term and home care contexts. BMC Nurs 14:1–13 Nieminen AL, Mannevaara B, Fagerström L (2011) Advanced practice nurses’ scope of practice: a qualitative study of advanced clinical competencies. Scand J Caring Sci 25(4):661–670 Guo H, Zhu W, Li J (2023) Developing a core competency framework for advanced practice nursing in mainland China: a sequential exploratory study. BMC Nurs 22(1):179 Lai J, Brettle A, Zhang Y, Zhou C, Li C, Fu J, Wu Y (2022) Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study. Nurse Educ Today 116:105436 Chen L, Wu Y, Wang S, Zhao H, Zhou C (2021) Construction of evidence-based practice competencies for nurses in China: A modified Delphi study. Nurse Educ Today 102:104927 Bandura A (2001) Social cognitive theory: An agentic perspective. Ann Rev Psychol 52(1):1–26 Gibbs JC (2019) Moral development and reality: Beyond the theories of Kohlberg, Hoffman, and Haidt. Oxford University Press Sackett DL, Rosenberg WMC (1995) On the need for evidence-based medicine. J Public Health 17(3):330–334 Cummings S, Bridgman T, Brown KG (2016) Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Hum Relat 69(1):33–60 McNicholas C, Lennox L, Woodcock T, Bell D, Reed JE (2019) Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study. BMJ Qual Saf 28(5):356–365 Yeung MMY, Yuen JWM, Chen JMT, Lam KKL (2023) The efficacy of team-based learning in developing the generic capability of problem-solving ability and critical thinking skills in nursing education: A systematic review. Nurse Educ Today 122:105704 Cardoso D, Rodrigues M, Pereira R, Parola V, Coelho A, Ferraz L, Apostolo J (2021) Nursing educators’ and undergraduate nursing students’ beliefs and perceptions on evidence-based practice, evidence implementation, organizational readiness and culture: An exploratory cross-sectional study. Nurse Educ Pract 54:103122 Baek H, Han K, Cho H, Ju J (2023) Nursing teamwork is essential in promoting patient-centered care: a cross-sectional study. BMC Nurs 22(1):433 Additional Declarations The authors declare no competing interests. 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7430762","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":503977617,"identity":"2b6637af-96c0-4f20-9502-b6514457210e","order_by":0,"name":"Xin Xiang","email":"","orcid":"","institution":"Shandong Academy of Social Science","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Xiang","suffix":""},{"id":503977618,"identity":"c0b89f95-7513-4440-9520-ea04671d9116","order_by":1,"name":"Yang Gao","email":"","orcid":"","institution":"Shandong Academy of Social Science","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Gao","suffix":""},{"id":503977619,"identity":"495e7ec7-8679-4db3-b781-8dc676727d1c","order_by":2,"name":"Luping Dong","email":"","orcid":"","institution":"The People’s Hospital of Guangxi Zhuang Autonomous Region","correspondingAuthor":false,"prefix":"","firstName":"Luping","middleName":"","lastName":"Dong","suffix":""},{"id":503977620,"identity":"2c4dc03c-cf37-4b4c-bd59-d6b917976b41","order_by":3,"name":"Yinshan Tang","email":"","orcid":"","institution":"Henley Business School, University of Reading, Reading","correspondingAuthor":false,"prefix":"","firstName":"Yinshan","middleName":"","lastName":"Tang","suffix":""},{"id":503977621,"identity":"9c5ed786-b606-4e42-8d56-7ca236193a73","order_by":4,"name":"Hongzhi Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIie3QsQrCMBCA4SuBZDnMWqmvIJwIxaHoqxQKmRx8hIKr4Kpv4SNEg3Z0dXAoCM6Ki4KoEUel0c0h/3TDfRwJgM/3jzFRnC63O3ImTHmgpOsmAhUDzhrSDq3JQGVuIiF+kqQ+BorwsAhyl2gOQe0GyJEMpO2ENANhlrMqEpugaE9CtCTQuz5ta4BKbaoJpCFS+LrSpz2DEGMXsfspPQlFHXsr/4LEEeoU60NL4DuCWWuaa5TMfvKIVMadb1kX8/KY6x6XhSnP16QrhVlVkvf4b+s+n8/n+9QDp8lF2ZNQLFgAAAAASUVORK5CYII=","orcid":"","institution":"Guangxi Academy of Medical Sciences (The People’s Hospital of Guangxi Zhuang Autonomous Region)","correspondingAuthor":true,"prefix":"","firstName":"Hongzhi","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-08-22 04:54:50","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-7430762/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7430762/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89790299,"identity":"3faed23a-a620-4195-abac-21cd60193853","added_by":"auto","created_at":"2025-08-25 05:37:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1291740,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7430762/v1/636dc158-6eeb-4ed3-a89e-ec388f8cfa82.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eImproving the Competency of Evidence-Based Nursing in China: Addressing Workforce Crisis and Inefficiencies in Leveraging the Potential of a Vast Healthcare Market\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe World Health Organization (WHO) and nations worldwide remain committed to achieving Universal Health Coverage (UHC), striving to deliver high-quality healthcare services and foster health equity [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The enhancement of health service coverage and the realization of the right to the highest attainable standard of health depend on the availability, accessibility, acceptability, and quality of the health workforce [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This necessitates evidence-based health workforce strategies to efficiently allocate limited resources across all healthcare system levels. However, policymakers and scholars widely recognize that health workforce shortages remain a significant challenge for countries at various socioeconomic development levels [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The WHO projects a health workforce gap of 10\u0026nbsp;million by 2030, with half of this deficit expected in the nursing sector [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Given their pivotal role in health promotion and disease prevention, especially in delivering services to the most vulnerable and hard-to-reach populations, nurses are indispensable for achieving UHC [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In response to nurse shortages, countries have implemented human resource strategies to optimize workforce availability and accessibility. For instance, China has introduced incentive policies to encourage individuals to pursue nursing, offering scholarships and allowances [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Nonetheless, nursing, as a highly specialized profession, requires more than a mere increase in quantity to meet healthcare needs aligned with Sustainable Development Goals (SDGs) and UHC. Indeed, inefficiencies in strategy implementation and unmet demand arise from the mismatched capacities of nurses, particularly evident in Evidence-Based Nursing Practices (EBNP) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Research indicates lower satisfaction with implementing EBNP and insufficient nursing competency, underscoring the urgent need to enhance nurses\u0026rsquo; competencies to effectively implement EBNP [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Identifying the characteristics of a capable health workforce for EBNP implementation is paramount to addressing the unmet demand. Therefore, this study aims to explore this question.\u003c/p\u003e\u003cp\u003eEBNP, recognized as an effective strategy for enhancing healthcare quality, has garnered widespread acceptance among health policymakers, healthcare professionals, and researchers [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Previous studies have demonstrated the positive impact of EBNP on healthcare outcomes, patient satisfaction, resource efficiency, reduced hospital stays, and improved cost efficiency [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. While EBNP is rapidly advancing in developed nations such as the U.S., U.K., Australia, and Spain, it is still in its early stages in low- and middle-income countries (LMICs) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The escalating need for evidence in healthcare decision-making in LMICs, driven by a high burden of diseases and illnesses, has become increasingly apparent.\u003c/p\u003e\u003cp\u003eChina is one of the most populous countries globally and ranks among the countries with the highest elderly population. The large population, uneven distribution of healthcare resources, and significant regional disparities in healthcare services underscore the urgent need for EBNP in China to enhance healthcare quality and standards [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In response, China has actively adopted the evidence-based healthcare model proposed by the Joanna Briggs Institute (JBI) of Australia, which is the largest global organization promoting EBNP, to guide its national EBNP development. Recent scholarly evidence suggests that the significant potential of EBNP to enhance healthcare quality in China. For instance, Wang et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] conducted a study on patients with coronary heart disease, demonstrating that a nurse-led biofeedback-assisted relaxation training program, rooted in EBNP, led to significant improvements in sleep quality and quality of life. The study employed a randomized design, assigning patients to morning, night, morning-night, or control groups, and outcomes were measured through self-reported sleep-related indicators and validated scales like the Pittsburgh Sleep Quality Index (PSQI) and Zung\u0026rsquo;s Self-rating Anxiety Scale (SAS), revealing enhanced physical activity and notable reductions in anxiety and depression symptoms. These outcomes underscore the capacity of EBNP to achieve tangible patient-centered results in specific clinical contexts, illustrating how integrating evidence-based interventions can elevate patient care. However, the implementation of EBNP in China faces substantial barriers, while limit its practical effectiveness and widespread adoption. Despite its theoretical promise, many nurses encounter significant challenges in translating EBNP principles into routine clinical practice [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Key obstacles include limited leadership support, insufficient understanding of EBNP methodologies and systemic gaps in professional training [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Among these challenges, the lack of adequate knowledge, skills, and competence among nursing staff stands out as one of the most fundamental issues [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These barriers have collectively contributed to the underutilization of EBNP, leaving it unable to meet the pressing demand for improved healthcare quality and standards in China.\u003c/p\u003e\u003cp\u003eIn response to the challenge of insufficient EBNP competence among nursing professionals, there is a call for increased research efforts dedicated to constructing a competence framework for EBNP, enabling more effective implementation. To date, there has been a scarcity of studies systematically proposing such a framework. This study, therefore, seeks to fill this gap by identifying the core competencies necessary for EBNP and proposing a competency framework for its effective implementation in China through a qualitative study employing semi-structured interviews and the Delphi method.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe adopted a two-phase approach to develop the core competencies for EBNP. Phase 1 consisted of qualitative interviews to draft an initial competency framework, followed by Phase 2, which employed the Delphi method to validate the competency framework for EBNP.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePhase 1: Semi-structured interviews\u003c/h2\u003e\u003cp\u003eThis phase utilized a qualitative descriptive study approach, employing semi-structured interviews with key stakeholders to investigate the essential competencies required for nurses to implement EBNP in clinical practice. Semi-structured interviews were chosen to enable a more in-depth exploration of specific topics. The interview outline was crafted following the framework of the evidence-based healthcare model of JBI.\u003c/p\u003e\u003cp\u003eThis study selectively engaged key stakeholders involved in, influencing, or researching EBNP, including directors of nursing, nurses, and experts from universities. Participants were chosen based on several criteria: (1) nurses with a minimum of 3 years of EBNP experience, defined as direct participation in evidence-based practice activities, such as implementing evidence-based interventions, contributing to EBNP related clinical decision making, or actively engaging in EBNP training and workshops; (2) directors of nursing with at least two years of leadership experience in nursing departments and holding an associate professional title or above; (3) university experts with a background in supervising EBNP training programs or relevant research experience in EBNP; (4) candidates with a geographical distribution covering regions with varying concentrations of health resources; and (5) an attempt to distribute the percentage of respondents from different organizations based on the actual situation. Initial participant recruitment utilized researchers\u0026rsquo; personal networks or invitation emails sent to potential candidates. Subsequently, a snowball sampling procedure was employed, encouraging participants to invite other qualified respondents. Semi-structured interviews were conducted with a total of 67 participants. The final sample size was determined by the concept of data saturation, which refers to the point at which no new themes or categories emerge from additional interviews, and the data collected adequately represents the phenomena under study. When the research team noted that no new information or themes were emerging, and that the data from subsequent interviews were consistently fitting into the pre-existing thematic categories, it was agreed that saturation had been reached. Specifically, the researchers reviewed transcripts after each interview, comparing the data to existing themes, and determined whether any new themes or perspectives had emerged. The decision to cease interviews was made after a thorough analysis of the data from the 67th participant, at which point no new themes were identified. This ensured that the sample size was adequate for capturing the diversity of perspectives with the target population, while also maintaining the rigor of the study.