Nursing Students in Spain and Chile Show Moderate Evidence-Based Practice Competence, Study Finds

Evidence-based practice, the discipline of integrating the best available research evidence with clinical expertise and patient values, has long been championed as the backbone of safe, high-quality healthcare. Yet a stubborn gap between what researchers publish and what clinicians actually apply at the bedside continues to frustrate health systems worldwide. A new multicentre study from Spain and Chile suggests that the roots of that gap may be traceable to the classroom, where future nurses develop, or fail to develop, the competence to find, appraise, and apply research evidence in daily practice.

Researchers surveyed more than 1,000 undergraduate nursing students across three public universities: the Universidad de Alicante and Universitat Jaume I in Spain, and the Universidad de Valparaíso in Chile. The cross-sectional study, conducted during the 2024/2025 academic year, set out to measure overall evidence-based practice competence and its three core dimensions, knowledge, skills, and attitudes, and to compare how these competencies vary across institutions with different curricular and regulatory contexts. The findings, published in BMC Nursing, offer one of the most detailed comparative portraits to date of how well nursing programmes are equipping students for evidence-informed decision-making.

Of 1,788 eligible students, 1,035 were included in the final analysis, a response rate of 57.9 percent. Competence was assessed using the validated EBP-COQ questionnaire, administered through the REDCap electronic data capture platform, a tool widely used in clinical research for secure, standards-compliant data collection. The questionnaire breaks evidence-based practice competence into measurable components, allowing researchers to quantify not just what students know about research methodology, but how confident and capable they feel when translating that knowledge into clinical action.

The headline number from the survey is a mean overall competence score of 3.75, with a standard deviation of 0.43, on a scale where higher values indicate stronger competence. That figure places students squarely in the moderate range, competent enough to engage with research evidence but far from mastery. More revealing is the pattern across dimensions: attitudes scored highest, followed by skills, with knowledge trailing behind. In other words, students believe in the value of evidence-based practice and are reasonably willing to embrace it, but the methodological knowledge underpinning it, understanding study designs, statistics, and research interpretation, remains the weakest link.

That inversion of the classic competence hierarchy carries real technical significance. Attitudes are comparatively easy to cultivate through exposure to inspiring clinical examples and institutional culture. Knowledge of research methodology, by contrast, demands sustained, structured instruction in biostatistics, critical appraisal frameworks, and the interpretation of confidence intervals, effect sizes, and study limitations. The study’s authors point out that methodological knowledge and skills represent the most challenging components of evidence-based practice competence, and their data back that claim: these were precisely the areas where students struggled most.

One of the most encouraging findings is that competence increased significantly across academic years, with a p-value below 0.001, indicating the trend is extremely unlikely to be due to chance. Students in later years consistently outperformed their younger peers, suggesting that repeated curricular exposure to evidence-based practice concepts compounds over time. This dose-response-like pattern between academic progression and competence hints that evidence-based practice is not a skill acquired in a single course, but a capacity built through progressive, layered training woven throughout the entire degree programme.

The multivariable analysis, using multiple linear regression, identified four independent predictors of higher competence: academic year, university, clinical work experience, and academic engagement. Notably, three factors often assumed to matter, age, previous health sciences education, and prior evidence-based practice training, were not significant predictors once other variables were controlled for. That null result is striking: it suggests that simply ticking a box labelled EBP training does not guarantee competence, and that the quality, timing, and integration of that training within the curriculum may matter far more than its mere presence.

Clinical work experience emerging as an independent predictor adds another layer to the story. Students who spend time in real healthcare settings appear to develop stronger evidence-based practice competence, likely because clinical environments create authentic opportunities to confront uncertainty, search for answers, and see the consequences of evidence-informed decisions. Combined with the significance of academic engagement, the finding paints a picture of competence as a product of active, applied learning rather than passive absorption, echoing broader research on how professional expertise develops through deliberate practice in authentic contexts.

The differences between universities, visible even after statistical adjustment, highlight how institutional context shapes outcomes. Spain and Chile operate under different regulatory frameworks, curricular structures, and clinical training models, and the study’s comparative design was explicitly intended to capture that variation. While the authors caution that the cross-sectional design cannot establish causation, the between-university differences suggest that how a programme sequences, reinforces, and clinically anchors evidence-based practice content may be as important as how much of it is taught.

The study’s conclusions point toward concrete curricular reform: nursing programmes should integrate evidence-based practice progressively across all academic years, providing repeated, active, and clinically applied training in evidence searching, critical appraisal, interpretation of research findings, and evidence-informed decision-making. The authors also call for longitudinal research to track how these competencies evolve over time and to identify which educational approaches deliver the greatest gains. For a profession that forms the largest segment of the global health workforce, the message is clear: closing the research-to-practice gap starts not in the hospital, but in how nursing schools teach students to think with evidence.

Subject of Research: Evidence-based practice competence among undergraduate nursing students in Spain and Chile

Article Title: Evidence-based practice competence among undergraduate nursing students: a multicentre cross-sectional study in Spain and Chile

Article References: Bustos-González, L., Ilieva-Stefanova, Z., Sánchez-Marco, M., Flores-Pradillas, A., Orts-Cortés, M. I., Ortiz-Mallasén, V., Antolí-Forner, A., Valero-Chillerón, M. J., González-Chordá, V. M., Bettancourt-Ortega, L., González-Nahuelquín, C., Giménez-Estrada, E., Melo-Severino, A., & Llagostera-Reverter, I. (2026). Evidence-based practice competence among undergraduate nursing students: a multicentre cross-sectional study in Spain and Chile. BMC Nursing. https://doi.org/10.1186/s12912-026-05255-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05255-x

Keywords: evidence-based practice, nursing students, nursing education, competency-based education, student engagement, cross-sectional study, Spain, Chile, Evidence-based, practice, competence, undergraduate