Analysis of Educational Needs for the Development of a Clinical Practice Adaptation Program for Nursing Students

Article information

J Korean Acad Fundam Nurs. 2024;31(3):338-348

Publication date (electronic) : 2024 August 31

doi : https://doi.org/10.7739/jkafn.2024.31.3.338

Ji Won Han ¹⁾

, Sun Young Jung ²⁾^,

¹⁾Nurse, Daegu Catholic University Medical Center, Daegu, Korea

²⁾Professor, College of Nursing ‧ Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea

Corresponding author: Jung, Sun Young College of Nursing, Daegu Catholic University 33 Duryugongwon-ro, 17-gil, Namgu, Daegu 42472, Korea Tel: +82-53-650-4977, Fax: +82-53-650-4392, E-mail: syjung@cu.ac.kr

Received 2024 May 29; Revised 2024 August 6; Accepted 2024 August 16.

Abstract

Purpose

This study aimed to identify the educational needs for developing a clinical practice adaptation program for nursing students.

Methods

This descriptive survey collected data through a questionnaire from 124 third- and fourth-year nursing students in Daegu. The data were analyzed using frequencies, the t-test, one-way analysis of variance, importance-performance analysis (IPA), and Borich's needs analysis method with IBM SPSS Statistics 25.0.

Results

IPA identified 11 educational items requiring intensive improvement. Additionally, Borich's needs analysis method was utilized to establish educational priorities. Among these, the highest educational need was for “understanding and precautions of significant drugs in internal medicine and surgery.”

Conclusion

This study's findings have implications for developing a clinical practice adaptation program for nursing students.

Keywords: Needs assessment; Nursing; Practical nursing; Students

INTRODUCTION

1. Background

Clinical practice is an essential educational course for learning the skills and abilities required in nursing practice [1]. It provides nursing students with a significant learning opportunity to observe the roles of nurses as pro-spective nurses and to apply theoretical knowledge in the field [2]. The Korean Accreditation Board of Nursing Education (KABONE) recommends completing clinical practice to ensure that nursing education can cultivate talents with the competencies required by society and provides evaluation standards for this purpose [3]. Accordingly, all nursing education institutions operate clinical practices to train nurses with practical skills and improve the quality management of nursing education [4].

However, nursing students experienced clinical practice stress in applying theoretical knowledge learned in an unfamiliar hospital environment during clinical practice for the following reasons: awareness of limitations in the application, anxiety due to lack of knowledge and nursing skills, difficulty in judging situations, interpersonal relationships with patients, guardians, and medical staff, and ambiguity of the role of nursing students [5]. According to previous studies, clinical practice stress among nursing students negatively correlates with their clinical performance abilities [6]. Therefore, interventions targeting clinical practice stress are necessary to enhance nursing students’ clinical performance and practice satisfaction.

Nursing students felt difficult and burdened about directly applying the theories they learned in school to patients in an unfamiliar clinical practice environment [7]. According to prior research analyzing the clinical practice experiences of nursing students following their initial clinical placement, students frequently reported a significant discrepancy between their theoretical education and the practical realities of clinical settings [8]. Additionally, students found it challenging to apply theoretical knowledge in fast-paced and often unpredictable clinical practice environments [5]. Therefore, to enhance adaptation to the clinical setting and increase the effectiveness of practice education, there is a need for an intensive on-campus practice program composed of essential competencies that must be acquired before beginning clinical practice [9].

KABONE has selected 18-core nursing skills that must be learned and achieved in nursing education programs, focusing on ensuring the essential competencies of professional nurses required in clinical settings [10]. However, as medical technology advances and the severity and complexity of patient conditions increase, along with the expanding role of nursing, there is a growing disparity between theoretical knowledge learned in school and practical skills demanded in clinical settings [11]. Relying solely on the 18-core nursing skill evaluation items provided by KABONE may require revision to enhance the proficiency of nursing students. While studies are analyzing the importance and performance of core clinical nursing skills as proposed by KABONE, more literature needs to examine the importance and performance of educational content in adapting nursing students to clinical practice. Therefore, there is a need to reassess and clarify the academic content essential for enhancing nursing students’ adaptation to clinical practice.