\u003c/p\u003e\u003cp\u003eAccording to the evidence-based healthcare model of JBI, the interview guide comprised a set of primary questions and potential follow-up questions developed through a review of the literature and the collective expertise of the research team. The objective was to discern the fundamental competencies required for nurses to effectively implement EBNP in clinical settings. The semi-structured interview questions included:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePlease introduce yourself and your working background.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePlease elucidate your comprehension of EBNP, particularly the evidence-based healthcare model of JBI in the context of EBNP implementation.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat are the essential competencies for implementing EBNP in clinical practice in China?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eKindly offer suggestions for enhancing competencies in EBNP implementation.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e(For nurses specifically) Kindly share your experiences both successful and unsuccessful, in implementing ENBP.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e(For nurses specifically) What factors, in your opinion, influence your competencies?.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThese questions were designed to align with the group characteristics of the respondents and to explore the competencies needed for effective EBNP implementation. The interview guide served as a framework to ensure comprehensive and consistent data collection across participants.\u003c/p\u003e\u003cp\u003e Individual interviews were conducted either at the participants\u0026rsquo; workplaces in a conference setting or through video calls to accommodate geographical distances. The research team conducted 67 in-depth interviews between March and November 2022, with each interview lasting one to two hours. Recordings were made after obtaining prior oral informed consent and were transcribed within 24 hours of the interview. The ultimate count of participants was determined through saturation, signifying the point at which additional interviews did not yield new thematic insights. To uphold ethical standards, personal information and specific workplace locations were omitted from the data.\u003c/p\u003e\u003cp\u003eThe transcripts of audio recordings are transcribed and supplemented with field observation notes and interview transcripts to form comprehensive interview data. Each interview transcript undergoes member checking to validate the integrity and accuracy of the interviews. Thematic analysis, guided by the framework proposed by Braun and Clarke [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], was employed to analyze the data. Data coding and analysis were carried out using NVivo 12.0. The details of coding process were reported below:\u003c/p\u003e\u003cp\u003eInitial coding: Two researchers independently reviewed the transcribed data and developed an inital set of codes related to the competencies necessary for implementing EBNP. These codes were derived inductively from the data, meaning that the researchers did not begin with a predefined set of codes but instead allowed themes and categories to emerge naturally from the interview transcripts.\u003c/p\u003e\u003cp\u003eCodebook development: To ensure systematic analysis, a codebook was developed during the initial phase of coding. The codebook contained definitions of each code, along with illustrative examples from the transcripts. This process allowed for consistency in coding across all transcripts and facilitated transparent tracking of the evolving themes.\u003c/p\u003e\u003cp\u003eInter-coder reliability: After the initial coding phase, the two researchers compared their code data. Any discrepancies or differences in coding were discussed in detail, and a third researcher was consulted to help resolve disputes. A consensus approach was used to ensure that the final coding accurately reflected the data. The inter-coder reliability was assessed by calculating Cohen\u0026rsquo;s kappa coefficient for a randomly selected portion of the data, achieving a value of 0.75, indicating a high level of agreement between the coders.\u003c/p\u003e\u003cp\u003ePattern identification and theme development: The researchers examined the data for patterns, relationships, and contradictions in the coded responses. By grouping related codes together and analyzing their frequency and co-occurrence across different interviews, patterns were identified. These patterns informed the development of broader themes and sub-components related to competencies in EBNP. Additionally, the researchers focused on contradictions within the data, as these often provided valuable insights into complex or underexplored aspects of the competency domains.\u003c/p\u003e\u003cp\u003eRefinement of themes and sub-components: The identified codes, sub-components, and themes were compared with the original data, ensuring that the analysis remained grounded in the actual interview transcripts. These discussions were iterative, involving continual dialogue among the researchers, ensuring that each theme accurately captured the nuances of the data. Themes were refined and redefined as necessary based on the emerging data.\u003c/p\u003e\u003cp\u003eValidation and Consensus: Throughout the process, continual discussions were held among all authors to validate the themes and ensure that the interpretation of the data was consistent. This collaborative approach facilitated the development of a final set of competency domains and sub-components that were grounded in the experiences and perspectives of the interview participants.\u003c/p\u003e\u003cp\u003eThe detailed coding process allowed us to identify key competencies necessary for the successful implementation of EBNP in nursing practice. The final competency domains and sub-components in this phase were derived through a rigorous, transparent, and iterative process of analysis, ensuring the robustness and validity of the findings.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePhase 2: Delphi process\u003c/h3\u003e\n\u003cp\u003eThis phase utilized a Delphi study, a widely recognized consensus-building technique employed in the formulation of competency frameworks, to validate the initially proposed competency framework for the implementation of EBNP in China and to establish the content validity of the framework. The Delphi process consisted of three rounds, with the first round being qualitative and the subsequent rounds (2 and 3) involving quantitative assessments.\u003c/p\u003e\u003cp\u003eTo ensure the representativeness of the experts in the Delphi study, we assembled the panel using a purposive stratified sampling approach. This approach was chosen to ensure a balanced and comprehensive representation of diverse perspectives within the field of EBNP in China. Invitations were extended via email, including study details and an estimate of the time commitment expected for their participation. A total of 29 experts were selected, and the sampling strategy aimed to capture a range of expertise and experience across different dimensions relevant to EBNP. The characteristics and professional backgrounds of the selected experts ensured a balanced representation of perspectives, as outlined below:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eClinical and academic expertise\u003c/strong\u003e\u003cp\u003eExperts were selected from both clinical practice and academic research backgrounds to ensure that the panel captured the full spectrum of perspectives on EBNP. Nursing directors, who bring valuable experience from clinical practice, were selected to provide insights on the practical implementation of EBNP in hospital settings. In contrast, nursing educators and researchers, with their focus on teaching and advancing the theoretical aspects of EBNP, were included to ensure the inclusion of scholarly perspectives and evidence-based knowledge dissemination.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGeographic diversity\u003c/strong\u003e\u003cp\u003eExperts were recruited from both developed and underdeveloped regions of China to capture the differing stages of EBNP implementation across the country. Experts from more developed areas, where EBNP has been more established, provided insights into the challenges and successes of implementing evidence-based practices in well-resourced environments. Conversely, experts from less developed regions, where EBNP is still emerging, shared their perspectives on the barriers and opportunities for advancing EBNP in areas with fewer resources and infrastructure. This geographic diversity was essential to ensure that the findings of the study reflect the realities of EBNP across the entire country.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInternational and domestic educational backgrounds\u003c/strong\u003e\u003cp\u003eTo enhance the diversity of perspectives, the panel included experts with varying levels of international exposure to evidence-based nursing education. Some experts had received advanced training in countries with well-established EBNP systems, such as Australia and Canada, and brought with them international best practices and global perspectives on EBNP. Other experts had been trained within China, contributing valuable insights into how EBNP is being integrated within the local context, and highlighting the unique challenges and strengths of domestic EBNP practices. This mix of international and domestic educational backgrounds helped ensure that the panel was well-rounded and inclusive of different approaches to EBNP.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eProfessional experience\u003c/strong\u003e\u003cp\u003eThe selection of experts was also informed by their professional experience and position within the nursing community. Nursing directors were required to have a minimum of five years of leadership experience in nursing departments, defined as holding a managerial or supervisory position with responsibilities such as overseeing clinical nursing practices, developing and implementing nursing policies, coordinating team activities, and managing staff performance and professional development, ensuring that they had practical knowledge of managing and implementing EBNP in clinical settings. Nursing educators and researchers were selected based on their significant involvement in EBNP education and research, with at least three years of experience in these fields, and holding positions such as associate professors or higher. This level of expertise was critical to ensure that the panel was composed of individuals who could contribute valuable insights into both the theory and practice of EBNP.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe 29 experts were deemed sufficient to provide a wide range of viewpoints while maintaining a manageable group size for effective discussion and consensus-building. Additionally, the sample size aligns with recommendations in Delphi methodology for obtaining reliable expert opinions, where 15\u0026ndash;30 participants are typically considered optimal for balancing diversity and manageability of the panel.\u003c/p\u003e\u003cp\u003eThree rounds were conducted from March 2023 to May 2023. In round 1, the initial template was sent to the panel to modify key themes and potential components of framework obtained from interviews. Experts were required to review and refine these competencies by identifying redundancies, integrating related concepts, and increasing the necessary competencies to drop. Two open-ended questions were established as follows: (1) Please kindly provide comments or modifications regarding the proposed theme and components of competency framework for EBNP implementation; (2) Please provide additional competencies that are crucial but missing from the proposed framework. The responses were collected and used to generate a comprehensive set of modified and newly proposed components encompassing all themes.