Introduction

As a clinical approach that integrates the best research evidence, clinical expertise, and patient-specific needs [1], Evidence-Based Practice (EBP) requires more than technical competence—it demands the capacity to interpret, adapt, and apply evidence within complex, often unpredictable clinical environments. In the nursing context, EBP is often referred to as Evidence-Based Nursing (EBN), reflecting its discipline-specific implementation. This process is inherently social and cognitive, shaped by interactions between learners, clinical mentors, organizational norms, and situational demands. Social Cognitive Theory (SCT) [2] offers a particularly relevant theoretical lens for understanding how nursing students develop EBP capabilities during internships [3, 4]. Central to SCT are the constructs of observational learning, self-efficacy, and the reciprocal interplay among personal factors, behavior, and environment—all of which are salient in clinical placements where students learn not only from instruction but also by observing role models, navigating power dynamics, and negotiating what counts as “valid” evidence in practice. Rather than treating EBP as a set of skills to be transmitted, SCT helps frame it as a situated practice that emerges through social participation and reflective engagement. The “National Nursing Development Plan (2021–2025)“ [5] issued by China’s National Health Commission in 2022 emphasized the need to focus on cultivating the capabilities of nursing professionals, improving their working methods, and strengthening standardized systems for nursing practices. This initiative aims to achieve homogenization of nursing techniques across different regions and departments in China. However, translating EBP into routine practice—especially among learners—requires more than knowledge transfer; it demands contextual alignment, facilitation, and judgment about evidence applicability. International implementation frameworks such as the integrated PARIHS (i-PARIHS) model [6] and the JBI FAME framework [7] provide valuable lenses for understanding this process: i-PARIHS underscores the critical role of facilitators and receptive contexts in enabling evidence use, while JBI FAME guides practitioners in evaluating whether evidence is feasible, appropriate, meaningful, and effective in specific settings. In teaching hospitals, clinical preceptors often serve as key facilitators; however, their availability, EBP competence, and willingness to mentor can vary widely [8, 9].

EBP is particularly critical during clinical internships, as this period represents the first authentic opportunity for nursing students to integrate research evidence into real-time patient care decisions under supervision. International studies emphasize that clinical placements serve as a pivotal “bridge” between theoretical knowledge and professional practice [10]. It is within these real-world clinical contexts—not just classrooms—where students’ ability to apply, adapt, and advocate for evidence is truly tested and shaped. Yet the transfer of classroom-acquired EBP competencies into dynamic clinical environments remains uncertain, especially when students face hierarchical norms, time constraints, and limited mentorship [11]. Cardoso et al. evaluated the effectiveness of an EBP educational program for undergraduate nursing students and reported that the program enhanced students’ knowledge and skills in EBP [12]. Jeong et al., through a systematic review and meta-analysis, assessed the impact of EBP educational programs on undergraduate nursing students and revealed that such programs promote improvements in students’ EBP capabilities, critical thinking, and problem-solving skills [13]. This gap is especially pronounced in the Chinese context, where recent studies report persistent difficulties in EBP implementation among nursing students during clinical rotations [14, 15].

To address this, we adopt a phenomenological approach to explore the lived experiences of undergraduate nursing students as they encounter and navigate EBP during internships. How do undergraduate nursing students experience and make sense of applying EBP in real-world clinical settings? Phenomenology allows us to access the subjective, often tacit dimensions of experiential learning that standardized assessments may overlook. While Social Cognitive Theory provides a useful vocabulary for conceptualizing these processes—especially observational learning and self-efficacy—this study adopts a descriptive phenomenological stance that prioritizes participants’ unmediated accounts over theoretical interpretation. Thus, SCT informs our questioning but does not structure our analysis. By centering students’ voices through semi-structured interviews, this study seeks to illuminate the social, emotional, and cognitive processes that shape EBP engagement in real-world clinical settings. Findings will inform more responsive pedagogical and mentoring strategies that align with how students actually learn to “do” EBP—not just know it.

