The Application Effect of the 5E Instructional Model in the 'Basic Nursing' Course in Characteristic Industry College

Title Page

Juan Qiao 1✉

Hejia Wan 1✉ Email18236939481@163.com Email2240536681@qq.com

School of Nurisng (Nursing School of Smart Healthcare Industry) Henan University of Chinese Medicine

Juan Qiao^1,*, Hejia Wan^1,*

1 Henan University of Chinese Medicine, School of Nurisng (Nursing School of Smart Healthcare Industry)

*Corresponding author.

Juan Qiao 18236939481@163.com;

Hejia Wan 2240536681@qq.com;

ORCID:

Hejia Wan

https://orcid.org/0009-0003-3900-1967 ;

The Application Effect of the 5E Instructional Model in the 'Basic Nursing' Course in Characteristic Industry College

Abstract

Background

Basic Nursing is a core course in the nursing program, and traditional teaching methods are often insufficient to effectively promote students' knowledge integration and development of critical thinking, especially in Characteristic Industry College emphasizing the integration of industry and education. The constructivist-based 5E Instructional Model (Engage, Explore, Explain, Elaborate, Evaluate) is believed to enhance student engagement and thinking skills.

This study aims to evaluate the implementation effect of this model in the 'Basic Nursing' course at a Characteristic Industry College focused on intelligent health care.

Methods

A retrospective cohort study design was used, selecting 2021 nursing students at Henan University of Chinese Medicine as the control group (n = 60) and 2022 students as the Observation group (n = 60). The control group received traditional teaching, while the experimental group was taught using the 5E Instructional Model. Teaching effectiveness was assessed through course grades (formative and Summative Assessment) and the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV). Data were analyzed using t-tests and chi-square tests in SPSS 26.0.

Results

The experimental group had significantly higher total course scores (88.57 ± 5.30) than the control group (80.74 ± 2.94) (P < 0.01), with particularly strong performance in Formative Assessment such as Reflective Notes, group collaboration, and practical innovation. The experimental group also showed a significantly higher total CTDI-CV score (281.25 ± 34.47) compared to the control group (254.77 ± 18.28) (P < 0.001), with notable improvements in dimensions like open-mindedness, analytical ability, and systematization.

Conclusion

The 5E Instructional Model can effectively enhance students' knowledge integration, clinical practice skills, and critical thinking, making it suitable for nursing courses in Characteristic Industry College. It is recommended as an effective supplement to traditional teaching to promote the systematic improvement of the quality of nursing education.

Keywords:

Basic Nursing

5E Instructional Model

Critical Thinking

Specialty Industry College

Teaching Reform

1 Background

Basic Nursing is a core compulsory course in the undergraduate nursing education curriculum, usually offered to second-year nursing students. The course covers the entire nursing process from patient admission to discharge, emphasizes practical teaching, and lays the foundation for subsequent clinical specialty courses and practical training [1]. However, traditional teaching methods often struggle to effectively cultivate students' abilities to actively construct knowledge, internalize and integrate it, and apply it in practice, resulting in fragmented learning, insufficient development of clinical thinking skills, and limited critical thinking levels [2]. In professional education fields such as industry-specific colleges, this teaching dilemma is especially prominent, as the development of such colleges must closely align with industry needs and focus on cultivating practical skills (Fig. 1).

Fig. 1

The Limitation of Traditional Teaching Methods

The 5E Instructional Model is a constructivist teaching model developed by the Biological Sciences Curriculum Study (BSCS, 1989) and consists of five stages: attraction, inquiry, explanation, transfer, and assessment [3]. This model, as an inquiry-based teaching method, has been used in the overall curriculum design of BSCS since the late 1980s [4] and occupies a very important position. Currently, it is widely used globally, aiming to promote active learning, conceptual understanding, and critical thinking [5]. Bibliometric analysis shows [6] that the 5E Instructional Model is widely used in science education and its popularity continues to rise in higher education and career development. Furthermore, this teaching model has been effectively implemented in multiple disciplines such as language education [7], mathematics [8], and medical training [9, 10], fully demonstrating its universality in improving student participation, knowledge retention, and problem-solving abilities.

In the field of nursing education, multiple studies have verified the effectiveness of the 5E model. For example, Jun WH et al. [11] applied the 5E model to Basic Nursing courses and found that students' initiative, critical thinking and learning outcomes were significantly improved. They concluded that the model is particularly suitable for courses that combine theory and practice. Recently, Kim H et al. [12] combined the 5E learning cycle with the Jeffries simulation model and applied it to a virtual reality-based trauma nursing course, which effectively improved nurses' knowledge reserves and professional confidence. These research results fully demonstrate the application potential of this model in clinical education.