This study aims to assess the importance and performance of academic content for nursing students’ adaptation to clinical practice. To this end, a Delphi survey will be conducted to gather consensus on academic content crucial for nursing students’ adaptation to clinical practice. Furthermore, it seeks to identify the educational needs for developing a nursing student's clinical practice adaptation program through Interpretative Phenomenological Analysis (IPA) and Borich's needs assessment.

2. Purpose

This study aims to identify the educational needs for developing a clinical practice adaptation program for nursing students. The specific objectives are as follows:

• To understand the general characteristics of the participants.
• To assess the importance and performance of academic content related to clinical practice adaptation for the participants.
• To examine the importance and performance of academic content related to clinical practice adaptation based on the participants’ general characteristics.
• To analyze the educational needs for developing a clinical practice adaptation program for nursing students.

METHODS

1. Study Design

This study is a descriptive survey to identify educational needs by analyzing educational requirements for developing a clinical practice adaptation program for nursing students.

2. Study Participants

This study selected third- and fourth-year nursing students from a 4-year university's nursing department in Daegu as participants. The researcher visited the target university to explain the study's purpose to the department head and sought permission and cooperation. Recruitment was conducted via department bulletin board announcements from April 19th to April 23rd, 2024. Participants who voluntarily chose to take part and understood the research purpose, methods, and procedures were included based on selection criteria. They completed the questionnaire in approximately 10 minutes. Using G* Power 3.1.9.4 software, with a significance level of .05, a power of 95%, and an effect size of .30 set for the t-test [12], the minimum required sample size was calculated to be 111. Considering a dropout rate of 10%, a total of 124 participants were surveyed. Among them, 124 participants responded, and five still needed to complete the questionnaire. Consequently, a total of 119 questionnaires were used for the final analysis.

3. Measurement

1) The importance and performance of academic content for nursing students’ adaptation to clinical practice

The researcher derived the measurement tool for assessing the significance and performance of academic content for nursing students’ adaptation to clinical practice based on specific content in the New Nurse Education Management System Guidelines distributed by the Korean Nursing Association [13]. The Delphi survey involved 20 experts, including 10 nursing professors specializing in adult nursing (3), maternal nursing (1), pediatric nursing (1), and fundamental nursing (5) from nursing colleges, as well as four education-dedicated nurses from tertiary hospitals, one preceptor nurse from a tertiary hospital, and five novice nurses with less than one year of experience in tertiary hospitals [14]. In the first Delphi survey, the validity of six categories, 34 academic items, and 87 academic contents were assessed using open-ended questions regarding the validity and a 4-point Likert scale ranging from ‘not valid at all’ (1 point) to ‘very valid’(4 points). As a result, three categories, 14 academic items, and 35 academic contents were derived. Among the original six categories, ‘Nursing practice knowledge & patient-centered care’ and ‘Safety and quality’ were retained. In contrast, the ‘Law and ethics’, ‘Population health’, ‘Information technology and healthcare technology’, and ‘Professionalism and leadership’ categories were deleted. Additionally, the category of ‘Interprofessional education’ was added. Furthermore, 20 academic items and their corresponding 52 academic contents unrelated to clinical practice or deemed in-appropriate for the curriculum were removed. The second Delphi survey, excluding one fundamental nursing professor who declined to participate for personal reasons, involved the same 19 experts and validated the content validity of academic content through a 4-point Likert scale ranging from ‘not valid at all’ (1 point) to ‘very valid’ (4 points) and open-ended questions. Additionally, the importance of academic content was collected using a 4-point Likert scale ranging from ‘not important at all’ 1 point to ‘very important’ 4 points.

Regarding the tool's reliability, Cronbach's ⍺ was .97 for importance and .95 for performance. The reliability for each category of importance is as follows: Cronbach's ⍺ was .96 for Nursing practice knowledge & patient-centered care, Cronbach's ⍺ was .93 for Safety and quality, and Cronbach's ⍺ was .84 for Interprofessional partnership. The reliability for each performance category is as follows: Cronbach's ⍺ was .94 for Nursing practice knowledge & patient-centered care, Cronbach's ⍺ was .82 for Safety and quality, and Cronbach's ⍺ was .80 for Interprofessional partnership.