Objects and methods

Participants

A purposive sampling method was employed to recruit undergraduate nursing interns who were in their final year of a four-year nursing program (expected graduation in 2025) at Guilin Medical University and undertaking clinical internships in tertiary hospitals in Guangdong Province and the Guangxi Zhuang Autonomous Region. Semi-structured interviews were conducted between August and December, 2024. The inclusion criteria were as follows: (a) were currently enrolled as an undergraduate nursing intern in a four-year nursing program; (b) had rotated through four or more clinical departments; and (c) were willing to participate in the study. The exclusion criteria were as follows: (a) students admitted through associate-to-bachelor programs or other nontraditional pathways into the four-year nursing program; (b) students who did not meet internship requirements or had not yet started their clinical placement. The interviews were conducted until data saturation was achieved, with no new themes emerging. A total of 13 participants were interviewed, including 4 males and 9 females. The sample size was determined based on the principle of information power [16], which suggests that the required number of participants depends not only on data saturation but also on the study’s aim, the specificity of the sample, the quality of dialogue during interviews, and the depth of analysis. Given that our research focused on a specific phenomenon—undergraduate nursing interns’ lived experiences of implementing EBP during clinical placements—and that participants were homogeneous in their educational background (all final-year students from the same four-year program) yet diverse in clinical placement settings (six tertiary hospitals across two provinces), a relatively small but information-rich sample was deemed sufficient to capture meaningful and nuanced insights. Interviews continued until no new thematic content emerged, confirming both thematic saturation and adequate information power. This study was approved by the Medical Ethics Committee of Guilin Medical University (GLMC20240901).

Methods

Interview methods

Using a descriptive phenomenological approach within qualitative research, data were collected through semistructured interviews. Thirteen undergraduate nursing interns from six tertiary hospitals in Guangdong Province and the Guangxi Zhuang Autonomous Region were selected as interview subjects. Participants were selected based on their exposure to EBP-related activities during clinical placements, diversity of hospital settings, and willingness to reflect on their practice experiences. The interview guide was initially informed by core constructs of SCT—particularly observational learning, self-efficacy, and person–environment interactions—to sensitively prompt reflections on how students learn and act in clinical contexts. However, consistent with descriptive phenomenology’s emphasis on bracketing (epoche), SCT was not used as an interpretive framework during analysis; its role was limited to shaping open-ended, experience-focused questions. The guide was further refined through extensive literature review and iterative team discussions. After pilot interviews were conducted with four undergraduate nursing interns, adjustments were made to finalize the interview guide. These four pilot participants were not included in the final dataset of 13 interviewees used for analysis. The final interview questions were as follows: (a) How familiar are you with EBP? (b) What improvements have you made in meeting individual patient care needs during your internship? (c) How do your clinical instructors guide you in caring for patients on the basis of both their needs and EBP? (d) What challenges have you encountered while applying EBP? (e) As undergraduate nursing interns, how do you think schools and hospitals can better support you in utilizing EBP? (f) How do you plan to incorporate EBP into your future career? To strengthen theoretical grounding and methodological transparency, each interview question was explicitly aligned with relevant constructs of SCT—namely observational learning, self-efficacy, and person–environment interaction. This mapping is summarized in Table 1. The interviews were conducted either face-to-face or online. Prior to the interviews, the participants were scheduled for a time and location (for face‒to‒face interviews) and were informed about the study’s purpose, significance, and methods. With the participants’ informed consent, the interviews were recorded. During the interviews, the participants were again briefed on relevant matters to ensure that they were fully informed. Each interview lasted approximately 25 min—a duration reflective of the heavy clinical workload and limited availability of nursing interns. While this relatively short duration may have constrained the depth of exploration in individual interviews, we took several steps to mitigate this limitation and support data quality. To maximize data richness within this constraint, interviewers employed focused, experience-based questioning. Throughout the interviews, the primary interviewer—trained in qualitative methods—paid close attention to participants’ verbal expressions, emotional tone, and contextual cues. Key responses were occasionally paraphrased or gently repeated for clarification and confirmation, ensuring fidelity to participants’ intended meanings. The interviewer maintained reflexivity and an objective stance throughout the process to minimize bias. Data collection continued until thematic saturation was achieved, defined as three consecutive interviews yielding no new codes or thematic insights related to the research question. This was assessed through weekly team meetings where transcripts and emerging codes were reviewed collaboratively. Data collection ceased after 13 interviews, at which point thematic saturation had been reached—defined as three consecutive interviews yielding no new codes or thematic insights related to the research question. This suggests that, despite time constraints, recurring and meaningful patterns had emerged across the dataset.