Although such studies have confirmed the potential of this model in nursing education, its specific application in Characteristic Industry College (especially emerging health-related colleges in China) still lacks in-depth exploration. The innovative value and justification of this study lie in its unique background environment, namely, the Characteristic Industry College. In China, the Characteristic Industry College, as an innovative education model, emphasizes the collaboration of the government, schools, industries, and enterprises, and is committed to cultivating talents that meet the needs of the region and industry [13–14]. In 2022, the School of Nursing of Henan University of Chinese Medicine established the first batch of Characteristic Industry College in Henan Province—the Smart Health and Wellness Nursing Characteristic Industry College, aiming to deeply integrate educational resources to meet the needs of regional industry development [1]. Under this framework, Basic Nursing courses face unique challenges: they must not only align with the industry's smart health and wellness capabilities, but also cultivate critical thinking skills to adapt to complex industry scenarios.

This special background brings unique teaching challenges, requiring a move beyond simple knowledge transmission [15]. The course Basic Nursing must be aligned with national requirements and regional health development goals, and the following enhancement goals need to be achieved:

Strengthen knowledge integration: Students should not only master Basic Nursing skills, but also understand their application and innovation in smart health and geriatric nursing (the course content is designed to be patient Basic Nursing, which is naturally connected with elderly patients).

Enhance ability requirements: The goal is not only to cultivate qualified nurses, but also to cultivate top talents who can promote the development of the industry, which requires stronger critical thinking, innovative awareness and the ability to solve complex industry problems [16].

Deepen the integration of theory and practice: The "industry education integration" mechanism requires the course content to be seamlessly connected with the dynamics of the real industry and enterprise practice [17], while traditional teaching methods often cannot meet this requirement.

These unique and high-level teaching goals and challenges require us to apply the "5E" teaching model in a deep and contextualized way, rather than simply copying it. It is necessary to test the effectiveness of this model in solving teaching pain points and cultivating nursing talents that meet the mission of characteristic industry colleges through systematic design and evaluation - especially in the current more challenging educational ecosystem (Fig. 2).

Fig. 2

The role and expected effects of the 5E teaching method in industry-specific colleges

Therefore, this study, based on constructivist theory, aims to systematically design and implement the "5E" teaching model, applying it to the Basic Nursing courses of a specialized industry-specific college focusing on smart healthcare and nursing. The study aims to evaluate the impact of this model on the following three aspects:

(1)

promoting students' knowledge integration and internalization;

(2)

enhancing clinical critical thinking skills;

(3)

strengthening students' awareness of industry frontiers and their ability to transfer knowledge.

This study not only verifies the effectiveness of this teaching model but also explores its adaptability to the new requirements of higher nursing education reform in China, particularly for the development needs of specialized industry-specific colleges, aiming to provide an evidence-based research paradigm for similar institutions.

2 Materials and Methods

2.1 Study Design

This retrospective cohort study used a retrospective cohort design, comparing two student cohorts enrolled at different times based on teaching management data from the Henan University of Chinese Medicine's academic affairs system, to evaluate the effectiveness of the "5E" teaching cycle model in the Basic Nursing course at a Characteristic Industry College.

The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Henan University of Chinese Medicine (Approval No.

: 2024HL-390), and all participants signed informed consent forms.

Convenience cluster sampling was used. The study subjects were all students enrolled in the Basic Nursing course in the 2021 and 2022 cohorts; therefore, the sample size was determined by the overall eligible population during this period, and no pre-existing sample size estimation was performed. The 2021 control cohort and the 2022 exposure cohort each enrolled 60 students (Fig. 3). The control group received traditional teaching methods; the experimental group received the "5E" teaching cycle model. Inclusion criteria were: second-year university students enrolled in the Basic Nursing course who voluntarily participated in this study.

Exclusion criteria include: dropping out of school midway, incomplete data records, or simultaneous participation in other teaching and research projects that may affect the results. The STROBE (cohort) has been uploaded as Supplementary File 1.

Fig. 3

Research Design Flowchart

2.2 Data gathering tool

The data collection covered the 2022–2023 academic years (reference cohort) and the 2023–2024 academic year (exposed cohort). The assessment tools included three.

2.2.1 General demographic data

General demographic data included students' gender, age, and Grade Point Average (GPA), which were used to measure students' baseline level at the time of inclusion in the study. GPA is a commonly used undergraduate academic evaluation standard in Chinese universities [18]. It is calculated based on students' exam scores (usually on a percentage scale) and their corresponding credits using a specific algorithm. A student's GPA comprehensively reflects their knowledge mastery, learning engagement, and academic ability [19]. This data was collected before the start of the study.