2) IPA and Borich's needs analysis

IPA involves evaluating the importance and performance of each attribute, allowing for simultaneous comparative analysis of their relative importance and performance [15]. The measured importance and performance are graphically represented in four quadrants based on the X and Y axes. Borich [16] developed a method for determining educational needs by analyzing the relationship between the current level of abilities perceived by the educational targets and the required level of abilities for each academic content. Borich's needs analysis formula follows [Σ (required competence level - present competence level) × average of required competence level] / number of cases.

4. Ethical Considerations

The Daegu Catholic University Institutional Review Board approved the study (Approval Number: CUIRB-2024-0002). Written consent was obtained from all participants. Ethical considerations included providing participants with information on the study's purpose, ensuring anonymity and confidentiality, the right to withdraw without penalty, and the disposal of data upon withdrawal. Participants were informed that their responses would not impact their academic grades and were given a small gift as compensation for their participation.

5. Data Analysis

The collected data were analyzed using IBM SPSS Statistics 25.0, employing the following specific methods: General characteristics of the participants were analyzed using frequency and percentage. The importance and performance of academic content for nursing students’ adaptation to clinical practice were analyzed using mean and standard deviation. Differences in the importance and performance of academic content for nursing students’ adaptation to clinical practice according to their general characteristics were analyzed using t-tests and one-way ANOVA. Post-hoc tests were conducted using the Scheffé test. IPA and Borich's Needs Analysis methods were used to conduct the educational needs analysis for developing a nursing student's clinical practice adaptation program.

RESULTS

1. Results of the Delphi Survey

The results of the two-round Delphi survey, which aimed to derive a measurement tool for assessing the importance and performance of academic content for nursing students’ adaptation to clinical practice, led to the derivation three categories, 13 academic items, and 31 academic contents (Table 1).

Table 1.

Results of the Delphi Survey (N=19)

2. Differences in the Importance and Performance of Academic Content according to General Characteristics of Participants

The participants comprised 104 women (87.4%) and 15 men (12.6%). The average age was 21.4±1.4 years old. Among them, 80 students (67.2%) were in their third year, and 39 (32.8%) were in their fourth year. Last semester's academic GPA was 3.5 to 3.9 for 54 students (45.4%), 3.0 to 3.4 for 33 students (27.7%), 4.0 or higher for 25 students (21.0%), and 1.5 to 2.9 for seven students (5.9%). Regarding satisfaction with clinical practice, 81 students (68.0%) were satisfied, 29 students (24.4%) were neutral, and nine students (7.6%) were dissatisfied (Table 2).

Table 2.

Differences in the Importance and Performance of Academic Content According to Participants’ General Characteristics (N=119)

The analysis of differences in the importance and performance of academic content for nursing students’ adaptation to clinical practice according to their general characteristics revealed statistically significant differences based on clinical practice satisfaction. Specifically, there were significant differences in importance (F=4.957, p=.009) and performance (F=6.721, p=.002). Participants who were satisfied with their clinical practice demonstrated higher importance ratings than those who were dissatisfied. Additionally, satisfied participants exhibited higher performance ratings than those who reported neutral satisfaction levels (Table 2).

3. Importance and Performance of Academic Content Perceived by Participants

The importance of academic content for nursing students’ adaptation to clinical practice had an overall average of 4.21±0.71 points, while the performance had an overall average of 3.70±0.59 points (Table 3).

Table 3.

Importance and Performance of Academic Content as Perceived by Participants (N=119)

4. Educational Needs for Developing Nursing Students’ Clinical Practice Adaptation Program

1) Results of IPA

The IPA analysis of educational needs for developing a clinical practice adaptation program for nursing students is as follows (Figure 1). The academic contents (No.) located in the second quadrant include suction therapy nursing (oral and nasal, endotracheal suction) (3), indwelling catheterization (7), intradermal Injection (11), intravenous Injection (12), preparation and administration of infusion pump and syringe pump (13), understanding and precautions of significant drugs in internal medicine and surgery (14), major diagnostic tests and precautions in internal medicine and surgery (19), connecting and identifying abnormalities in 3-Lead ECG Monitoring (21), major diseases and nursing care in internal medicine and surgery (23), isolation patient nursing (types of isolation: airborne, droplet, contact) (26), and notifying using SBAR (31) were factors considered to be of high importance, the performance level was low. Therefore, the relevant academic content was a critical area that needed intensive improvement.

Figure 1.

Results of importance-performance analysis.