Table 1 Alignment of interview questions with SCT constructs
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Data analysis methods

After each interview, the primary interviewer listened to the audio recording multiple times and transcribed it verbatim into a digital document within 24 h. All personally identifiable information—including participants’ names and hospital affiliations—was removed during transcription. The quotations presented in the results section have been lightly edited for grammar, fluency, and conciseness to improve readability, while ensuring that the participants’ intended meanings remain fully intact. Participants were assigned numerical codes, and clinical sites were labeled alphabetically to ensure confidentiality. Data analysis followed Colaizzi’s seven-step phenomenological method, which provides a systematic approach to uncovering the essence of participants’ lived experiences. The steps were operationalized as follows: (a) Immersion: Researchers read all transcripts repeatedly to become thoroughly familiar with the data; (b) Extraction of significant statements: Meaningful phrases directly related to EBP experiences were identified; (c) Formulation of meanings: Each statement was interpreted to capture its underlying significance; (d) Clustering of meanings into themes: Similar meanings were grouped into preliminary thematic clusters; (e) Integration and refinement: Clusters were reviewed, merged, or split through iterative team discussions to develop coherent sub-themes; (f) Comprehensive description: Rich narrative descriptions of each theme were drafted; (g) Validation: Where feasible, preliminary findings were shared with a subset of participants for member checking. To support this manual interpretive process, NVivo Pro was used to manage the coding workflow. Specifically, significant statements were imported into NVivo and coded line-by-line by two independent researchers using descriptive initial codes. These codes were then organized into nodes corresponding to Colaizzi’s thematic clusters. NVivo facilitated code comparison, retrieval of supporting quotations, and audit trail documentation, but all analytical decisions—such as theme definition, merging, and final naming—were made collaboratively by the research team based on Colaizzi’s philosophical and procedural guidance, not driven by software output. An illustrative example of how raw data progressed through Colaizzi’s steps to form a final theme is provided in Table 2.

Table 2 Colaizzi audit trail: evidence-based nursing experiences
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Quality control

Prior to the interviews, the interviewer communicated with the participants to schedule a suitable time. The interviews were conducted in a quiet and private setting to ensure the accuracy of the data collection. After each interview, the audio recordings were transcribed, and the summarized results were returned to the participants for verification to ensure authenticity and credibility.

Results

Thirteen final-year undergraduate nursing students (9 female, 4 male; aged 21–22) from Guilin Medical University participated. Participant characteristics are summarized in Table 3.

Table 3 General information of the research subjects (n = 13)
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Theme one: Understanding and internalizing the EBP concept

Initial contact and Understanding

In this interview, all the nursing interns reported being introduced to the concept of EBP during their undergraduate theoretical coursework. After entering clinical practice, they gradually recognized that EBP is not merely classroom content but rather a way of thinking and a practical tool that can guide their clinical work. S1 stated, “Through understanding EBN’s role in clinical practice, I’ve been able to make more professional judgments—leading to better patient care.”

The role of internship experience

Integrating relevant clinical practice content into the specific application of EBP during clinical internships can improve nursing students’ understanding and internalization of EBP principles. Through diverse nursing practice activities, students can accumulate valuable clinical experience and gradually learn to apply the most appropriate evidence according to specific clinical situations to guide their care. S4 stated, “During a catheter removal, my instructor left 1 mL of water in the balloon—contrary to standard protocol—based on a study suggesting it reduces discomfort. The patient confirmed feeling less pain. This showed me how EBN can refine practice step by step.” S12 stated, “During my internship, I cared for a patient with a stoma infection. Although the stoma appeared healthy, underlying fat tissue was eroded. Instead of routine disinfection, we consulted a senior nurse and a specialist, following a complex, individualized protocol. This experience showed me that EBN isn’t about rigidly applying textbook procedures—it requires adapting evidence to each patient’s unique condition, which deepened my understanding of EBN.”