2.2.2 Assessment grades for Basic Nursing courses

This course employs an assessment model combining 60% formative assessment and 40% summative assessment. Formative assessment includes online tests, study notes, online forums (such as case analysis), Class Participation (such as the number of questions answered and progress in online video learning), practical skills assessments and Reflective Notes (such as "What were the problems and highlights during this practical training? Analyze the reasons?"), Group Work (such as "Penicillin anaphylactic shock group resuscitation drill"), and individual assignments on practical innovation (such as "Based on industry and enterprise practices, innovatively raise a question from the patient's perspective or the perspective of the training materials, and find relevant information to answer it.").

Summative assessment is conducted in the form of a final exam. The course team jointly develops the teaching materials. The study plan determines the weight, score and scoring criteria of each assessment and adopts a combination of online and offline scoring. The practical skills assessment mainly includes modular multi-station assessment, practical assessment of various injection methods and comprehensive assessment of case teams. A standardized percentage scoring table based on the textbook operation process is used [20] to evaluate the students' operation completion and examine the operation norms such as aseptic technique, humanistic care, safety and comfort principles [21]. In the team assessment, the team collaboration score is scored quantitatively. If the team division of labor is reasonable and communication is smooth, 2 points are awarded; otherwise, no points are awarded. This data was collected after students completed the Basic Nursing course. The data all come from the Henan University of Chinese Medicine's academic affairs system. Each student's score is statistically calculated in percentage form (Fig. 4).

Fig. 4

Correspondence diagram of the scores, assessment points and evaluation rubrics of the Basic Nursing course assessment results

2.2.3 Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV)

California Critical Thinking Disposition Inventory (CCTDI) was Developed in 1990 by Dr. Peter Facione and his team at the University of California, USA[22], the Chinese version was revised by Hang et al. in 2021 [23] named Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV). The questionnaire includes seven aspects of critical thinking: truth-seeking, open-mindedness, analytical ability, systematization ability, confidence in critical thinking, thirst for knowledge and cognitive maturity. The questionnaire has a total of 70 items, with 10 items for each trait. The Liker 6-point scale is used, and the answers to each item are assigned values from "strongly disagree" to "strongly agree". Positive items are assigned values of "1 point, 2 points, 3 points, 4 points, 5 points, 6 points" in turn; negative items are assigned values in reverse order. The CTDI-CV has a total score of 70–420. Critical thinking is categorized into four levels based on the following criteria: negative critical thinking ability (< 210 points); moderate critical thinking ability (210–279 points); positive critical thinking ability (280–349 points); and very strong critical thinking ability (350–420 points). The scale has a content validity of 0.89, a Cronbach's αof 0.90, and Cronbach's αvalues for each dimension ranging from 0.54 to 0.77, demonstrating good reliability and validity. Data was collected at two time points: before and after the study.

2.3 Intervention Methods, Game Design, and Study Implementation Process

This study was conducted in the 2023.09-2024.06 in a academic year. The total class hours for the Basic Nursing course were 144 hours, spanning the entire second year of university, with 72 hours per semester. The course content consisted of equal parts theory and practice, employing a blended teaching model combining online and offline methods. Instructors delivered lectures according to the syllabus schedule and weekly teaching plan, with practical training sessions conducted in the nursing comprehensive training center's training rooms.

2.3.1 Control group teaching methods

The control group adopted a traditional teaching model based on the course syllabus, the core of which was the systematic transmission of knowledge and standardized demonstration of skills led by the instructor. This model aimed to ensure that all students mastered unified and standardized basic knowledge and operational procedures.

Theoretical teaching adopted a blended format combining online and offline methods. For the online portion, students accessed pre-recorded videos, teaching materials, and reading materials through the course platform for self-study. Offline classroom instruction involves teachers systematically reviewing the core knowledge points of each chapter, focusing on the analysis of concepts, the explanation of principles, and the demonstration of procedures, forming a knowledge transfer model primarily based on teacher lectures.

Practical training is conducted in the nursing training center, strictly following the classic "demonstration + imitation verification" teaching path. Its specific process is as follows:

Step 1: Teacher Demonstration: The teacher first demonstrates a nursing operation skill completely and accurately, simultaneously explaining key steps, precautions, and evaluation criteria.

Step 2: Student Practice: After the teacher's demonstration, students practice in groups or individually on a model to imitate and reproduce the teacher's standardized operation.

Step 3: Teacher Guidance: The teacher circulates during student practice, observing their operations and providing immediate correction and individualized guidance for any errors.

Step 4: Student Counter-Demonstration: Randomly selected or designated students perform counter-demonstrations, serving as a sample to assess their skill mastery.

Step 5: Teacher Summary: Based on the observations and feedback, the teacher summarizes and emphasizes common problems, core points, and frequent errors encountered during the training.