2) Results of Borich's needs analysis

Based on the Borich needs analysis, the educational need for understanding and precautions of significant drugs in internal medicine and surgery (14) was the highest priority, with a score of 5.51. The next priorities are as follows: Connecting and identifying abnormalities in 3-Lead ECG monitoring (21), preparation and Administration of infusion pump and syringe pump (13), intravenous injection (12), major diseases and nursing care in internal medicine and surgery (23), as shown in Table 4.

Table 4.

Results of Borich's Needs Analysis (N=119)

DISCUSSION

This study was conducted to identify nursing students’ educational needs and to develop a program for their adaptation to clinical practice.

The Delphi survey of 19 experts included five academic items derived from the New Nurse Education Management System Guidelines distributed by the Korean Nursing Association [13]: ‘nursing care before and after surgery and treatment’, ‘nursing care before and after examination’, ‘patient education by disease’, ‘infection control’, and ‘interprofessional education’. These academic items are crucial for nursing students in real clinical settings but are not directly covered in the fundamentals of nursing practice. Therefore, instructors must address these academic items for nursing students through programs out-side the regular curriculum. Conversely, transfusion nursing was excluded from the 18-core nursing skills proposed by KABONE because experts reflected that it requires concurrent theory and practical instruction typically provided in advanced nursing courses, making it less suitable for nursing students preparing for clinical placements.

In this study, the importance of academic content for adapting to clinical practice among participants was 3.70 out of 5. Although no prior studies were directly comparable to measuring the performance of educational content for clinical practice adaptation, a previous study assessing the importance of core basic nursing skills among fourth-year nursing students yielded a score of 4.73[17], which was higher than the score obtained in this study. The tool used in this study was newly developed based on expert opinions collected through a Delphi survey to assist nursing students in adapting to clinical practice. This newly developed tool includes not only content from the nursing education curriculum but also practical content applicable to actual clinical practice, which may explain the relatively lower score.

In this study, the performance level of the academic content for clinical practice adaptation among participants was 3.70 out of 5. Although no prior studies were directly comparable to measuring the performance of academic content for clinical practice adaptation, a previous study estimated the self-confidence of fourth-year nursing students in performing fundamental nursing skills at 3.42 out of 5[18]. This study presumes that the performance level was high because the tool consisted of content that nursing students directly performed or observed in clinical practice.

In this study, the average score of perceived importance of academic content for clinical practice adaptation among nursing students was significantly higher than the average performance score. This result shows that nursing students recognized the educational content for adaptation to clinical practice as important but needed more experience in carrying out the educational content. Furthermore, these results stem from ongoing issues in the fundamentals of nursing practice, such as insufficient credit hours and practical sessions, inadequate equipment and facility resources, and the absence of clear curriculum standards [19]. Therefore, instructors should seamlessly integrate the fundamentals of nursing practice with clinical training to ensure an efficient and practical education that reflects the demands of real-world clinical settings [19]. Additionally, it is believed that there is a need for an extracurricular practice program within the nursing curriculum composed of essential competencies to enhance clinical adaptation skills and improve the effectiveness of practical training before entering clinical practice [9].

In this study, there was a significant difference in the perceived importance and performance of academic content for clinical practice adaptation according to the satisfaction level of the participants with their clinical practicum. This finding is similar to a study that observed differences in confidence in performing essential nursing skills based on clinical practicum satisfaction among nursing students in their third and fourth years [20]. Therefore, nursing educational institutions may need to provide nursing students with various observations and experiences during clinical practicum to enhance their satisfaction with clinical practice, thereby increasing their recognition of the importance of academic content for clinical practice adaptation and boosting their confidence in performing clinical skills.