Internalized markers

Beyond mere knowledge, EBP must also be internalized in terms of behavior and thinking habits. When asked whether they consciously and actively consulted relevant literature or guidelines in their nursing practice, only a small number responded affirmatively. Most participants acknowledged that EBP could improve work efficiency and enable the provision of more rational treatment plans for patients. Some nursing students mentioned that they had begun attempting to cite recent research findings during team discussions, which, to some extent, helped foster a more scholarly atmosphere within the clinical unit, representing a step toward integrating EBP into their clinical practice. S4 stated, “My instructor told me: ‘Keep up with the latest 2024 literature, stay informed, and keep improving your skills.’ Later, while monitoring a postoperative patient with an abdominal drain, I noticed milky, turbid fluid—unlike typical bloody output. Curious, I searched the literature, identified it as possible chylous leakage, and shared this finding with my team during ward rounds, offering a brief educational explanation.”

Theme two: Obstacles in clinical applications

Nursing students encounter numerous difficulties when applying EBP in practice. These challenges not only hinder their ability to access and understand research findings but also affect their use of EBP in clinical settings, creating barriers to the effective integration of EBP into clinical practice. Key obstacles include language barriers and limitations of translation tools when using foreign-language literature, a lack of statistical knowledge, difficulty in effectively extracting and identifying key information from the literature, insufficient literature search skills, and high pressure due to time constraints. S7 stated, “I sometimes struggle to understand English articles, so I rely on translation tools—but the translations aren’t always accurate. The hardest part isn’t reading the articles; it’s finding the right ones to use.” S10 stated, “I’m not sure why, but I just don’t get statistical analysis—and sometimes the results don’t make sense to me.” S11 stated, “When searching for nursing interventions related to diabetic foot, I find it hard to filter articles by publication date. Even when I retrieve relevant papers, I struggle to extract key information and judge whether they represent the best available evidence. With limited exposure to research during my studies and pressure to complete tasks quickly, I often end up feeling uncertain.” S12 stated, “Searching for foreign-language literature is quite challenging.” Although some students attempted to seek help from clinical instructors, overall, the interns displayed a relatively passive attitude when facing these challenges, possibly due to unresolved difficulties and a lack of effective support channels.

Theme three: Support systems and employment planning

The role of the support system

During the EBP process, the nursing students, on the basis of their own experiences, noted that the school and internship hospital could provide more effective support in multiple aspects and put forward their own suggestions for improvement.

School education serves as the foundational stage for nursing students to acquire EBP concepts. Some students expressed a desire to engage in EBP, but their lack of research competence discouraged them. S2 stated, “I may not have high expectations for nursing research… There are significant barriers, and without guidance, I feel the school’s support is insufficient. Many of us are eager to do research—but we simply don’t know how to get started.” S9 stated, “For these courses, we should go to the computer lab—each student with a computer— so we can follow along the instructor in real time. Without hands-on practice, we won’t remember the procedures. The teachers explain things clearly and are very patient, but without doing it ourselves, the teaching isn’t fully effective.” In facing EBP challenges, students also shared their suggestions. S5 stated, “When teaching, instructors could select high-quality articles and guide us through interpreting them.” S6 stated, “From the school’s perspective, I think they could offer elective courses—or EBN content into core courses like medical-surgical nursing.” S10 stated, “I think before clinical clerkships, schools should encourage students to read relevant literature on diseases—not just rely on textbook knowledge—so they can bring evidence-based insights into their clinical learning.”

The clinical internship is a critical phase for nursing students to acquire and practice EBP concepts. The students generally expressed a strong desire for enhanced EBP training. S1 stated, “Owing to the relatively short rotation period in each department, we haven’t accumulated much experience in EBN.” S3 stated, “I feel that the internship hospital does not place sufficient emphasis on EBN practice, and its implementation is inadequate.” In response, the students also offered their suggestions: S4 stated, “I hope the head nurse could lead regular sessions on specific diseases—where we learn together, and study the latest nursing techniques through current literature.” S7 stated, “I hope the hospital can establish a formal system—like weekly short lectures in Gastroenterology every Friday, led by the chief physician or head nurse, sharing the latest guidelines or research and highlighting key care points. I believe individualized, evidence-based care will become a trend, and only this way can we truly improve nursing quality and patient safety. " S9 stated, “The department could include EBN in the orientation program for new interns. Introducing this concept early would help, since we’re unfamiliar with it when first entering the clinical environment.”