\u003c/p\u003e\u003cp\u003eThree rounds were conducted from March to May 2023. In the initial round, the preliminary template was distributed to the panel for the modification of key themes and potential components derived from interviews. Experts were tasked with reviewing and refining these competencies, which involved identifying redundancies, integrating related concepts, and suggesting necessary competencies for addition. Two open-ended questions were formulated as follows: (1) Kindly provide comments or modifications concerning the proposed themes and components of the competency framework for EBNP implementation; (2) Offer additional competencies deemed crucial but currently absent from the proposed framework. Responses were collected and utilized to generate a comprehensive set of modified and newly proposed components, spanning all themes.\u003c/p\u003e\u003cp\u003eSubsequently, two additional rounds of the Delphi process were administered through self-administered questionnaires. Specifically, the second round questionnaire was developed based on the outcomes of the initial round and comprised three sections: (1) a cover letter introducing the study and providing instructions for completing the questionnaire; (2) sociodemographic information of experts and their familiarity with the field of EBNP; (3) the proposed competency framework for EBNP implementation, consisting of five domains and 20 components. The questionnaire utilized a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree; 2\u0026thinsp;=\u0026thinsp;disagree; 3\u0026thinsp;=\u0026thinsp;undecided; 4\u0026thinsp;=\u0026thinsp;agree; 5\u0026thinsp;=\u0026thinsp;strongly agree) to enable experts to assess the extent of their agreement or disagreement with this competency framework. In the third round, feedback was disseminated regarding the outcomes derived from the second round. The identical questionnaire, along with a succinct statistical summary of responses from the second-round, was returned to the experts. Encouragement was extended to the experts to reevaluate and adjust their initial votes in light of the synthesized results. This process provided an opportunity for experts to revise their responses, taking into account the collective opinions within the panel. The experts were requested to complete the questionnaire within a two-week time-frame and scored based on their individual opinions, with anonymity assured.\u003c/p\u003e\u003cp\u003eTo analyze the ratings from the second and third rounds, the mean and content validity ratios (CVRs) for each item were calculated. The CVR is the appropriate technique for determining consensus among a panel of experts and is computed as (n\u003csub\u003ee\u003c/sub\u003e-N/2)/(N/2), where n\u003csub\u003ee\u003c/sub\u003e is the number of panel lists who indicated \u0026lsquo;agree or strongly agree\u0026rsquo; and N is the total number of panel lists. If any item met the criteria of mean\u0026thinsp;\u0026lt;\u0026thinsp;4 or CVR\u0026thinsp;\u0026lt;\u0026thinsp;0.70, it was considered nonessential and subsequently removed from competency framework after discussing with the research team.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e All participants involved in the interviews and the Delphi process provided informed consent in response to a letter that explicitly stated the voluntary nature of participation and guaranteed complete confidentiality. Ethical approval for this study was granted by the Research Ethics Committee of the Guangxi Academy of Medical Sciences (IIT\u0026minus;2023\u0026minus;79).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eThe characteristics of participants and Delphi experts\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 67 individuals from 17 provinces across mainland China were participated in the semi-structured interviews. Among these participants, 23 were affiliated with universities, while 44 were associated with tertiary hospitals. The majority of the participants (28 individuals, 41.79%) had more than 10 years of professional experience, and 77.61% (52 individuals) held a master's degree or above. Among the respondents, 40 (59.70%) had over three years of evidence-based nursing experience, 56 (83.58%) had participated in or instructed evidence-based nursing training programs, and 37 (55.22%) had been involved in related research activities. A detailed presentation of the demographic characteristics and EBNP-related experience of the participants is provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\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\u003eDemographic characteristics of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Cases (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86.57%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.43%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnder 30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.42%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46.27%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.34%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e51\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.97%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of work experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 years or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38.81%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41.79%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational degree\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.39%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaster\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46.27%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePh.D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.34%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducator or researcher from university\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.33%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirector of nursing department\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46.27%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEBNP nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGeographical location\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEastern region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.31%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.36%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWestern region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.33%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEBNP-related experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of EBNP experience (\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;3 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59.70%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttended EBNP training programs (Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83.58%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipated in EBNP research (Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.22%\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\u003eWe invited 32 experts to participate in the Delphi process, of whom 29 (90.63%) responded in the first round. The respondent rate in the second and third round was 100%. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the demographic characteristics of the expert panel involved in the Delphi method. Female experts constituted the largest proportion (25 individuals, 86.21%). The majority of experts (20 individuals, 68.97%) were affiliated with universities, including 9 professors and 11 associate professors. Most of these university-based experts had over six years of experience in EBNP education (14 individuals, 70%). Additionally, nine experts were nursing supervisors from hospitals, of whom five had 5\u0026ndash;10 years of experience managing nursing departments, while four had over 10 years of management experience.\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\u003eDemographic characteristics of Delphi study\u003c/p\u003e\u003c/div\u003e\u003c/caption\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\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Cases (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale/Woman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.21%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale/Man\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.79%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDegree type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaster\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePh.D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.52%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.83%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e51\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.69%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAffiliation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.97%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.03%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePosition\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.03%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociate professor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.94%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirector of nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.03%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of leadership experience (for Director of nursing) (n\u0026thinsp;=\u0026thinsp;9)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.56%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.44%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of EBNP education (for Associate professor and professor) (n\u0026thinsp;=\u0026thinsp;20)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eCompetency dimensions of EBNP\u003c/h3\u003e\n\u003cp\u003eThe thematic analysis of the interview data revealed five distinct competency domains essential for effective evidence-based nursing implementation. These domains include personal traits, professional value, research ability, leadership and management, and implementation and mentoring. Additionally, a total of 24 sub-component were identified, providing a comprehensive framework that outlines the multifaceted nature of nursing competence in the context of EBNP, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInitial competency framework from interview\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003ePersonal traits\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-reflection\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf improvement\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResponsibility\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCourage\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003eProfessional value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmpathy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCare for others\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthical practice\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLegal practice\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEquality and respect\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePromoting professional development\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eResearch ability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIdentification clinical issues\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEvidence search ability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiterature quality assessment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSolving clinical problem with scientific thinking\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eLeadership and management\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunication with other colleges and patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeamwork\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth education skills\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRisk management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient safety management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eImplementation and mentoring\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical nursing practical skills\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEvidence application scenario assessment ability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEBNP program construction ability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEBNP program implementation ability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbility to evaluate the effect of EBNP program\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\u003eThe valuable feedback received in the first round of Delphi experts promoted the renaming and consolidation of several themes and components from the initial template. Specifically, three items were renamed: \u0026ldquo;implementation and mentoring\u0026rdquo; was changed to \u0026ldquo;implementation and assessment,\u0026rdquo; \u0026ldquo;evidence search ability\u0026rdquo; was revised to \u0026ldquo;literature search ability,\u0026rdquo; and \u0026ldquo;communication\u0026rdquo; was updated to \u0026ldquo;communication with other colleagues and patients\u0026rdquo;. Additionally, several items were merged: \u0026ldquo;legal practice\u0026rdquo; and \u0026ldquo;ethical practice\u0026rdquo; were combined into \u0026ldquo;legal/ethical practice,\u0026rdquo; \u0026ldquo;EBNP program implementation ability\u0026rdquo; was consolidated into \u0026ldquo;EBNP program construction,\u0026rdquo; and \u0026ldquo;risk management\u0026rdquo; and \u0026ldquo;patient safety management\u0026rdquo; were consolidated into \u0026ldquo;risk and safety management\u0026rdquo;. Furthermore, \u0026ldquo;care for others\u0026rdquo; was combined into the broader concept of \u0026ldquo;empathy\u0026rdquo;.