In the after-class consolidation phase, students primarily rely on the course platform. The platform's "Resource Area" provides students with supplementary video and text materials; the "Forum Area" allows students to post discussion and analysis topics, with students independently planning their after-class learning and discussion. Teachers do not provide structured online guidance or interaction.

This teaching path design ensures a high degree of synchronization between the teaching progress and the textbook and syllabus, emphasizing the mastery and replication of standard operating procedures.

2.3.2 Experimental group with 5E teaching method

Based on constructivist learning theory, this study systematically integrates the "5E" teaching model into the practical training of Basic Nursing within the context of a Characteristic Industry College for smart healthcare and nursing. This model is student-centered, guiding students to actively construct knowledge and develop clinical thinking and critical abilities through five progressive stages: Engage, Explore, Explain, Elaborate, and Evaluate. Teachers play the roles of guide, resource provider, and feedback facilitator, especially in the exploration and explanation stages, promoting deep student participation through questioning, demonstration, and scaffolding guidance [24–25]. The teaching implementation covers three stages: online preparation before class, offline practical training in the classroom, and post-class extension. The teaching process embodies the constructivist concept of "student-centered, teacher-led," while highlighting the role of Characteristic Industry College in industry-education integration and innovative talent cultivation [14]. Before class (online preparation): Students complete theoretical knowledge video learning and online testing through the MOOC platform. The intelligent platform automatically records the completion rate and participates in scenario case discussions, laying the foundation for classroom exploration. The course employs the 5E Instructional Model. Taking the "nasogastric method" in the nutrition and diet chapter as an example, the Table 1 below details the specific teaching activities, teacher roles, student behaviors, interaction methods, and design intentions for each "5E" stage, and incorporates new industry developments and real-world business cases.

Teacher role during class: In the exploration phase, teachers help students identify problems and adjust their learning strategies through observation, questioning, and individual guidance [24]. In the explanation phase, teachers integrate students' discoveries with new industry knowledge, systematically clarify concepts, and introduce industry and enterprise mentor resources to enhance the connection between teaching content and the forefront of disciplines and industry and enterprise pain points [13]. If the problem is not solved, the next "5E" teaching cycle mode is entered. After class (extension): Students complete the innovative tasks in the transfer phase, participate in the "Three Rural Areas" health volunteer service or the "Challenge Cup" entrepreneurship training project, apply what they have learned to real industry scenarios, and achieve "unity of knowledge and action".

This study used SPSS software (version 26.0) for statistical analysis. Quantitative data conforming to a normal distribution were expressed as mean ± standard deviation (x ± s), and independent samples t-tests were used for comparisons between groups. Qualitative data were expressed as the number of cases, and chi-square tests were used for comparisons between groups. The significance level of the test was set at α = 0.05.

Table 1

Implementation Process of the 5E Instructional Model in the Practical Course of 'Basic Nursing' (Using 'Nasogastric Feeding' as an Example)
5E Stage	Teaching activities	The Role of Teachers	Student activities	Forms of interaction	Design Intent	Industry/Enterprise Case Integration
Engagement	1.Play a video showing typical clinical scenarios of nasogastric care in the health and wellness industry. 2.Pose a guiding question: 'How can we prevent the risk of aspiration during the nasogastric process?' 3. Clarify the skill objectives of this section and industry standards.	Scenario Creator, Question Guide	Watch the case, think about the problem, and offer preliminary opinions	Group discussion, Q&A interaction	Stimulate interest, connect with industry practice, and create cognitive conflict	Introducing the real-life scenarios of nasogastric feeding care for elderly patients in smart elderly care institutions
Exploration	Students are grouped to practice simulated nasogastric feeding operations. Record doubts and common mistakes during the operation. 3. Teachers circulate to provide guidance and highlight key steps (such as adjusting positioning and confirming the tube).	Observer, assistant guide, resource provider	Hands-on practice, recording problems, group discussion	Group collaboration, individual guidance from the teacher, peer learning	Understand the difficulties of skills through practice, and cultivate the ability to explore independently and collaborate	Use enterprise-donated intelligent nasogastric feeding simulation equipment to enhance the realism of practical training
Explanation	1. Group representatives report issues encountered during the operation 2. Teacher systematically explains nasogastric techniques, incorporating the latest industry developments (such as the use of smart monitoring nasogastric pumps) 3. Industry mentors intervene online to introduce the latest standards and common risk points of nasogastric care in senior care institutions	Knowledge integrator, concept clarifier, industry connector	Listen to explanations, participate in discussions, ask questions to clarify	Group presentation, detailed teaching by the teacher, interaction with corporate mentors	Form scientific concepts, understand industry standards, and broaden professional horizons	Introduction of Application Cases and Data Support for Smart nasogastric Pumps in Healthcare and Wellness Institutions
Elaboration	1. Present real cases provided by the company: the process of handling complications in a nasogastric tube patient at a certain elderly care center. 2. Organize a "scenario debate": how to optimize the nursing process in this case? 3. Assign a "specialized innovation integration" task: design a nasogastric tube assistive device suitable for home care.	Scenario designer, task facilitator, innovation guide	Analyze cases, participate in debates, and complete innovative task designs	Scenario debates, cross-group communication, creative presentations	Promote knowledge transfer, cultivate clinical decision-making and innovation skills	Based on the real pain points of enterprises, encourage students to propose solutions that meet industry needs
Evaluation	1. Students use a 'mind map' to organize the key points of nasogastric feeding procedures and complete a self-assessment. 2. Groups conduct peer evaluations based on a standardized scoring sheet. 3. The teacher provides a summary and feedback, and assigns a reflection log and preparation tasks for the next class.	Evaluator, feedback provider, learning facilitator	Self-assessment and peer assessment, writing reflections, completing assignments	Individual reflection, peer evaluation, teacher-student evaluation	Use multiple assessments to evaluate learning outcomes, promote metacognition and continuous improvement	Develop an evaluation scale based on industry operating standards to strengthen awareness of regulations