IPA assesses the importance and performance of each attribute, enabling a comparative analysis of their relative significance and outcomes. The evaluated importance and performance are graphically represented in four quadrants based on the X and Y axes. The second quadrant, in particular, identifies areas requiring educational intervention and those that should be prioritized for improvement. The results of prioritizing the academic contents in the second quadrant of the IPA according to Borich's needs analysis are as follows: ‘understanding and precautions of significant drugs in internal medicine and surgery’, ‘connecting and identifying abnormalities in 3-Lead ECG monitoring’, ‘preparation and administration of infusion pump and syringe pump’, ‘intravenous injection’, ‘major diseases and nursing care in internal medicine and surgery’, ‘indwelling catheterization’, ‘major diagnostic tests and precautions in internal medicine and surgery’, ‘notify using SBAR’, and ‘suction therapy nursing (oral and nasal, endotracheal suction)’. Therefore, it has been identified that is necessary to structure the program's academic content based on IPA and Borich's needs analysis results to develop a program for nursing students to adapt to clinical practice. When operating a program that includes the academic content of ‘understanding and precautions of significant drugs in internal medicine and surgery’, ‘major diseases and nursing care in internal medicine and surgery’, and ‘major diagnostic tests and precautions in internal medicine and surgery’, it is essential for instructors to collaborate closely with clinical practice leaders. This collaboration ensures the integration of theoretical knowledge in a manner that reflects the unique characteristics of the clinical practice site. Additionally, the contents such as ‘connecting and identifying abnormalities in 3-Lead ECG monitoring’, ‘preparation and administration of infusion pump and syringe pump’, and ‘notify using SBAR’, are not extensively covered in the fundamentals of nursing practice. Therefore, instructors must provide prelearning opportunities to adequately prepare students for this content.

Conversely, Quadrant 4 identifies areas with low importance but high performance, suggesting that excessive training should be avoided. The academic contents corresponding to quadrant 2 of the IPA are as follows: ‘measurement and interpretation of vital signs’, ‘applying oxygen therapy’, ‘oral medication, topical medication, rectal suppository administration’, ‘pain management nursing’, ‘blood sugar test measurement and interpretation’, ‘oxygen saturation monitoring’, ‘wearing medical protective equipment (gloves, goggles, gown, etc.)’, ‘aseptic techniques (hand washing, maintaining and securing aseptic areas)’, ‘fall prevention’ and ‘understanding of professional collaborative relationships’.

Among the academic contents perceived as necessary by experts were as follows: ‘intravenous injection’, ‘measurement and interpretation of vital signs’, ‘applying oxygen therapy’, ‘subcutaneous injection’, ‘oxygen saturation monitoring’, ‘suction therapy nursing (oral and nasal, endotracheal suction)’, ‘indwelling catheterization’, ‘subcutaneous injection’, ‘intramuscular injection’, ‘basic life support’, and ‘wearing medical protective equipment (gloves, goggles, gown, etc.)’, were identified as academic contents with high performance by nursing students. Therefore, this study underscores nursing students’ need to learn these academic contents thoroughly for clinical practice. However, since ‘basic life support’ is not extensively covered in basic nursing practice training, nursing students are encouraged to complete separate cardiopulmonary resuscitation (CPR) training before engaging in clinical practice.

Furthermore, it is necessary to focus on the differences in the perceived importance of academic content between nurses and nursing professors. In particular, academic contents such as ‘blood sugar test measurement and interpretation’ and ‘major diseases and nursing care in internal medicine and surgery’ were perceived as more than 0.3 points higher in importance by nurses compared to nursing professors. Nursing students had ample opportunities to perform blood sugar tests during clinical practice [21]. Therefore, instructors need to include’ blood sugar test measurement and interpretation’ in the fundamentals of nursing practice, and nursing students should be allowed to practice this procedure before entering clinical practice. Furthermore, academic content such as ‘major diseases and nursing care in internal medicine and surgery’ is suggested to be incorporated into simulation-based education or practice after developing sufficient nursing competencies before participating in clinical practice [22].

CONCLUSION

This study aimed to assess the importance and performance of academic content for nursing students’ adaptation to clinical practice. The educational needs analysis for developing a nursing student's clinical practice adaptation program was conducted using IPA and Borich's Needs Analysis methods.

In this study, IPA identified eleven educational items requiring intensive improvement. Additionally, Borich's Needs Analysis was utilized to establish educational priorities. Among these, the highest educational need was understanding and precautions of significant drugs in internal medicine and surgery (14).

This study was conducted targeting third and fourth-year nursing students at a single university, so there are limitations to generalizing the results. Therefore, future research should identify educational needs among nursing students from various regions. Additionally, since the data were collected from nursing students with clinical practicum experience, it is crucial to consider the importance of academic content perceived by nursing professors and nurses.