\u003c/p\u003e\u003cp\u003eFollowing the first round\u0026rsquo;s outcomes, the framework for evidence-based nursing competency underwent expert validation using a 5-level scale in the second and third rounds. A consensus on the core competencies for evidence-based nursing was achieved through three rounds of Delphi, with all items demonstrating 100% content validity. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the proposed evidence-based nursing competency framework, comprising 5 domains and 20 sub-components, and includes a statistical description of the results from the second and third rounds (with the second round's results shown in parentheses). Additionally, t-tests were utilized to determine the significance of differences between the statistical descriptions across the two rounds.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eCompetency framework for evidence-based nursing in China\u003c/b\u003e It reports the mean values in Round 3 first and those in Round 2 in brackets; a t test was used to test whether the means of competencies of Round 3 have statistical significance compared with Round 2. *** denotes that the mean value is different between rounds with statistical significance level of 1%.\u003c/p\u003e\u003c/div\u003e\u003c/caption\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003ePersonal traits\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-reflection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.45\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf improvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.48\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResponsibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.66\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCourage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.34\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.34)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eProfessional value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmpathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.21\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLegal/ethical practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.31\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEquality and respect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.51\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePromoting professional development\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.24\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eResearch ability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIdentification clinical issues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.66\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiterature search ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.76\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiterature quality assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.55\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSolving clinical problem with scientific thinking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.62\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eLeadership and management\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunication with other colleges and patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.66\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeamwork\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.41\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth education skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.34\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.27)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRisk and safety management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.24\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eImplementation and assessment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical nursing practical skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.55\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEvidence application scenario assessment ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.59\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEBNP program construction ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.45\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbility to evaluate the effect of EBNP program\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.55\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(4.52)\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\u003cb\u003eCompetency framework for EBNP\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe proposed competency framework consists of 5 domains and 20 sub-components, representing core competencies crucial for nurses to effectively implement evidence-based nursing practices in China. We then provide a detailed analysis of these competencies within the context of evidence-based nursing in China.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePersonal traits\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe personal traits domain reflects the attitudes and motivations that drive individuals to actively engage in EBNP. This confirmed prior study highlighting personal traits as a crucial determinant affecting nursing performance [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. As one respondent noted, \u0026ldquo;The ability to engage with EBNP from a personal commitment to continuous learning and improvement. It\u0026rsquo;s about staying updated and reflecting on your own practice to be better every day\u0026rdquo;. EBNP, as an ongoing process of learning, emphasizes the use of the latest and most reliable clinical evidence when making nursing decisions and and formulating practices. Respondents highlighted the need for nurses to possess key personal traits to ensure that they continuously reflect on and summarize their clinical practice. One participant explained, \u0026ldquo;We can\u0026rsquo;t just do the job; we need to keep improving ourselves, especially by staying informed about the latest research and adapting our practice accordingly\u0026rdquo;. Therefore, nursing professionals must maintain a constant focus on new clinical research, guidelines, and practical experiences to improve patient outcomes and their own professional growth. The four core sub-competencies identified in this domain are self-reflection, self-improvement, responsibility, and courage.\u003c/p\u003e\u003cp\u003eSelf-reflection emphasizes the capacity of individuals to engage actively in a thorough and systematic analysis of their thoughts, actions, experiences, and emotions. In the context of EBNP, nurses are expected o constantly assess their practices, and reflect deeply on their actions, decisions, and clinical judgments. Observable behaviors that exemplify this competency include regularly keeping a reflective journal to document and analyze clinical experiences, seeking feedback from colleagues to identify areas for improvement, and critically evaluating clinical decisions after patient interactions to assess whether evidence-based practices were properly applied. One participant stated, \u0026ldquo;Through self-reflection, I am able to identify where I may have made decisions based on assumptions rather than evidence, which helps me to improve my nursing competencies.\u0026rdquo; Another respondent emphasized, \u0026ldquo;Self-reflection allows me to see my own biases and knowledge gaps, which is crucial for my professional growth in EBNP\u0026rdquo;.\u003c/p\u003e\u003cp\u003eSelf-improvement denotes the ongoing learning, development, and enhancement of one\u0026rsquo;s abilities within a professional sphere, aiming for excellence and continuous progress. In EBNP, nurses are encouraged to maintain a learning mindset and update their knowledge and skills by actively seeking the latest research findings, clinical guidelines, and best practices to deliver optimal nursing care. Observable behaviors demonstrating this competency include attending relevant workshops and training sessions on new evidence-based practices, reading and applying the latest research articles to clinical settings, and engaging in peer discussions to share knowledge and reflect on new developments in nursing. One nurse explained, \u0026ldquo;In my daily practice, I regularly look for the newest guidelines and research to improve my care. It\u0026rsquo;s not just about keeping up; it\u0026rsquo;s about being proactive in applying new evidence to improve patient outcomes.\u0026rdquo;\u003c/p\u003e\u003cp\u003eResponsibility refers to the sense of accountability individuals hold when undertaking specific tasks, roles, or responsibilities, and the willingness to take responsibility for their actions and decisions. In the realm of EBNP, nurses have a significant responsibility to ensure that the care provided is based on the latest evidence, thereby maximizing patient treatment outcomes and satisfaction. Observable behaviors include ensuring that care plans are based on current, evidence-based guidelines, consistently reviewing clinical guidelines to ensure they are integrated into practice, and taking ownership of patient care outcomes by actively seeking evidence to address any gaps in practice. A respondent highlighted, \u0026ldquo;As a nurse, he/she should feel a strong responsibility to ensure that the treatments he/she provide are evidence-based, as it directly affects patient outcomes. They should always make sure to check if the latest evidence is applied in the care plans\u0026rdquo;.\u003c/p\u003e\u003cp\u003eCourage represents the quality demonstrated by individuals when facing difficulties, challenges, uncertainty, or risks, involving displaying confidence, decisiveness, and determination in decision-making and action, even in the face of pressure or potential negative consequences. Observable behaviors reflecting this competency include proposing evidence-based changes to clinical practices despite resistance from colleagues or institutional norms, actively advocating for patient safety even in difficult or uncomfortable situations, and being willing to challenge outdated practices that may compromise care quality. One participant shared, \u0026ldquo;At times, challenging the status quo is essential. In EBNP, suggesting changes to established practices is not always easy, but it\u0026rsquo;s necessary for improving patient safety and care quality.\u0026rdquo; Another respondent emphasized, \u0026ldquo;It takes courage to speak up and advocate for evidence-based changes, especially when the traditional ways of doing things are deeply entrenched in the culture of the institution\u0026rdquo;.\u003c/p\u003e\n\u003ch3\u003eProfessional value\u003c/h3\u003e\n\u003cp\u003e Professional value involves a set of principles and values that govern the behavior of nurses within EBNP, aiming to assist them in navigating ethical and moral challenges inherent in their profession, ensuring that their actions align with societal expectations, legal regulations, and professional standards. One respondent emphasized, \u0026ldquo;Professional values serve as the moral and ethical cornerstone for nurses practicing, empowering nurses to uphold the highest standards of professionalism in clinical care and ensuring that patients receive comprehensive, compassionate, and safe care\u0026rdquo;. This domain contained four key aspects: empathy, legal/ethical practice, equality and respect, and promoting professional development. Those findings align with previous studies, but they also expand beyond the traditional focus on promoting professional development and legal/ethical practice [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEmpathy refers to the nurse\u0026rsquo;s ability to understand and share the emotions, experiences, and perspectives of patients. In the context of EBNP, it is crucial for nurses to connect with patients on an emotional level, resonate with their needs, and respond accordingly to provide compassionate, personalized care. Observable behaviors that exemplify this competency include actively listening to patients\u0026rsquo; concerns, using empathetic language to acknowledge patients\u0026rsquo; feelings, and demonstrating attentiveness to non-verbal cues, such as body language or facial expressions, to assess emotional states. One respondents stated, \u0026ldquo;Empathy plays as a pivotal role in forming strong nurse-patient relationships. It builds patient trust and facilitates better participation in treatment decisions, which is key to improve patient outcomes\u0026rdquo;. Empathy fosters patient trust, enhances engagement in care, and ensures better adherence to treatment plans.