2.4 Quality Control

To ensure data quality, this study adopted several quality control measures: implementing a separation mechanism between teaching and assessment to ensure the objectivity of performance evaluation; immediately verifying the completeness of questionnaire data after collection and promptly supplementing missing items; and clearly defining a historical control framework during the research design phase to avoid cross-contamination between interventions. Through the above design, this study effectively evaluated the long-term effects of the "5E" teaching model in a real educational setting, while fully considering the inherent limitations of retrospective studies.

3 Results

3.1 Comparison of pre-intervention demographic data between the two groups

A total of 120 participants were included (control group: n = 60; observation group: n = 60).

Sex: overall, 25 females (20.8%) and 95 males (79.2%). In the control group, there were 12 females (20.0%) and 48 males (80.0%); in the observation group, 13 females (21.7%) and 47 males (78.3%). Fisher’s exact test showed no significant difference (p = 1.0000).

Age: 17 years, 23 cases (19.2%; control 10 [16.7%], observation 13 [21.7%]); 18 years, 83 (69.2%; control 43 [71.7%], observation 40 [66.7%]); 19 years, 11 (9.2%; control 6 [10.0%], observation 5 [8.3%]); 20 years, 2 (1.7%; one per group [1.7%]); 21 years, 1 (0.8%; observation 1 [1.7%]). The chi-square test indicated no significant difference in age distribution between groups (χ²=1.591, p = 0.8105).

Therefore, the two groups were comparable at baseline in terms of sex and age composition (Table 2).

Table 2

Comparison of Demographic Data of the Two Groups of Students Before Intervention
Variable	Level	Type	Overall	Control group	Observation group	Test	Statistic	p-value
Sex	female	Categorical	25 (20.8%)	12 (20.0%)	13 (21.7%)	Fisher	0.904	1.0000
	male		95 (79.2%)	48 (80.0%)	47 (78.3%)
Age	17	Categorical	23 (19.2%)	10 (16.7%)	13 (21.7%)	χ²	1.591	0.8105
	18		83 (69.2%)	43 (71.7%)	40 (66.7%)
	19		11 (9.2%)	6 (10.0%)	5 (8.3%)
	20		2 (1.7%)	1 (1.7%)	1 (1.7%)
	21		1 (0.8%)	0 (0.0%)	1 (1.7%)

3.2 Comparison of Basic Nursing Course Assessment Scores Between the Two Groups

After the course, the total assessment score for the Basic Nursing course in the control group was (80.74 ± 2.94), while that in the experimental group was (88.57 ± 5.30). The difference between the two groups was statistically significant (P value < 0.05), as detailed in Table 3.

Further analysis of the formative assessment results revealed that the experimental group performed particularly well in, group collaboration, online forum participation, and practical innovation tasks, reflecting the positive impact of the "5E" teaching model on students' comprehensive ability development.

In their Reflective Notes, students in the experimental group generally demonstrated stronger knowledge integration and self-reflection abilities. For example, one student wrote: "Through the real-world cases in the 'transfer' phase, I not only mastered the essentials of nasogastric feeding but also understood its practical significance in smart healthcare scenarios. This shifted my understanding of nursing from 'skill execution' to 'problem solving.'" This feedback reflects students' proactive construction of knowledge internalization and clinical thinking.

