A five-step model for postgraduate nursing education in the digital intelligence era: development and evaluation using a non-synchronous controlled trial

The rapid advancement of digital and intelligent technologies is transforming healthcare systems and creating new competency requirements for postgraduate nursing education. However, existing training models often fail to systematically integrate digital competencies with clinical and professional competency development. This study aimed to develop and preliminarily evaluate a competency-based Five-Step Model for postgraduate nursing education that aligns with digitally enabled healthcare environments. A two-phase study consisting of model development followed by a non-synchronous controlled trial. In Phase 1, evidence synthesis, curriculum and situational task design, and expert consensus procedures were used to construct the model. In Phase 2, the model was implemented as a curriculum-based educational intervention. The experimental group (2024 cohort; n = 47) received Five-Step Model–based instruction, while the control group (2023 cohort; n = 44) received conventional instruction. Outcomes included academic performance, professional competence (NPC Scale-SF), digital health literacy (DHLI), clinical competency assessed by an Objective Structured Clinical Examination (OSCE), and feasibility and acceptability. Between-group differences were analyzed using independent-samples t tests, Mann-Whitney U tests, and chi-square tests as appropriate. Compared with the control group, the experimental group had higher academic performance (mean difference = 3.44, 95% CI 1.16–5.72), professional competency (mean difference = 3.09, 95% CI 1.99–4.19), and digital health literacy (mean difference = 1.50, 95% CI 0.88–2.12). Clinical competency was also higher across all three OSCE stations (all Holm-adjusted P < 0.001). After multiplicity adjustment, significant differences remained in all DHLI components and in the nursing care and medical and technical care domains. Acceptance and satisfaction were higher in the experimental group, but the differences were not statistically significant after Holm correction. Implementation of the Five-Step Model was associated with improvements in academic achievement, professional competence, digital health literacy, and clinical performance among postgraduate nursing students. By embedding digital intelligence within a structured competency framework, the model may offer an approach to advancing nursing education reform in digitally enabled healthcare environments.