\u003c/p\u003e\u003cp\u003e Legal/ethical practice underscores the necessity for nurses to uphold ethical principles and adhere to legal regulations in their professional responsibilities. In EBNP, nurses must consistently navigate ethical challenges while complying with relevant laws and regulations. This include ensuring informed consent, maintaining patient confidentiality, and adhering to professional guidelines. Observable behaviors in this area include consistently discussing treatment options with patients to ensure informed consent, safeguarding patient information and ensuring it is shared only with appropriate healthcare professionals, and upholding ethical standards by addressing any conflicts of interest or ethical dilemmas in a timely manner. A respondents noted, \u0026ldquo;Legal/ethical practice is foundational in safeguarding patients\u0026rsquo; rights and ensuring that the healthcare professionals operate within acceptable ethical and legal frameworks\u0026rdquo;. Ethical practice not only protects patients but also ensures that all members of the healthcare team uphold high standards of conduct.\u003c/p\u003e\u003cp\u003eEquality and respect are fundamental principles guiding nurses\u0026rsquo; interactions with patients, colleagues, and other healthcare professionals. These principles advocate for the eradication of discrimination in healthcare settings, ensuring that every individual receives fair and dignified treatment. Observable behaviors reflecting equality and respect include treating all patients, regardless of background, with the same level of care and respect, being culturally sensitive in communication, and ensuring that all team members are equally heard in collaborative decision-making. One respondent noted, \u0026ldquo;In EBNP, equality and respect are critical. Nurses must be sensitive to cultural, religious, and personal differences among patients to provide culturally competent care\u0026rdquo;. Additionally, these values also apply to collaborative work with colleagues, fostering an inclusive environment where all perspectives are valued. \u0026ldquo;In an interdisciplinary team, respect for each team member\u0026rsquo;s contributions enhances collaboration and drives the team towards common goals,\u0026rdquo; another respondent added.\u003c/p\u003e\u003cp\u003ePromoting professional development refers to the ongoing pursuit of knowledge and skills to advance both individual and disciplinary growth. Nurses practicing EBNP are expected to stay abreast of latest developments in medical and nursing knowledge to meet increasingly complex needs of patients and improve healthcare delivery. Observable behaviors in this area include attending continuing education courses, participating in professional conferences, engaging in self-directed learning, and applying new knowledge and skills in clinical practice. Respondents emphasize that, as professionals, EBNP nurses not only aim for personal growth but also contribut to the advancement of nursing science and evidence-based practice in China. One participant noted, \u0026ldquo;Nurses in China have an immense potential to drive the development of evidence-based practice. This responsibility is not just to improve our own skills but to contribute to the growth of the entire profession.\u0026rdquo;\u003c/p\u003e\n\u003ch3\u003eResearch ability\u003c/h3\u003e\n\u003cp\u003eResearch ability refers to the capacity of nursing professionals to engage in academic thinking, master scholarly skills, and design and implement scientific research projects. In the context of EBNP, nurses must continually engage in academic research and knowledge innovation to refine and enhance clinical practice continually. Previous research has acknowledged the importance of research skills for nursing professionals [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], but it has not specifically explored how research skills mainfest in the implementation of EBNP in China. This gap is largely attributed to differences between China and the Western countries in the characteristics of evidence-based nursing practitioners. Most Chinese evidence-based nursing practitioners have only received undergraduate education, which often lacks formal training in academic research skills. However, evidence-based nursing practice requires nurses to explore and apply the latest scientific evidence, much of which is published in English-language international journals. As such, proficiency in academic research skills is essential for accessing these cutting-edge scholarly resources. This study specifically identified several key components of research ability, including identification of clinical issues, literature search ability, literature quality assessment, and solving clinical problems with scientific thinking.\u003c/p\u003e\u003cp\u003eIdentification of clinical issues refers to the ability to recognize problems within clinical practice. EBNP emphasizes guiding clinical practices based on the most current scientific evidence. To implement EBNP effectively, nurses must first accurately identify existing problems in clinical practice, which enables targeted literature searchers, evidence evaluation, and evidence-based decision-making. Observable behaviors that exemplify this competency include actively observing patient care processes, discussing and identifying challenges in clinical team meetings, conducting regular audits to spot gaps in patient care, and documenting observed problems for further analysis. As one respondent explained, \u0026ldquo;Identifying clinical problems is the first crucial step to ensuring that nursing interventions are both effective and appropriate\u0026rdquo;.\u003c/p\u003e\u003cp\u003eLiterature search ability is the proficiency of nurses in navigating various literature databases and accurately accessing sources of evidence. Effective literature retrieval provides a wealth of evidence to guide clinical practice. Observable behaviors related to this competency include using multiple sources, such as academic journals, medical databases, and online platforms, to retrieve evidence, performing advanced search strategies using keywords, filters, and Boolean operators; and demonstrating the ability to organize and synthesize retrieved data into relevant clinical topics. However, many respondents highlighted hat nurses in China often lack awareness of existing academic databases, particularly international ones, and tend to rely on limited and single channels for literature retrieval. As noted in previous studies, this lack of familiarity with international databases has been a barrier to evidence-based practice in China [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. One respondent pointed out, \u0026ldquo;This limited access to international databases restricts our ability to obtain the most up-to-date clinical clinical evidence\u0026rdquo;. This lack of awareness hampers their ability to access the latest research, making it imperative to improve literature retrieval skills in the context of EBNP in China.\u003c/p\u003e\u003cp\u003eLiterature quality assessment refers to the skills required to evaluate and interpret evidence, identifying the most appropriate sources of evidence for clinical practice. Given the diversity of available evidence, nurses must be able to evaluate its relevance and quality to ensure it is suitable for addressing clinical needs. Observable behaviors in this area include assessing the credibility of the source of evidence (e.g., peer-reviewed journals, reputable institutions), applying critical appraisal tools to assess the methodology of studies, and comparing evidence from multiple sources to ensure consistency and reliability. Respondents emphasized the importance of discerning high-quality evidence. As one participant noted, \u0026ldquo;For EBNP to be effective, we must be able to find and apply the evidence most relevant to patient needs. This requires the ability to critically evaluate the quality of the available evidence\u0026rdquo;.\u003c/p\u003e\u003cp\u003eSolving clinical problem with scientific thinking refers to the ability to systematically analyze, evaluate, and resolve clinical problems based on the latest scientific evidence and theoretical knowledge. Scientific thinking enables nurses to engage in independent reasoning and adopt a methodical approach to solving clinical issues. Observable behaviors that exemplify this competency include using structured frameworks for problem-solving (e.g., PICO method), analyzing patient cases using evidence-based guidelines, testing hypotheses to verify clinical assumptions, and utilizing decision-making models to guide the implementation of interventions. Respondents emphasized the importance of approaching clinical problems from a scientific perspective. One respondent noted, \u0026ldquo;By analyzing clinical issues through the lens of scientific thinking, nurses can systematically identify the root causes of problems and develop evidence-based solutions\u0026rdquo;. This ability not only improves clinical practice but also strengthens the overall quality of care provided to patients.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLeadership and management\u003c/h2\u003e\u003cp\u003eThe leadership and management domain focuses on the efficient collaboration of nurses with other healthcare stakeholders to ensure the delivery of high-quality patient care. EBNP often requires teamwork and coordination among various stakeholders, including nurses, physicians, and patients. Nurses who possess strong leadership and management skills can efficiently organize and coordinate team members to provide optimal nursing services, enhance patient satisfaction, and promote the development of evidence-based medicine. In contrast to previous research, which primarily emphasized management aspects [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], this domain highlights the critical leadership role of nurses in advancing evidence-based scientific development among stakeholders, as well as their managerial responsibilities in implementing evidence-based nursing practice.\u003c/p\u003e\u003cp\u003eCommunication with other colleagues and patients is the ability to promptly and clearly convey information and share knowledge with colleagues and patients, thereby reducing information asymmetry. Proficient communication skills facilitate collaboration among team members, ensuring smooth information flow and mutual understanding. Observable behaviors that exemplify this competency include actively listening to colleagues during handoff discussions, using clear and concise language to explain complex medical terms to patients, providing timely updates on patient conditions during team meetings, and tailoring communication to suit the needs of different audiences (e.g., using simple language for patients with limited medical knowledge). One respondent noted, \u0026ldquo;Positive communication with patients helps nurses more personalized care, addressing not only their physiological needs but also their psychological and emotional concerns\u0026rdquo;.\u003c/p\u003e\u003cp\u003eTeamwork ability refers to the capacity for interdisciplinary collaboration, where team members leverage their respective expertise and skills to deliver comprehensive care. In healthcare settings with limited resources, effective teamwork ensures better coordination in the allocation and utilization of resources, ultimately benefiting patient care. Observable behaviors that demonstrate this competency include actively participating in team meetings, offering constructive feedback to colleagues, sharing relevant research or evidence during discussions, and respecting each team member\u0026rsquo;s contributions. Nurses should also demonstrate flexibility by adjusting their roles to accommodate the needs of the team. As one respondent stated, \u0026ldquo;Through collaboration, team members can exchange ideas, share experience, and jointly develop problem-solving methods, thereby enhancing the overall proficiency and capability of the healthcare team\u0026rdquo;.\u003c/p\u003e\u003cp\u003eHealth education skills are crucial for nursing professionals to effectively impart knowledge and strategies that help patients understand and manage their conditions while adopting proactive health behaviors. Nurses engaging in health education foster patient empowerment, leading to improved self-management and self-care. Observable behaviors in this area include explaining treatment plans and health risks in a way that patients understand, using visual aids or printed materials to enhance patient comprehension, regularly checking in with patients to assess their understanding of health instructions, and encouraging patients to ask questions about their care. As one respondent noted, \u0026ldquo;EBNP emphasizes the prevention and management of chronic diseases, and health education plays a key role in empowering patients to adopt healthy lifestyle changes, including dietary, exercise, and medication management\u0026rdquo;.