Future employment planning

Nursing students have their own career paths in mind for the future. 85% of the students expressed a willingness to continue working in clinical nursing and would consider pursuing postgraduate studies to increase their academic qualifications in response to future industry demands. S6 stated, “For me, I’m more inclined to enter the workforce first. Although postgraduate study is part of my long-term plan, I’ll probably put it on hold initially and prioritize gaining work experience.” S10 stated, “I plan to start with clinical work—my main focus right now is employment. I’ll likely pursue postgraduate study in the future, as it’s becoming more common among nurses.” S12 stated, “My plan is to work in a hospital first. Depending on how things go, I might consider graduate studies later—right now, I just want to secure a job. " Moreover, 15% of the students indicated that they might not pursue clinical nursing in the future. S2 stated, “I’m not very willing to work in clinical nursing—I feel resistant to the role right now. That’s my current mindset.” S8 stated, “Right now, I’m still exploring my options—I might stay in a nursing-related field, but not necessarily as a hospital nurse.” (n = 13).

Discussion

Paying attention to the cognitive and internal barriers to EBP among nursing students and proposing dynamic teaching improvement strategies

While prior literature has documented the theory–practice gap in nursing education [17, 18], our findings reveal a novel mechanism through which this gap may be bridged: students’ cognitive transformation toward EBP was frequently catalyzed not by formal classroom instruction, but by observing clinical instructors deliberately deviate from standard protocols in ways explicitly justified by recent evidence—such as retaining 1 mL of water in a urinary catheter balloon to reduce patient discomfort. These “evidence-informed adaptations” served as powerful learning moments that helped students reconceptualize EBP not as rigid compliance, but as a dynamic, patient-centered process of clinical refinement. This challenges the prevailing assumption that EBP internalization depends primarily on curriculum delivery or technical skill acquisition [19]. Instead, it underscores the pedagogical significance of authentic, situated modeling in the clinical learning environment [20,21,22]. From the perspective of Social Cognitive Theory [23]—though not applied as an analytical framework in this study—such observations functioned as vicarious experiences—a core source of self-efficacy—through which students witnessed how experienced nurses integrate research into clinical judgment while prioritizing patient outcomes, this aligns with Amin et al.‘s assertion that role modeling constitutes a central pathway for professional value internalization in clinical settings [24]. Notably, participants did not interpret these deviations as rule-breaking, but as professional, evidence-grounded refinements, suggesting that the instructor’s credibility and transparency were essential to their educational impact [25]. Thus, rather than viewing clinical instructors merely as protocol enforcers, our data position them as critical role models whose intentional, transparent adaptations constitute informal yet potent pedagogical acts. This dimension of EBP socialization—learning through witnessing context-sensitive evidence use in real time—has been underemphasized in both Chinese and international nursing education frameworks, which tend to prioritize formal curricula over the hidden curriculum of clinical practice.

Optimizing the cultivation of scientific research tools and literature retrieval capabilities to overcome obstacles in clinical application

Contrary to portrayals of nursing students as passive or skill-deficient, our findings reveal that even within resource-limited clinical environments, participants exercised notable agency in mobilizing evidence. A striking example involved an intern who, upon observing atypical milky postoperative drainage, independently searched the literature, identified the possibility of chylous leakage, and presented this evidence-based insight during ward rounds—prompting further clinical evaluation. This episode illustrates that, with minimal institutional support, students can function as “junior knowledge brokers”—actively bridging research evidence and frontline care, and contributing to team-level learning despite hierarchical and systemic barriers [26, 27]. Their actions were deeply mediated by self-efficacy—an SCT construct referring to one’s belief in their capability to execute behaviors required to manage prospective situations [23]. While some students demonstrated high self-efficacy through independent evidence-seeking (e.g., S4), others expressed helplessness (“I just don’t get statistical analysis,” S10), highlighting that technical training alone is insufficient; fostering self-efficacy through mastery experiences, verbal persuasion, and emotional support may be equally critical for EBP engagement. Their actions were not driven by formal training in database navigation or research methods, but by clinical curiosity and a sense of professional responsibility. The emergence of this role challenges conventional EBP education models that position students solely as knowledge recipients awaiting capacity building. Instead, it suggests that early professional identity formation includes an evidentiary dimension, wherein students begin to see themselves as contributors—not just consumers—of clinical knowledge. This perspective aligns with—but also extends—existing literature on knowledge brokering, which has largely focused on experienced clinicians or dedicated implementation roles, rather than learners embedded in hierarchical care teams [28].