In Group Work and online forums, the experimental group exhibited a more active collaborative atmosphere and industry insight. Students stated: "During the 'inquiry' phase, our group had a heated discussion about the use of intelligent nasogastric feeding equipment.

We not only reviewed the latest industry standards but also proposed optimization suggestions based on cases shared by industry mentors." One group even had a heated discussion in class about the external fixation method of the nasogastric tube, and later, based on industry and enterprise practice, further improved the method and applied for a provincial-level undergraduate innovation training project. This type of interaction not only improved teamwork efficiency but also enhanced students' sensitivity to industry trends.

The participation rate in innovation and entrepreneurship projects among students in the experimental group was 47.8%, significantly higher than the 11% in the control group.

Furthermore, the participation rates in practical innovation and volunteer activities were significantly higher in the experimental group. Several students, combining the professional and innovative integration tasks in the "transfer" phase, designed nasogastric feeding assistive devices suitable for home care and actively participated in the "Three Rural Areas" health service project, transferring classroom learning to real-world care scenarios. One student commented: "The '5E' model made me realize that nursing is not just about technology, but also a bridge connecting technology and people. During our volunteer service, we tried using a self-made nasogastric tube external fixation device and received positive feedback from elderly patients, which gave me a deeper understanding of the value of nursing innovation."

The volunteer service participation rate among students in the experimental group was 73.4%, significantly higher than the 12.7% in the control group.

These qualitative feedback from formative assessment not only reflect students' high acceptance and recognition of the "5E" teaching model but also confirm its effectiveness in promoting students' higher-order abilities such as knowledge integration, industry awareness, and transfer application.

Table 3

Comparison of Basic Nursing Course Assessment Scores between the Two Groups of Students (x ± s)
Variable	Overall (mean ± SD)	Control group (mean ± SD)	Observation group (mean ± SD)	Test	Statistic	p-value
Total Formative Assessment Score	84.66 ± 5.80	80.74 ± 2.94	88.57 ± 5.30	t	-10.005	0.0000
overall score	80.74 ± 4.68	78.22 ± 2.76	83.27 ± 4.86	t	-6.996	0.0000
Practical Innovation Assignment	98.25 ± 3.87	98.17 ± 4.11	98.33 ± 3.64	t	-0.235	0.8147
Online Forum	80.42 ± 28.97	92.33 ± 14.30	68.50 ± 34.63	t	4.927	0.0000
Class Participation	82.50 ± 6.64	82.00 ± 6.05	83.00 ± 7.20	t	-0.824	0.4119
Online Testing	84.49 ± 6.19	82.68 ± 6.35	86.30 ± 5.51	t	-3.334	0.0011
Group Work	85.58 ± 4.82	84.83 ± 3.56	86.33 ± 5.74	t	-1.720	0.0885
Study Notes	93.42 ± 14.17	93.50 ± 7.77	93.33 ± 18.56	t	0.064	0.9490
Practical Training Assessment	80.14 ± 13.59	67.51 ± 5.53	92.77 ± 4.21	t	-28.135	0.0000
Study Notes	86.19 ± 4.91	82.70 ± 2.63	89.68 ± 4.12	t	-11.069	0.0000
Total Summative Assessment Score (Final grade)	74.94 ± 6.70	74.55 ± 5.21	75.32 ± 7.94	t	-0.622	0.5353

3.3 Comparison of Critical Thinking Ability

After instruction, the CTDI-CV total score was lower in the control group than in the observation group (254.77 ± 18.28 vs 281.25 ± 34.47; t = − 5.258, p < 0.001). At the dimension level, the observation group showed higher means with statistically significant between-group differences for open-mindedness (35.90 ± 5.72 vs 39.82 ± 6.83; t = − 3.406, p = 0.0009), analytical ability (38.68 ± 5.07 vs 41.72 ± 5.89; t = − 3.024, p = 0.0031), systematic capacity (34.97 ± 4.03 vs 38.45 ± 6.43; t = − 3.555, p = 0.0006), critical-thinking self-confidence (38.18 ± 6.99 vs 44.05 ± 6.50; t = − 4.762, p < 0.0001), and curiosity (39.27 ± 5.16 vs 44.55 ± 7.07; t = − 4.676, p < 0.0001), while differences were not significant for truth-seeking (33.08 ± 8.81 vs 35.67 ± 9.57; t = − 1.538, p = 0.1267) and cognitive maturity (34.68 ± 8.93 vs 37.00 ± 9.24; t = − 1.396, p = 0.1654), as shown in Table 4. The corresponding dumbbell plot displays these between-group contrasts across all seven dimensions in alignment with the tabulated values (Fig. 5).