\u003c/p\u003e\u003cp\u003eRisk and safety management ability involves nurses\u0026rsquo; ability to mitigate medical risks, ensure patient safety, and deliver high-quality care. EBNP emphasizes the reduction of health risks and the enhancement of patient safety through the use of scientific evidence and best practices. Observable behaviors that exemplify this competency include regularly performing risk assessments for patients (e.g., fall risk, infection control), checking for potential medication interactions before administering drugs, following established protocols for infection prevention, and reporting safety concerns immediately to the appropriate authorities. Nurses should also actively engage in patient safety training sessions and encourage colleagues to adhere to safety guidelines.. One respondent emphasized, \u0026ldquo;Proficient risk and safety management helps prevent medical errors, ensuring that patients receive the right treatment at the right time, thereby avoiding adverse outcomes\u0026rdquo;.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eImplementation and assessment\u003c/h3\u003e\n\u003cp\u003eImplementation and assessment domain refers to the ability to integrate evidence-based knowledge with clinical practice, develop clinical practice protocols, and access the outcomes of EBNP. This competency domain enables nurses to effectively translate evidence-based nursing principles into practical actions and ensure their execution aligns with the standards and quality expectations of best practices. Respondents frequently mentioned the importance of ongoing evaluation, with one stating, \u0026ldquo;We must constantly check whether what we\u0026rsquo;re doing aligns with evidence-based guidelines; it\u0026rsquo;s not enough just to implement, evaluation is key to improvement\u0026rdquo;. Additionally, nursing professionals need to regularly access the effectiveness of evidence-based nursing strategies and adjust practices based on these evaluations to continuously improve the quality of care. As one respondent emphasized, \u0026ldquo;It\u0026rsquo;s not just about applying evidence; we have to review the results and refine our strategies based on what works best for the patients\u0026rdquo;. This domain highlights both the application of evidence and the continuous assessment of its effects to drive the development of evidence-based medicine.\u003c/p\u003e\u003cp\u003eNursing practice skills encompass the essential clinical knowledge, experience, and abilities that nurses acquire, allowing them to convert evidence-based theoretical knowledge into practical application. Proficiency in these skills enables nurses to perform nursing tasks effectively, improving work efficiency, reducing errors, and enhancing the safety and quality of care. Observable behaviors that exemplify this competency include accurately assessing patient conditions based on physical exams, interpreting lab results to guide clinical decisions, applying evidence-based protocols during routine care, and using appropriate nursing techniques to ensure patient comfort and safety. One respondent reflected, \u0026ldquo;Without solid clinical practice skills, even the best evidence can\u0026rsquo;t be applied effectively. The skills are the bridge between theory and real-world care\u0026rdquo;.\u003c/p\u003e\u003cp\u003eEvidence application scenario assessment ability involves evaluating the specific circumstances of patients and integrating the latest evidence to guide clinical decisions and actions. Effective practice requires an in-depth understanding of clinical contexts, such as patient medical histories, symptoms, and diagnostic results. Observable behaviors demonstrating this competency include conducting thorough patient assessments, considering both the latest evidence and the unique aspects of each patient\u0026rsquo;s condition, modifying evidence-based protocols based on patient preferences and available resources, and continuously updating care plans in response to new clinical information. One nurse elaborated, \u0026ldquo;Every patient is different, and EBNP needs to be flexible. It\u0026rsquo;s about knowing the research, but also knowing the patient in front of you\u0026rdquo;. Another respondent added, \u0026ldquo;You can\u0026rsquo;t just follow a guideline blindly; you have to adapt it to the reality of the situation, considering everything from the patient\u0026rsquo;s condition to available resources\u0026rdquo;. Nurses must therefore blend scientific evidence with clinical experience and individual patient differences to create the most appropriate care plans.\u003c/p\u003e\u003cp\u003eAbility to construct EBNP program refers to the ability to plan, design, and establish projects within EBNP. Clear planning and careful design ensure that the goals of these projects are feasible and that resources are allocated appropriately. Observable behaviors include developing clear objectives and timelines for EBNP projects, identifying necessary resources (e.g., staff, equipment, funding), and ensuring that all project components are aligned with evidence-based guidelines. Additionally, nurses must ensure the sustainability of programs by planning for ongoing monitoring and adaptation. One nurse explained, \u0026ldquo;You can\u0026rsquo;t expect good results from evidence-based projects if they\u0026rsquo;re not carefully planned from the start, clear goals and the right resources are crucial\u0026rdquo;. Another participant stressed, \u0026ldquo;It\u0026rsquo;s important to know that every project should be sustainable and adaptable, ensuring that we can meet patients\u0026rsquo; needs without overextending resources\u0026rdquo;.\u003c/p\u003e\u003cp\u003eAbility to evaluate the effect of EBNP programs refers to the capacity to evaluate the outcome and effects of EBNP and engage in retrospective reflection on the entire process. Reflecting on the outcomes allows nursing professionals to identify shortcomings and adjust practices to enhance care quality. Observable behaviors that demonstrate this competency include systematically collecting data on patient outcomes (e.g., patient satisfaction, health improvements), analyzing the effectiveness of implemented EBNP programs, seeking feedback from patients and colleagues to identify areas for improvement, and revising care strategies based on evaluation findings. Respondents emphasized the importance of continuous evaluation in ensuring the ongoing improvement of nursing services. One respondent noted, \u0026ldquo;If we don\u0026rsquo;t evaluate the outcomes, we miss opportunities to refine and improve our practices. It\u0026rsquo;s through evaluation that we can find gaps and make changes\u0026rdquo;. Another nurse highlighted, \u0026ldquo;Evaluation is where new knowledge emerges. By assessing our practice, we contribute to evidence that can be shared and used to further develop the field\u0026rdquo;. In this way, the evaluation process not only improves current practice but also contributes to the advancement of evidence-based medicine.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEBNP holds great potential for enhancing medical efficiency, ensuring patient safety, improving patient satisfaction, advancing healthcare services, and accelerating progress towards UHC. Despite China\u0026rsquo;s position as the world\u0026rsquo;s most populous and rapidly aging country, it has yet to fully harness the extensive benefits of EBNP, primarily due to the insufficient capabilities among its nursing workforce. This gap underscores the critical need for a scientifically robust and systematic EBNP competency framework in China. This study proposed a core competency framework comprising five domains and 20 items essential for nurses implementing evidence-based nursing in China, aiming to foster a health workforce dedicated to advancing evidence-based medicine and global health. To our knowledge, this study marks the first attempt to develop a national-scale competency framework for EBNP in China, expected to significantly contribute to the competency maturation in mainland China.\u003c/p\u003e\u003cp\u003eThis study, based on the JBI model, proposes a competency framework for EBNP consisting of five core domains and twenty sub-components. The JBI model provides a solid foundation for evidence-based healthcare, emphasizing interdisciplinary competencies such as evidence generation, synthesis, translation, and implementation. In contrast, the competency framework presented in this study further delineates these competencies, focusing on how nursing professionals can effectively apply EBNP in their clinical settings, thereby offering a more structured and practice-oriented framework. Furthermore, these domains are closely linked to established theoretical frameworks, enhancing the framework\u0026rsquo;s scientific rigor and theoretical value. Specifically, the personal traits domain is crucial in shaping EBNP, with traits like self-reflection and self-improvement aligning with Bandura\u0026rsquo;s social cognitive theory [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], which highlights the role of self-efficacy and persistence in motivating challenging yet achievable behaviors. These traits support the adoption of evidence-based practices and professional development. The professional values domain, including empathy, ethics, equality, and respect, is essential for patient-centered care. These values resonate with Kohlberg\u0026rsquo;s theory of moral development [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], which emphasizes moral reasoning driven by principles of justice and respect, fostering ethical decision-making in nursing practice. The research ability domain bridges theory and practice by enabling nurses to critically appraise and apply the best available evidence to improve patient outcomes. This aligns with evidence-based medicine [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], which integrates research, clinical expertise, and patient values to optimize care. The leadership and management domain is vital for implementing systemic changes in healthcare. Nurses with strong leadership skills drive organizational change, promote interdisciplinary collaboration, and integrate evidence-based practices into clinical care. This aligns with Lewin\u0026rsquo;s change management theory [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], providing a framework for facilitating organizational change. The implementation and assessment domain ensures EBNP\u0026rsquo;s successful integration into clinical practice, promoting continuous improvement. This domain is linked to quality improvement theories [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], particularly the Plan-Do-Study-Act (PDSA) cycle, which supports iterative practice refinement through systematic evaluation.\u003c/p\u003e\u003cp\u003eThis study provided several new insights on developing workforce for EBNP. First, personal traits and professional value are two core domains of competency, highlighting personal internal driving force is one of the decisive factors for nurses\u0026rsquo; competency in evidence-based nursing. The professional value of nurses is essential to nursing practice. Research indicated that nurses\u0026rsquo; sense of responsibility and innate mission towards their job duties drive them to contribute the advancement of nursing science and the maintenance of health equity, while striving for high-quality nursing outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Evidence-based nursing is committed to global health which places a priority on improving health and achieving health equity for all people worldwide. Hence, this requires courage, responsibility, equal and respect, and other internal trait to drive nurses to actively implement this concept.\u003c/p\u003e\u003cp\u003eProfessional education of evidence-based nursing should be strengthened in China. Prior study has demonstrated that evidence-based nursing training can effectively enhance the knowledge and self-efficacy of nurses and nursing students, thereby further promoting implementation practices [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. With the implementation of evidence-based nursing in China, although some universities have started offering evidence-based nursing programs, they are mainly focused on the postgraduate level, with very few offering undergraduate programs in this field. This has resulted in an inadequate supply of professionally trained talent to meet the market demand in clinical practice. Such domains identified in this study as research ability. However, the competencies proposed in this study require specialized development and the optimal stage of intervention is undergraduate education. Additionally, there is a need to strengthen continuing education in evidence-based nursing, providing more opportunities for in-service nurses to undergo retraining, thus meeting the demand of nursing professionals who have not received specialized education but wish to actively participate in evidence-based nursing practice.