Based on this study, the researcher believes that developing and educating nursing students on a clinical practicum adaptation program can enhance their adaptability to clinical settings, thereby increasing the effectiveness of clinical practicum. Therefore, it is suggested that experimental research be conducted to assess the effectiveness of the clinical practicum adaptation program based on the findings of this study.

Notes

CONFLICTS OF INTEREST

The authors declared no conflict of interest.

AUTHORSHIP

Study conception and design acquisition - Han JW and Jung SY; Data collection - Han JW; Data analysis & Interpretation - Han JW; Drafting & Revision of the manuscript - Han JW and Jung SY.

DATA AVAILABILITY

Please contact the corresponding author for data availability.

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Table 1.

Results of the Delphi Survey (N=19)

Categories	Academic items	Academic contents	Content validity			Importance
			M± SD	CVR	CV	Total (N=19)	Nurse (N=10)	Professor of nursing (N=9)
			M± SD	CVR	CV	M± SD	M± SD	M± SD
Nursing practice knowledge & patient-centered care	Vital signs	1. Measurement and interpretation of vital signs	3.89±0.32	1.00	0.08	3.95±0.23	4.00±0.00	3.89±0.33
	Respiratory nursing care	2. Applying oxygen therapy	3.89±0.32	1.00	0.08	3.95±0.23	3.89±0.33	4.00±0.00
	Respiratory nursing care	3. Suction therapy nursing (oral and nasal, endotracheal suction)	3.89±0.32	1.00	0.08	3.89±0.32	3.90±0.32	3.89±0.33
	NM	4. Application of gavage feeding	3.84±0.37	1.00	0.10	3.84±0.37	3.80±0.42	3.89±0.33
	Elimination/ Urinary nursing care	5. Cleansing enema	3.74±0.45	1.00	0.12	3.68±0.67	3.50±0.85	3.89±0.33
		6. Nelaton catheterization	3.84±0.37	1.00	0.10	3.79±0.54	3.70±0.67	3.89±0.33
		7. Indwelling catheterization	3.84±0.37	1.00	0.10	3.89±0.32	3.89±0.33	3.90±0.32
	Medication administration nursing/ Intravenous therapy nursing	8. Oral medication, topical medication, rectal suppository administration	3.74±0.45	1.00	0.12	3.74±0.65	3.70±0.67	3.78±0.67
		9. Subcutaneous injection	3.84±0.37	1.00	0.10	3.89±0.32	3.80±0.42	4.00±0.00
		10. Intramuscular injection	3.79±0.42	1.00	0.11	3.89±0.32	3.80±0.42	4.00±0.00
		11. Intradermal injection	3.79±0.42	1.00	0.11	3.95±0.23	3.90±0.32	4.00±0.00
		12. Intravenous injection	3.89±0.32	1.00	0.08	4.00±0.00	4.00±0.00	4.00±0.00
		13. Preparation and administration of infusion pump and syringe pump	3.79±0.42	1.00	0.11	3.79±0.71	3.90±0.32	3.67±1.00
		14. Understanding and precautions of major drugs in internal medicine and surgery	3.26±0.65	0.79	0.20	3.47±0.61	3.40±0.52	3.56±0.73
	PMN	15. Pain management nursing	3.79±0.42	1.00	0.11	3.84±0.37	3.80±0.42	3.89±0.33
	CR	16. Basic life support	3.84±037	1.00	0.10	3.89±0.32	3.90±0.32	3.89±0.33
	Nursing care before and after surgery and treatment	17. Nursing care before surgery and treatment for internal medicine and surgery	3.74±0.45	1.00	0.12	3.84±0.37	3.80±0.42	3.89±0.33
	Nursing care before and after surgery and treatment	18. Nursing care after surgery and treatment for internal medicine and surgery	3.74±0.45	1.00	0.12	3.84±0.37	3.80±0.42	3.89±0.33
	Nursing care before and after examination	19. Major diagnostic tests and precautions in internal medicine and surgery	3.68±0.48	1.00	0.13	3.79±0.42	3.70±0.48	3.89±0.33
		20. Blood sugar test measurement and interpretation	3.84±0.37	1.00	0.10	3.84±0.50	4.00±0.00	3.70±0.67
		21. Connecting and identifying abnormalities in 3∼lead ECG monitoring	3.74±0.45	1.00	0.12	3.84±0.37	3.89±0.33	3.80±0.42
		22. Oxygen saturation monitoring	3.89±0.32	1.00	0.08	3.95±0.23	3.90±0.32	4.00±0.00
	PED	23. Major diseases and nursing care in internal medicine and surgery	3.42±0.61	0.89	0.18	3.58±0.61	3.80±0.42	3.33±0.71
Safety and quality	Infection control	24. Wearing medical protective equipment (gloves, goggles, gown, etc.)	3.89±0.32	1.00	0.08	3.89±0.32	3.90±0.32	3.89±0.33
		25. Aseptic techniques (hand washing, maintaining and securing aseptic areas)	3.84±0.37	1.00	0.10	3.84±0.37	3.80±0.42	3.89±0.33
		26. Isolation patient nursing (types of isolation: airborne, droplet, contact)	3.89±0.32	1.00	0.08	3.84±0.37	3.80±0.42	3.89±0.33
	Patient safety	27. Fall prevention	3.89±0.32	1.00	0.08	3.84±0.37	3.80±0.42	3.89±0.33
	Patient safety	28. Application and management of medical restraint	3.79±0.42	1.00	0.11	3.79±0.42	3.70±0.48	3.89±0.33
Interprofessional partnership	Interprofessional education	29. Understanding of professional collaborative relationships	3.37±0.60	0.89	0.18	3.32±0.82	3.00±0.82	3.67±0.71
		30. Verbal and EMR prescription confirmation	3.89±0.32	1.00	0.08	3.79±0.42	3.70±0.48	3.89±0.33
		31. Notify using SBAR	3.89±0.32	1.00	0.08	3.74±0.56	3.60±0.70	3.89±0.33