Table 4

Comparison of Critical Thinking Ability Scores Between the Two Groups of Students (x ± s)
Variable	Overall (mean ± SD)	Control group (mean ± SD)	Observation group (mean ± SD)	Test	Statistic	p-value
The total score of search for truth	34.38 ± 9.25	33.08 ± 8.81	35.67 ± 9.57	t	-1.538	0.1267
total score of Open mindedness	37.86 ± 6.57	35.90 ± 5.72	39.82 ± 6.83	t	-3.406	0.0009
total score of Analytical ability	40.20 ± 5.68	38.68 ± 5.07	41.72 ± 5.89	t	-3.024	0.0031
total score of Systematic capacity	36.71 ± 5.62	34.97 ± 4.03	38.45 ± 6.43	t	-3.555	0.0006
total score of Critical thinking self-confidence	41.12 ± 7.34	38.18 ± 6.99	44.05 ± 6.50	t	-4.762	0.0000
total score of Curiosity	41.91 ± 6.71	39.27 ± 5.16	44.55 ± 7.07	t	-4.676	0.0000
total score of Cognitive maturity	35.84 ± 9.13	34.68 ± 8.93	37.00 ± 9.24	t	-1.396	0.1654
Total Scale Score	268.01 ± 30.52	254.77 ± 18.28	281.25 ± 34.47	t	-5.258	0.0000

Fig. 5

Two groups of students used a "dumbbell diagram" to analyze the dimensions of new thinking.

4 Discussion

This study evaluated the application effect of the 5E Instructional Model in the course of BN in a smart nursing and healthcare industry college through a retrospective cohort design. The results showed that, compared with the traditional teaching method, the experimental group of students who received the 5E Instructional Model showed significant advantages in the overall course score, formative assessment (such as Reflective Notes, group collaboration, and practical innovation tasks), and critical thinking total score and multiple dimensions (open-mindedness, analytical ability, systematization ability, etc.) (P < 0.05). This indicates that the “5E”teaching model not only improves students’ knowledge integration and clinical practice ability, but also promotes the development of their critical thinking. The findings of this study are highly consistent with the research conclusions of Jun WH et al. [11], that is, the 5E Instructional Model is particularly suitable for nursing courses that closely integrate theory and practice, and can effectively improve students’ active learning ability and critical thinking level. In addition, Kim H et al. combined the “5E” learning cycle with the Jeffries simulation model and applied it to the virtual reality trauma nursing course, which also confirmed the potential of this model in improving nurses’ knowledge reserves and professional confidence [12]. This study further expands these conclusions and verifies the applicability and effectiveness of the "5E" teaching model in the context of nursing education in Chinese characteristic industry colleges, especially in the context of emphasizing industry-education integration and smart elderly care. The effectiveness of the "5E" teaching model is rooted in constructivist learning theory. Its five stages—Engage, Explore, Explain, Elaborate, and Evaluate—constitute a spiral-upward cognitive development loop [26]. In the attraction stage, by introducing real industry cases, students' intrinsic learning motivation is stimulated, and the deficiencies or biases in their original cognitive structure are exposed [1]. In the exploration and explanation stage, under the guidance of teachers, students actively construct their understanding of nursing operation norms and principles through activities such as simulation operation, group discussion, problem recording and reporting, rather than passively accepting knowledge [27]. This process promotes students' in-depth understanding and conceptual reconstruction of nursing skills, effectively overcoming the common problem of "knowledge fragmentation" in traditional teaching. The transfer stage is the key to the transformation of knowledge into ability. By designing real-world tasks closely related to industry pain points, students are encouraged to apply what they have learned in class to complex and uncertain clinical situations, thereby developing their clinical reasoning, decision-making, and innovative thinking [13]. The evaluation process, through diverse assessment methods (such as mind mapping, standardized peer review, and reflective logs), not only examines learning outcomes but also promotes students' metacognitive development and self-regulation abilities.