\u003c/p\u003e\u003cp\u003eThe diversification of disciplines is crucial for conducting evidence-based nursing education. Incorporating evidence-based nursing-related courses comprehensively into undergraduate nursing education is the first step in assisting nursing students to systematically master the foundational skills and knowledge of evidence-based nursing to assume professional roles in evidence-based nursing practice [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Currently, nursing education in China primarily focuses on medical knowledge and clinical teaching, with other courses often presented as electives, leading to insufficient emphasis on these aspects in education. The proposed competency framework refers to various disciplines such as academic research, team management, legal regulations, and clinical practice. Therefore, specialized education needs to involve these interdisciplinary aspects to provide an optimized training pattern.\u003c/p\u003e\u003cp\u003eThe formation of an evidence-based nursing team is essential for the effective implementation of evidence-based nursing practices. Teamwork has long been advocated as an effective approach in the field of nursing, aiding in the reduction of medical and nursing error, thereby enhancing patient satisfaction and improving healthcare delivery [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Most evidence-based nursing professionals in China are often required by their leaders to engage in evidence-based nursing practices during their spare time, leading to a passive approach and nearly independent completion of the entire process. This significantly affects the effectiveness of evidence-based nursing practices. The implementation of evidence-based nursing involves multiple processes, and the competencies it emphasizes cover various domains, such as leadership and management, research ability, implementation and mentoring. Under the current nursing education system in China, it is challenging for an individual to possess all these core competencies simultaneously, and more often, individuals excel in specific domain. Therefore, an effective practice strategy is a collaborative team approach, integrating individuals with expertise in different core competencies to collectively carry out evidence-based nursing practices.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eImplementation barriers and cultural factors\u003c/h2\u003e\u003cp\u003eDespite the potential of the proposed competency framework, its implementation in China faces several challenges. A major barrier is the resource disparity between urban and rural regions. Rural healthcare institutions often lack access to evidence-based resources, such as academic databases and updated clinical guidelines, making it difficult for nurses to apply EBNP effectively. Smaller hospitals, in particular, may have limited opportunities for professional development, hindering nurses\u0026rsquo; ability to stay current with the latest research. Another challenge is nurse turnover, which remains high across many healthcare settings. Frequent staff changes disrupt continuous professional development and the consistent application of evidence-based practices, as newly hired nurses may not receive proper training in EBNP. Regional differences in nursing education also contribute to uneven competency levels. Urban areas typically offer more advanced training and resources, while rural areas often lack such opportunities, leading to disparities in readiness to implement the framework. Finally, institutional support is essential for EBNP implementation. Without strong backing from hospital management, nurses may struggle to integrate evidence-based practices into their routines, especially when they conflict with traditional practices or policies. To successfully integrate EBNP, healthcare institutions must foster an environment that supports professional development and aligns policies with evidence-based practices.\u003c/p\u003e\u003cp\u003eIn China\u0026rsquo;s healthcare environment, the authoritative culture and hierarchical structure can indeed influence nurses\u0026rsquo; acceptance of EBNP. Within the traditional hierarchical system in Chinese hospitals, decision-making is often top-down, with hospital management and senior physicians holding a dominant role in medical decisions. Their opinions and experiences are frequently regarded as highly authoritative. For example, when establishing clinical nursing protocols, decisions are often based on the management experience of hospital leadership or the clinical judgments of senior physicians, rather than on scientific evidence underpinning EBNP. Furthermore, nurses typically occupy a subordinate position within the healthcare team. This hierarchical relationship can deter nurses from voicing dissent when their views differ from those of management or senior physicians. For instance, when EBNP suggest adopting a new nursing technique, but senior physicians, based on traditional practices, deem the old methods more reliable, nurses may feel compelled to follow the physicians\u0026rsquo; opinions due to concerns about challenging their authority or jeopardizing their professional standing within the team, rather than proactively adopting EBNP. This situation can hinder the implementation and development of EBNP in China. To promote the advancement of EBNP in China, it is essential to enhance the education and training of nurses in EBN, improving their competence and awareness.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePolicy implication\u003c/h2\u003e\u003cp\u003eThese findings also provides several implication for policymakers seeking to enhance the competency of the nursing workforce in EBNP in China, aiming to address the nursing shortage and improve the effectiveness of EBNP implementation. First, policymakers should provide both financial and policy support to encourage universities to establish undergraduate programs in EBNP. This would equip nursing students with the foundational knowledge and skills necessary to build a talent pool for the future implementation of EBNP. Second, universities should regularly offer evidence-based nursing training programs to provide ongoing professional development opportunities for practicing nurses, thereby strengthening their capacity to implement EBNP. Third, hospitals should establish dedicated EBNP teams guided by the proposed competency framework. These teams would foster collaborative teamwork, enabling the effective integration of EBNP into clinical practice. Additionally, there is a need to reform the traditional hierarchical structure and authoritative culture in healthcare, establishing a more egalitarian and open model of team collaboration. This would encourage nurses to actively engage in medical decision-making and practice, thereby facilitating the implementation and growth of EBNP.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStrength and limitations\u003c/h2\u003e\u003cp\u003eThis study has significant theoretical and practical contributions. Firstly, by constructing a Chinese competency framework for EBNP guided by the JBI model, it substantially broadens the scope of research in the field of EBNP in China. The framework provides a comprehensive and systematic analysis of the competencies required for EBNP, offering new directions for refining EBNP theory. Secondly, the study provides empirical evidence to support the development of China\u0026rsquo;s evidence-based nursing workforce. The competency framework, based on rigorous research, clearly defines the essential competencies for evidence-based nurses, strengthening the theoretical foundation of the field. Thirdly, the framework serves as a blueprint for individuals pursuing a career in EBNP, offering clear guidance on the necessary knowledge, skills, and attitudes for professional development. Fourthly, it supports healthcare institutions in talent development, recruitment, assessment, and evaluation. By aligning with the framework, healthcare institutions can define training goals, select qualified staff, and establish indicators to ensure high-quality evidence-based nursing. Fifthly, it offers insights for universities to enhance their curricula for EBNP, ensuring they better meet the needs of the healthcare sector. Lastly, the research provides a valuable reference for countries in the early stages of EBNP, helping them avoid unnecessary trial-and-error and contributing to the global development of evidence-based medicine.\u003c/p\u003e\u003cp\u003eDespite significant efforts in this study to comprehensively explore the competency framework required for EBNP in China, enhance nursing professionals\u0026rsquo; competencies, and contribute more Chinese evidence to the global development of evidence-based medicine, several limitations inevitably exist, which provide opportunities for future research. First, during the research process, we included key stakeholders such as educators, researchers, managers, and nurses to gather a diverse range of perspectives. However, due to the inherent nature of the nursing profession, the gender distribution among respondents was imbalanced. This imbalance may have influenced the study\u0026rsquo;s findings, as gender differences may shape diverse experiences and viewpoints in EBNP. The disproportionate gender distribution may have led to the omission of certain perspectives or a lack of representation. Secondly, this study primarily focused on EBNP within tertiary hospitals, as EBNP in China is still in its nascent stages and primarily implemented in top-tier hospitals. However, this focus has limited our exploration of EBNP in primary or community healthcare settings. Primary and community healthcare institutions differ significantly from tertiary hospitals in terms of service population, resource allocation, and service models. As a result, the competency needs and challenges these institutions face in implementing EBNP may differ. Future research should consider primary and community healthcare settings as independent research subjects, investigating their unique needs in EBNP. Thirdly, the thematic analysis used to develop the initial competency framework is inherently subjective. While measures were taken to ensure rigor, such as independent coding by multiple researchers, some bias in interpreting qualitative data cannot be ruled out. Fourly, while this study proposes a competency framework for EBNP, the practical application of these theoretical constructs in real-world nursing practice remains a challenge. Future research should focus on the implementation of this framework in various healthcare settings, considering the practical effectiveness of its application. For instance, strategies such as training programs and policy support could be employed to enhance nursing professionals\u0026rsquo; evidence-based competencies, and the effectiveness of these interventions should be evaluated. Additionally, this study primarily addresses the construction of the competency framework for EBNP, while the quantifiable assessment of its implementation outcomes has been somewhat neglected. Future studies should emphasize the actual impact of EBNP on patient health outcomes and nursing quality, exploring specific evaluation indicators and methods to more comprehensively and accurately measure the value of EBNP. Finally, the competency framework was developed and validated within the context of the Chinese healthcare system. While the findings may have implications for other settings, the framework\u0026rsquo;s applicability to different cultural or organizational contexts remains uncertain without further adaptation and validation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe EBNP workforce plays a vital role in delivering high-quality nursing services, enhancing health equity, and promoting UHC. Given China\u0026rsquo;s potential to contribute significantly to global evidence-based medicine, the development of a competent nursing workforce to support the effective implementation of EBNP is both important and timely. This study identified five core competency domains essential for EBNP. The proposed competency framework offers a foundation for EBNP education, with the potential to guild the development qualified nursing professionals who can address healthcare service demands. Additionally, it provides a basis for improving the assessment, recruitment, and training of the nursing workforce, which may contribute to mitigating current workforce shortages. However, further research is needed to evaluate the framework\u0026rsquo;s practical application and long-term impacts on nursing practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with the approval of the Ethics Committee of Guangxi Academy of Medical Sciences (IIT-2023-79). Participation in this study was fully anonymous and voluntary, and all participants signed a written informed consent form. All interviews were performed in accordance with relevant guidelines and regulations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eX.X. contributes to write and critical review the manuscript, and code the results. Y.G. contributes to methodology and code the results. L.D. contributes to write the manuscript and code the results. Y.T. contributes to extract the results and invite the participants. H.W. contributes to conceptualization and design this study. