The growing integration of digital technologies into healthcare has reshaped the knowledge and skills required of nursing professionals. However, most undergraduate nursing programs continue to emphasize theoretical instruction, offering limited exposure to experiential or technology-oriented learning. To better prepare students for data-rich clinical environments, innovative pedagogical models that merge nursing practice with informatics and design thinking are needed. This study investigated whether a Design-Based Learning (DBL) framework could strengthen informatics literacy among undergraduate nursing students by embedding authentic, problem-driven activities within a “Nursing Informatics” course. Over four academic years (2020–2024), a participatory action research project was carried out with 622 nursing undergraduates at a large Chinese university. The redesigned course guided students through iterative design cycles, encouraging them to co-develop digital solutions to genuine clinical informatics challenges. A 28-item Likert-scale instrument (total score range 28–140) assessed informatics literacy before and after the course. Quantitative data were analyzed using paired t-tests and Bayesian modeling to identify significant learning gains, while focus group discussions provided complementary qualitative evidence. Students’ informatics literacy improved markedly across all cohorts (p < 0.001). For example, mean scores increased from 73.13 ± 13.38 to 86.55 ± 12.21 in 2018 (Cohen’s d = 2.21) and from 73.17 ± 15.15 to 92.47 ± 12.07 in 2021 (Cohen’s d = 3.07). Bayesian estimates corroborated these consistent gains. Qualitative findings revealed that the DBL experience nurtured interdisciplinary awareness, digital fluency, stronger professional identity, and collaborative problem-solving. Embedding design-based, participatory learning into a nursing informatics curriculum substantially enhanced students’ technological competence and critical engagement. The findings highlight DBL as a promising strategy for cultivating future nurses capable of thriving in increasingly digitized healthcare contexts. Further investigation should compare DBL to other instructional models and examine its lasting influence on clinical performance.