This study further found that the "5E" teaching model promotes students' critical thinking in multiple dimensions. The improvement in analytical and systematization abilities stems from students' observation, recording, and attribution analysis of operational details during the inquiry phase; the enhancement of open-mindedness and thirst for knowledge benefits from the inclusive discussion atmosphere and continuous problem challenges created during the teaching process. Most importantly, the improvement in critical thinking confidence indicates that students are more willing to use their knowledge to make independent judgments when facing complex nursing situations. For example, in the case debate and innovation tasks of the transfer phase, the experimental group students showed a stronger willingness and ability to analyze problems, find scientific evidence, and propose personalized nursing solutions, which is a direct manifestation of the application of critical thinking in clinical practice [28]. In the 5E Instructional Model, the teacher’s role has changed from the traditional “knowledge transmitter” to “learning designer, guide and facilitator”[26]. In the exploration stage, the teacher is no longer the only demonstrator of operation, but helps students identify problems through patrol, questioning and scaffolding guidance [25]. In the explanation stage, the teacher integrates students’ discoveries with new industry developments, systematically clarifies concepts, and introduces corporate mentor resources to closely link teaching content with the forefront of disciplines and industry pain points. This role change puts forward higher requirements for teachers [29], requiring them to have stronger course design ability, classroom control ability and industry insight. This study has several limitations. First, the sample comes from two grade cohorts in the same college, the sample size is relatively limited (n = 60 per group), and convenience cluster sampling is used, which may have selection bias and affect the extrapolation of the results. Second, the study design is a retrospective cohort study. Although the baseline comparison ensures the comparability of the two groups of students, it cannot completely eliminate the influence of confounding factors from different periods [30]. Future research could consider conducting multi-center, large-sample randomized controlled trials to further validate the effectiveness and universality of the "5E" teaching model; and extend this model to other core nursing courses (such as internal medicine nursing and critical care nursing) or other health-related majors to examine its cross-curricular transfer value.

The results of this study indicate that the "5E" teaching model is an effective strategy for addressing the pain points of traditional Basic Nursing courses, such as fragmented knowledge and insufficient cultivation of critical thinking. To promote this model, the following recommendations are made:

Universities should organize workshops on the "5E" teaching model for teachers to enhance their constructivist instructional design capabilities;

In curriculum development, industry real-world cases and corporate resources should be systematically integrated with the "5E" components to strengthen industry-education collaboration;

3) A diversified, process-oriented evaluation system should be established, incorporating critical thinking, innovative practice, and other competency indicators into the assessment scope.

In conclusion, within the context of Characteristic Industry College, the systematic application of the "5E" teaching model can effectively promote the integration of knowledge, internalization of skills, and development of critical thinking among nursing students, providing a powerful teaching practice paradigm for cultivating high-quality nursing talents that meet the strategic needs of Healthy China.

5 Conclusion

The results of this study indicate that, within the context of a Characteristic Industry College focusing on smart healthcare and nursing, the "5E" teaching model effectively enhances the teaching outcomes of the Basic Nursing course. Students in the experimental group showed significant improvements in both their academic performance and critical thinking skills. Students positively evaluated the applicability of the "5E" teaching model in their learning process, with the vast majority agreeing to integrate it into their teaching. Therefore, when designing instruction, teachers should, while employing traditional teaching methods, emphasize and fully leverage the potential of the "5E" teaching model. As an effective supplement to traditional teaching, this model can provide significant support for positive changes in the teaching process. It is recommended that institutions establish corresponding support systems to systematically plan and incorporate this modern teaching model into curriculum design and teaching practice.

Abbreviations

Basic Nursing BN

Biological Sciences Curriculum Study BSCS

5E Instructional Model 5E IM

Engage, Explore, Explain, Elaborate, Evaluate 5E

Critical Thinking CT

Characteristic Industry College CIC

Nursing Student(s) NS

Critical Thinking Disposition Inventory-Chinese Version CTDI-CV

Acknowledgement

The author would like to thank all the respondents who participated in this study.The authors declare that they did not use generative AI in the creation of this paper.

Author Contribution

Juan Qiao: Conceptualization, Data curation, Funding acquisition, Investigation, Resources, Writing -original draft, Writing -review editing.Hejia Wan: Conceptualization, Formal analysis, Methodology, Project administration, Validation, Visualization, Resources, Writing -original draft, Writing -review editing.

Hejia Wan: Conceptualization, Formal analysis, Methodology, Project administration, Validation, Visualization, Resources, Writing -original draft, Writing -review editing.

Funding

This study was supported by four grants: the Henan University of Chinese Medicine 2024 Education and Teaching Reform Research and Practice Project (2024JX35); Henan Province Key Research and Development and Promotion Special Project (Science and Technology Research) (222102320309); Henan Province Traditional Chinese Medicine Education and Teaching Reform Research and Practice Project (2024JX32) and the 2025 Henan Higher Education Society Higher Education Research Project (2025SXHLX153).

Data Availability

The interpretation of the data supporting this study's conclusions is presented in the article.Due to potential risks to student privacy, additional data at the individual student level is not publicly available, but anonymized data can be obtained from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study has been approved by the Ethics Committee of the First Affiliated Hospital of Henan University of Chinese Medicine, approval number: 2024HL-390.

All participants signed informed consent forms.

Participation in this study was voluntary, and participants could withdraw at any time after signing the consent form.

Consent for publication

All authors agree to publish this study, also, written informed consent for publication was obtained from all participants.

Competing interests

The authors declare no competing interests.

Electronic Supplementary Material

Below is the link to the electronic supplementary material

Supplementary Material 1

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