CR=cardiopulmonary resuscitation; CV=coefficient of variation; CVR=content validity ratio; M=mean; NM=nutritional management; PED=Patient education by disease; PMN=pain management nursing; SD=standard deviation.

Variables	Categories	n (%) or M± SD	Importance			Performance
Variables	Categories	n (%) or M± SD	M± SD	t or F	p (Scheffé)	M± SD	t or F	p (Scheffé)
Sex	Men	15 (12.6)	3.79±0.79	2.47	.015	3.58±0.55	.79	.429
Sex	Women	104 (87.4)	4.27±0.68			3.71±0.59
Age (year)		21.4±1.4
Year	Third	80 (67.2)	4.20±0.73	0.23	.817	3.70±0.57	0.00	.994
Year	Fourth	39 (32.8)	4.23±0.69			3.70±0.63
Previous semester grade point average	1.5∼2.9	7 (5.9)	4.18±0.52	1.25	.295	3.19±0.62	2.30	.081
	3.0∼3.4	33 (27.7)	4.15±0.74			3.74±0.47
	3.5∼3.9	54 (45.4)	4.13±0.73			3.68±0.54
	≥4.0	25 (21.0)	4.45±0.66			3.83±0.74
Clinical practice satisfaction	Dissatisfied^a	9 (7.6)	3.67±0.85	4.95	.009	3.62±0.48	6.72	.002
	Neutral^b	29 (24.4)	4.04±0.68		(a＜ c)	3.38±0.60		(b＜ c)
	Satisfied^c	81 (68.0)	4.33±0.67			3.82±0.55

Categories	Education items	Academic content (No.)	Importance	Performance
Categories	Education items	Academic content (No.)	M± SD	M± SD
Nursing practice knowledge & patient-centered care	Vital signs	1	3.89±1.23	4.50±0.64
	Respiratory nursing care	2, 3	4.24±0.80	3.66±0.70
	Nutritional management	4	4.18±0.85	3.39±0.89
	Elimination/urinary nursing care	5, 6, 7	4.22±0.83	3.34±0.91
	Medication administration nursing/intravenous therapy nursing	8, 9, 10, 11, 12, 13, 14	4.25±0.76	3.59±0.73
	Pain management nursing	15	4.01±1.07	3.88±0.90
	Cardiopulmonary resuscitation	16	4.25±1.13	4.05±0.95
	Nursing care before and after surgery and treatment	17, 18	4.23±0.85	3.32±0.90
	Nursing care before and after examination	19, 20, 21, 22	4.19±0.78	3.71±0.71
	Patient education by disease	23	4.37±0.76	3.28±0.88
Safety and quality	Infection control	24, 25, 26	4.21±0.92	4.07±0.70
Safety and quality	Patient safety	27, 28	4.05±0.98	4.10±0.62
Interprofessional partnership	Interprofessional education	29, 30, 31	4.31±0.77	3.72±0.80
Total			4.21±0.71	3.70±0.59

