Development and implementation of an ecological education model for evidence-based practice competency in undergraduate nursing students: A mixed-methods feasibility study.

Objectives: This study aimed to develop a competency-oriented ecological education model and evaluate the feasibility and preliminary outcomes of its implementation for enhancing evidence-based practice competencies among undergraduate nursing students. Methods: An ecological education model was developed based on educational ecology theory and the input-environment-output (IEO) theoretical framework, and implemented from 2019 to 2024. The model integrated three core components: a four-year progressive competency development pathway (ranging from evidence-based thinking in year one to comprehensive practice application in year four); a three-tier ecological environment (comprising physical, classroom, and practice environments that incorporates six best practice spotlight organization guidelines into eight core courses); and multidimensional practice platforms, including health science communication and guideline translation. The reform was conducted at a nursing school of a double first-class university in Beijing, China. A naturalistic longitudinal cohort design was employed, which included 1,223 undergraduate nursing students at baseline (2019, pre-reform) and 1,237 at post-implementation (2024). A convergent parallel mixed-methods approach was used to evaluate the implementation outcomes. Quantitative data on academic performance and innovation outcomes were collected at both time points, baseline and post-implementation. Semi-structured interviews with 18 students were conducted to supplement the exploration of their learning experiences. Results: Academic engagement increased from 78.5 % to 97.3 %, evidence-based graduation theses rose from 18.6 % to 30.0 %, and innovation and entrepreneurship projects increased from 40 to 150. Qualitative analysis revealed four themes and twelve subthemes, revealing enhanced critical appraisal skills (88.9 %), evidence synthesis capabilities (94.4 %), and professional confidence (83.3 %) among students. Integrated mixed-methods analysis revealed stage-specific characteristics across academic years: a complementarity pattern in Year 1 (foundational awareness building), a convergence pattern in Years 2-3 (systematic competency construction), an expansion pattern during the Year 3 transition (role adaptation challenges), and a convergence pattern in Year 4 (comprehensive transformation and professional confidence enhancement). Conclusions: This feasibility study demonstrated that the ecological education model could be successfully implemented in undergraduate nursing education with promising preliminary outcomes. This study provides an initial framework for nursing education innovation and establishes foundational evidence warranting future rigorous controlled studies to examine the model's effectiveness.