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr Xin Xiang\u003c/strong\u003e is currently a senior researcher at the Institute of Fiscal and Finance, Shandong Academy of Social Sciences. Xin gained a PhD from Henley Business School, University of Reading. Her research primarily focuses on medical leadership, human resource management, implementation sciences, health system, organizational studies and talent management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr Yang Gao\u0026nbsp;\u003c/strong\u003eis associate professor of Management at the the Institute of Fiscal and Finance, Shandong Academy of Social Sciences. His research focuses on organization study, policy study, and implementation sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMs Luping Dong\u0026nbsp;\u003c/strong\u003eis attending doctor in Department of Neurology, The People’s Hospital of Guangxi Zhuang Autonomous Region. She is interested in neurology and qualitative research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProfessor Yinshan Tang\u003c/strong\u003e is a professor in Management at Henley Business School, University of Reading and also is Vice Dean of HBS. His research mainly refers to management, organization study and qualitative research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr Hongzhi Wang\u003c/strong\u003e is a senior researcher working at Research Center of Hospital Management and Medical Prevention, Guangxi Academy of Medical Sciences. Dr Wang gained a PhD from Henley Business School, University of Reading. His main research areas include implementation sciences, health policy, health system management, competency development, hospital management, and talent management.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYip W, Fu H, Jian W, Liu J, Pan J, Xu D, Zhai T (2023) Universal health coverage in China part 1: progress and gaps. Lancet Public Health 8(12):e1025\u0026ndash;e1034\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgustina R, Dartanto T, Sitompul R, Susiloretni KA, Achadi EL, Taher A, Khusun H (2019) Universal health coverage in Indonesia: concept, progress, and challenges. Lancet 393(10166):75\u0026ndash;102\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLal A, Abdalla SM, Chattu VK, Erondu NA, Lee TL, Singh S, Phelan A (2022) Pandemic preparedness and response: exploring the role of universal health coverage within the global health security architecture. Lancet Global Health 10(11):e1675\u0026ndash;e1683\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi W, Gillies RM, Liu C, Wu C, Chen J, Zhang X, Sun H (2023) Specialty preferences of studying-abroad medical students from low-and middle-income countries. BMC Med Educ 23(1):158\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzabo S, Nove A, Matthews Z, Bajracharya A, Dhillon I, Singh DR, Campbell J (2020) Health workforce demography: a framework to improve understanding of the health workforce and support achievement of the Sustainable Development Goals. Hum Resour Health 18:1\u0026ndash;10\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee ACK, Morling JR (2024) The looming global workforce crisis in primary care. Public Health 229:63\u0026ndash;64\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2016) Global strategy on human resources for health: workforce 2030\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAsamani JA, Amertil NP, Ismaila H, Akugri FA, Nabyonga-Orem J (2020) The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana. Hum Resour health 18(1):16\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi H, Sun D, Wan Z, Chen J, Sun J (2020) The perceptions of older nurses regarding continuing to work in a nursing career after retirement: A qualitative study in two Chinese hospitals of different levels. Int J Nurs Stud 105:103554\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLai J, Brettle A, Zhang Y, Zhou C, Li C, Fu J, Wu Y (2022) Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study. Nurse Educ Today 116:105436\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLabrague LJ, McEnroe-Pettite D, Tsaras K, D\u0026rsquo;Souza MS, Fronda DC, Mirafuentes EC, Graham MM (2019) Predictors of evidence‐based practice knowledge, skills, and attitudes among nursing students. In Nursing forum (Vol. 54, No. 2, pp. 238\u0026ndash;245)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFu Y, Wang C, Hu Y, Muir-Cochrane E (2020) The barriers to evidence‐based nursing implementation in mainland China: A qualitative content analysis. Nurs Health Sci 22(4):1038\u0026ndash;1046\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArsenault Knudsen \u0026Eacute;N, Mundt MP, Steege LM Describing nurses' communication about evidence-based practice change: A social network analysis of hospital nurses. Worldviews on Evidence‐Based Nursing\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheng L, Feng S, Hu Y (2017) Evidence-based nursing implementation in Mainland China: A scoping review. Nurs Outlook 65(1):27\u0026ndash;35\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoswell C, Ashcraft A, Long J, Cannon S, DiVito-Thomas P, Delaney T (2020) Self‐efficacy: changing the tide of evidence‐based practice. Worldviews Evidence‐Based Nurs 17(2):129\u0026ndash;135\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim SC, Stichler JF, Ecoff L, Brown CE, Gallo AM, Davidson JE (2016) Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews Evidence‐Based Nurs 13(5):340\u0026ndash;348\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Y, Zhang C, Zhan P, Fu H, Yip W (2023) Trends and projections of universal health coverage indicators in China, 1993\u0026ndash;2030: An analysis of data from four nationwide household surveys. The Lancet Regional Health\u0026ndash;Western Pacific, p 31\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou S, Dong X, Liu F, Zhang Y, Yue D, Zhou Q, Zheng ZJ (2021) A stepped wedge cluster randomized control trial to evaluate the implementation and effectiveness of optimized initiatives in improving quality of care for ST segment elevation myocardial infarction in response to the COVID-19 outbreak. Implement Sci 16:1\u0026ndash;15\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang LN, Tao H, Zhao Y, Zhou YQ, Jiang XR (2014) Optimal timing for initiation of biofeedback-assisted relaxation training in hospitalized coronary heart disease patients with sleep disturbances. J Cardiovasc Nurs 29(4):367\u0026ndash;376\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao J, Liu X, Zhang W, Xing Y, Cho SW, Hao Y (2018) Evidence-based nursing outputs and hot spot analysis of the last 5 years in mainland China: Results of a bibliometric analysis. Int J Nurs Pract, 24(2), e12628\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBraun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Res Psychol 3(2):77\u0026ndash;101\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa H, Lin L, Zhang S, Lei L, Huang J, Lu F, Luo Y (2021) Exploring competencies of military nurses in general hospitals in China: a qualitative content analysis. BMC Nurs 20:1\u0026ndash;8\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFinnbakk E, Wangensteen S, Skovdahl K, Fagerstr\u0026ouml;m L (2015) The Professional Nurse Self-Assessment Scale: Psychometric testing in Norwegian long term and home care contexts. BMC Nurs 14:1\u0026ndash;13\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNieminen AL, Mannevaara B, Fagerstr\u0026ouml;m L (2011) Advanced practice nurses\u0026rsquo; scope of practice: a qualitative study of advanced clinical competencies. Scand J Caring Sci 25(4):661\u0026ndash;670\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo H, Zhu W, Li J (2023) Developing a core competency framework for advanced practice nursing in mainland China: a sequential exploratory study. BMC Nurs 22(1):179\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLai J, Brettle A, Zhang Y, Zhou C, Li C, Fu J, Wu Y (2022) Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study. Nurse Educ Today 116:105436\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen L, Wu Y, Wang S, Zhao H, Zhou C (2021) Construction of evidence-based practice competencies for nurses in China: A modified Delphi study. Nurse Educ Today 102:104927\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBandura A (2001) Social cognitive theory: An agentic perspective. Ann Rev Psychol 52(1):1\u0026ndash;26\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGibbs JC (2019) Moral development and reality: Beyond the theories of Kohlberg, Hoffman, and Haidt. Oxford University Press\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSackett DL, Rosenberg WMC (1995) On the need for evidence-based medicine. J Public Health 17(3):330\u0026ndash;334\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCummings S, Bridgman T, Brown KG (2016) Unfreezing change as three steps: Rethinking Kurt Lewin\u0026rsquo;s legacy for change management. Hum Relat 69(1):33\u0026ndash;60\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcNicholas C, Lennox L, Woodcock T, Bell D, Reed JE (2019) Evolving quality improvement support strategies to improve Plan\u0026ndash;Do\u0026ndash;Study\u0026ndash;Act cycle fidelity: a retrospective mixed-methods study. BMJ Qual Saf 28(5):356\u0026ndash;365\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYeung MMY, Yuen JWM, Chen JMT, Lam KKL (2023) The efficacy of team-based learning in developing the generic capability of problem-solving ability and critical thinking skills in nursing education: A systematic review. Nurse Educ Today 122:105704\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCardoso D, Rodrigues M, Pereira R, Parola V, Coelho A, Ferraz L, Apostolo J (2021) Nursing educators\u0026rsquo; and undergraduate nursing students\u0026rsquo; beliefs and perceptions on evidence-based practice, evidence implementation, organizational readiness and culture: An exploratory cross-sectional study. Nurse Educ Pract 54:103122\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaek H, Han K, Cho H, Ju J (2023) Nursing teamwork is essential in promoting patient-centered care: a cross-sectional study. BMC Nurs 22(1):433\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":"Evidence-based nursing practice, health workforce shortage, competency framework, nursing education, nursing care","lastPublishedDoi":"10.21203/rs.3.rs-7430762/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7430762/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEvidence-based nursing practice (EBNP) has the potential to enhance healthcare efficiency, ensure patient safety, improve patient satisfaction, advance healthcare services, and accelerate progress towards Universal Health Coverage. However, despite being the world’s most populous and rapidly aging country, China has not fully realized the benefits of EBNP. The primary factor contributing to the significant gap between the demand for and supply of EBNP is the inadequate capabilities within its nursing workforce. Identifying the core competencies required for EBNP implementation is crucial to address this unmet demand.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims:\u003c/strong\u003e This study aimed to identify the core competencies necessary for the nursing workforce and propose a competency framework to effectively implement EBNP in China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA qualitative study was conducted in two phases. In the first phase, in-depth, semi-structured interviews with 67 participants from 17 provinces across mainland China were conducted, followed by thematic analysis to develop an initial competency framework. The second phase involved the Delphi method, engaging 29 experts to validate the proposed framework for EBNP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe proposed competency framework consists of five domains and 20 sub-components essential for nurses to implement EBNP effectively in China. These domains include personal traits, professional value, research ability, leadership and management, and implementation and assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe findings provide valuable insights that can contribute to evidence-based nursing education, supporting the development of professionals equipped to address healthcare service demands. The proposed framework has potential applications in guiding the assessment, recruitment, and training of the nursing workforce, which may alleviate workforce shortage. Future research could further refine and integrate this framework into interventions and assessments, evaluating its long-term impacts on nursing practice.\u003c/p\u003e","manuscriptTitle":"Improving the Competency of Evidence-Based Nursing in China: Addressing Workforce Crisis and Inefficiencies in Leveraging the Potential of a Vast Healthcare Market","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-25 05:13:37","doi":"10.21203/rs.3.rs-7430762/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":"e2dc65f9-abaf-4b2c-be8d-aad725b72e8d","owner":[],"postedDate":"August 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53543311,"name":"Nursing"}],"tags":[],"updatedAt":"2025-08-25T05:13:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-25 05:13:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7430762","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7430762","identity":"rs-7430762","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}