Academic content	Importance	Performance	t	p	Borich	Priority
Academic content	M± SD	M± SD	t	p	Borich	Priority
1. Measurement and interpretation of vital signs	3.89±1.23	4.50±0.64	4.70	＜.001	-2.32	31
2. Applying oxygen therapy	4.19±0.95	3.92±0.76	2.39	.018	1.13	21
3. Suction therapy nursing (oral and nasal, endotracheal suction)	4.29±0.82	3.40±0.85	8.25	＜.001	3.82	10
4. Application of gavage feeding	4.18±0.85	3.39±0.89	6.49	＜.001	3.30	13
5. Cleansing enema	4.07±0.93	3.37±0.96	5.44	＜.001	2.84	14
6. Nelaton catheterization	4.24±0.93	3.38±0.97	6.72	＜.001	3.63	12
7. Indwelling catheterization	4.34±0.84	3.26±0.99	9.01	＜.001	4.71	6
8. Oral medication, topical medication, rectal suppository administration	3.76±1.18	4.13±0.80	2.84	.005	-1.36	29
9. Subcutaneous injection	4.14±0.99	3.76±0.89	3.24	.002	1.60	19
10. Intramuscular injection	4.24±0.97	3.82±0.89	3.55	.001	1.82	18
11. Intradermal injection	4.28±0.95	3.66±0.93	5.27	＜.001	2.62	16
12. Intravenous injection	4.49±0.82	3.42±1.08	8.66	＜.001	4.79	4
13. Preparation and administration of infusion pump and syringe pump	4.42±0.75	3.23±1.10	9.44	＜.001	5.27	3
14. Understanding and precautions of major drugs in internal medicine and surgery	4.40±0.82	3.15±1.10	9.65	＜.001	5.51	1
15. Pain management nursing	4.01±1.07	3.88±0.90	1.00	.317	0.51	24
16. Basic life support	4.25±1.13	4.05±0.95	1.50	.137	0.86	23
17. Nursing care before surgery and treatment for internal medicine and surgery	4.23±0.83	3.23±0.96	8.59	＜.001	4.01	9
18. Nursing care after surgery and treatment for internal medicine and surgery	4.24±0.93	3.35±0.93	7.14	＜.001	3.74	11
19. Major diagnostic tests and precautions in internal medicine and surgery	4.31±0.82	3.29±1.00	8.57	＜.001	4.42	7
20. Blood sugar test measurement and interpretation	4.01±1.12	4.08±0.94	0.57	.567	-0.30	25
21. Connecting and identifying abnormalities in 3∼lead ECG monitoring	4.45±0.77	3.29±1.05	9.61	＜.001	5.45	2
22. Oxygen saturation monitoring	4.01±1.19	4.26±0.84	1.96	.052	-1.01	28
23. Major diseases and nursing care in internal medicine and surgery	4.37±0.76	3.28±0.88	10.71	＜.001	4.77	5
24. Wearing medical protective equipment (gloves, goggles, gown, etc.)	4.11±1.05	4.24±0.80	1.22	.224	-0.55	27
25. Aseptic techniques (hand washing, maintaining and securing aseptic areas)	4.21±1.04	4.29±0.79	0.68	.496	-0.32	26
26. Isolation patient nursing (types of isolation: airborne, droplet, contact)	4.32±0.90	3.67±0.92	5.73	＜.001	2.80	15
27. Fall prevention	4.02±1.19	4.49±0.66	4.09	＜.001	-1.89	30
28. Application and management of medical restraint	4.08±0.92	3.71±0.86	3.42	.001	1.51	20
29. Understanding of professional collaborative relationships	4.13±0.96	3.92±0.86	1.75	.082	0.87	22
30. Verbal and EMR prescription confirmation	4.34±0.87	3.76±1.03	4.56	＜.001	2.51	17
31. Notify using SBAR	4.45±0.83	3.49±0.93	8.18	＜.001	4.26	8
Total	4.21±0.71	3.70±0.59	7.15	＜.001