Building a career support system based on different directions to promote the sustainable application of the EBP concept among nursing students

Contrary to assumptions that students passively await institutional support for EBP implementation, our findings reveal a proactive, collective expectation for structural integration. This aligns with Maquibar et al.‘s conclusions [29]. Participants did not frame EBP as an individual skill gap to be remedied through personal effort; instead, they explicitly called for organizational mechanisms—such as weekly evidence-update sessions led by head nurses or mandatory EBP orientation at the start of internships—to embed evidence use into routine clinical practice. These proposals reflect an emerging grasp of reciprocal determinism, the SCT principle that personal factors, behavior, and environment continuously influence one another [23]. This represents a generational shift in professional socialization: rather than adapting to existing hierarchies, students envision themselves as legitimate contributors to the design of evidence-informed care environments. Their proposals signal an evolving professional identity: no longer passive observers of nursing practice, but proactive co-creators of clinical knowledge infrastructures—an orientation that subtly contests conventional top-down approaches to nursing education and care delivery, this aligns with Fetters et al.‘s ideas [30]. Importantly, these demands arose organically from clinical immersion, not from formal curricula or career-path counseling. They signal a growing recognition among students that sustainable EBP requires systemic scaffolding, not just individual competence. This bottom-up pressure for institutional accountability offers a promising yet underexplored pathway for transforming EBP from an aspirational ideal into an operational norm in Chinese nursing contexts.

Limitations of the research

This study selected undergraduate nursing interns from the class of 2025 at Guilin Medical University for interviews, preliminarily exploring the details of receiving EBP education and applying EBP. However, there are several limitations: (a) the sample source is single and limited to only nursing students from Guilin Medical University, making it difficult to accurately and comprehensively reflect the overall situation of EBP education and EBP application nationwide. Nevertheless, as a qualitative study focused on in-depth understanding rather than statistical generalizability, our findings aim to provide contextually rich insights that may be transferable to similar settings; (b) the sample sites—six internship hospitals in Guangdong and Guangxi Provinces—are geographically limited, which limits the generalizability of the findings. To obtain more representative conclusions, future research should expand the hospital sample by including nursing interns from various tertiary hospitals across the country. (c) This study relies solely on the subjective memories and perceptions of the nursing students, which may lead to recall bias and subjective prejudice. Future related studies could incorporate quantitative data to obtain more objective and measurable evidence. (d) The research timeframe is relatively short (from August to December, 2024) and fails to capture long-term changes and developmental trends. Future studies could adopt a longitudinal design to track changes in nursing students’ learning and practical experiences over time, thereby gaining deeper insights into the internalization process of EBP concepts and laying a better foundation for clinical application. (e) Although one of the primary interviewers was a peer student from the same cohort—which likely reduced power asymmetry and encouraged candid responses—social desirability bias cannot be entirely ruled out, especially during face-to-face interviews where participants may still present idealized accounts of their EBP engagement. (f) The study also lacks explicit reflexive reporting; we did not systematically document the researchers’ professional backgrounds or preconceptions about EBP, which may affect interpretive transparency. (g) Although Social Cognitive Theory was referenced in the Discussion, it was used only to inform the interview guide and not as an analytical framework; its epistemological assumptions are not fully aligned with the descriptive phenomenological approach adopted in this study.

Conclusions

This study demonstrates that undergraduate nursing interns approach EBP of knowledge, but as active agents who selectively and contextually apply evidence—often shaped by the practices and expectations of their clinical preceptors. While challenges such as limited statistical literacy and literature retrieval skills persist, students’ willingness to seek evidence, share findings, and advocate for structured support reveals a readiness to engage with EBP when enabled by conducive learning environments. These findings call for concrete educational reforms: integrating hands-on EBP training into core courses, preparing students with practical research skills before clinical placement, and empowering clinical preceptors to model and mentor evidence-informed decision-making. By aligning school instruction with clinical realities through collaborative mechanisms—such as department-based evidence update sessions and EBP-oriented internship orientations—China can foster a new generation of nurses capable of delivering consistently high-quality, evidence-guided care.