Comparison of the Importance and Performance of Learning Objective-Based Core Nursing Skills as Perceived by Fundamental Nursing Practice Instructors: An Importance-Performance Analysis

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J Fundam Nurs Sci. 2026;33(1):107-117

Publication date (electronic) : 2026 February 28

doi : https://doi.org/10.7739/jkafn.2026.33.1.107

Hyojung Park¹⁾, Jiyeon Hong²⁾, Min-Jung Choi³⁾, Seyeon Park⁴⁾, Jongsoon Won⁵⁾, Hyeongyeong Yoon^6),

¹⁾Professor, College of Nursing, Ewha Womans University, Seoul, Korea

²⁾Professor, Department of Nursing, Howon University, Gunsan, Korea

³⁾Assistant Professor, College of Nursing, The Catholic University of Korea, Seoul, Korea

⁴⁾Assistant Professor, College of Nursing, Chungnam National University, Daejeon, Korea

⁵⁾Professor, College of Nursing(Seongnam), Eulji University, Seongnam, Korea

⁶⁾Assistant Professor, College of Nursing(Seongnam), Eulji University, Seongnam, Korea

Corresponding author: Yoon, Hyeongyeong College of Nursing, Eulji University 553, Sanseong-daero, Sujeong-gu, Seongnam 13135, Korea Tel: +82-31-740-7202, Fax: +82-31-740-7521, E-mail: hkyoon@eulji.ac.kr

*This research was supported by a grant from Korean Academy of Fundamentals of Nursing (2024).

Received 2025 August 22; Revised 2025 October 3; Accepted 2026 February 6.

Abstract

INTRODUCTION

According to Article 7 of the Medical Service Act [1], all nursing education institutions in South Korea must be accredited by the Korean Accreditation Board of Nursing Education (KABONE). KABONE lists 18 core nursing skills that nursing students must acquire due to their high frequency and importance in clinical practice [2]. In nursing education, fundamental nursing plays a critical role in promoting patient comfort and provides a foundation for the core nursing skills required in clinical practice [2,3].

The acquisition of new skills is a lengthy process; it begins with the stage of unconscious incompetence, in which individuals are not aware of what they do not know, followed by the stage of conscious incompetence, in which individuals recognize their deficiencies, and conscious competence, in which accuracy and refinement are achieved through repeated practice. Finally, through continuous practice and experience, learners reach the skilled stage, where the skill is performed naturally and automatically [4]. KABONE requires stepwise cultivation of core nursing skills according to the level of competency at the time of graduation [5]. Fundamental nursing practice represents the basic Level 1 stage, where students perform procedures under the instructor's guidance [5,6]. This crucial stage serves as the base for more advanced nursing education to be learned later [7]. The recommended difficulty levels for core nursing skills are categorized as high, medium, and low [5]. Hence, it is necessary to compare and analyze the importance and performance of core nursing skills acquired at the basic level to determine learners’ actual performance levels. Importance-Performance Analysis (IPA) is useful for systematically analyzing educational needs and deriving priorities [8], and has been applied in nursing education as an empirical tool for curriculum improvement [9]. IPA helps establish practical strategies to improve the quality of education by analyzing the gaps between importance and performance [10].

Currently, the fundamental nursing practice curriculum is planned and implemented by instructors at each educational institution, and the methods of teaching vary depending on instructors' perceptions of importance and performance abilities [11]. To develop stepwise competency levels as mandated by KABONE [5], it is necessary to analyze the importance and performance of core nursing skills according to the learning objectives of fundamental nursing education. In particular, to improve the curriculum, it is important to identify skills that are perceived as highly important but performed at a low level, or, conversely, those that are of low importance but performed at a high level. However, while previous studies have examined the importance and performance of safety-related practices among nurses and nursing students [12,13], few have analyzed the importance and performance of core nursing skills as perceived by educational instructors. In fundamental nursing education, the process of understanding instructors’ perceptions is essential for improving stepwise achievement levels and enhancing the curriculum. Therefore, this study was designed to analyze the importance and performance of core nursing skills based on learning objectives, as perceived by instructors of fundamental nursing practice, using IPA. This study aimed to define priorities for the qualitative improvement of the fundamental nursing practice curriculum and to provide foundational data for the development of effective educational strategies.

METHODS

RESULTS

1. Differences in Perceived Importance and Performance of Core Nursing Skills by Participants' General Characteristics

All 147 participants in this study were full-time faculty members at universities, and the majority were female (n=146, 99.3%). The mean age was 48.39±7.43 years, with 77 participants (52.4%) under the age of 50. By region of origin, Gyeongsang Province accounted for the largest proportion with 50 participants (34.0%). A total of 61 participants (41.5%) had more than 120 months of clinical experience, and 78 participants (53.1%) had more than 120 months of teaching experience. Regarding teaching experience in fundamental nursing, 80 participants (54.4%) had more than 60 months of teaching experience in theory courses, and 86 participants (58.5%) had more than 60 months in practice courses (Table 1). Analysis of differences between the mean importance and performance scores of the 27 core nursing skills based on learning objectives, according to participants’ general characteristics, showed no statistically significant differences (p<.05).

Table 1.

Differences in the Perceived Importance and Performance of Core Nursing Skills on Fundamentals of Nursing Practice Based on Participants' General Characteristics (N=147)

The credits, recognized class hours, and semesters of the fundamental nursing theory and practice courses offered at the nursing colleges to which the participants belonged are presented in Table 2. For Fundamental Nursing Theory I, 120 participants (81.6%) reported that the course was offered as 2 credits, with 122 participants (83.0%) indicating 2 class hours, and 125 participants (85.0%) reporting that it was offered in the first semester of the second year. For Fundamental Nursing Theory II, 126 participants (85.7%) indicated that the course was offered as 2 credits, 127 participants (86.4%) reported 2 class hours, and 101 participants (68.7%) noted that it was offered in the second semester of the second year. For Fundamental Nursing Practice I, 113 participants (76.9%) reported that the course was offered as 1 credit, 126 participants (85.7%) reported 2 class hours, and 104 participants (70.7%) indicated that it was offered in the first semester of the second year. For Fundamental Nursing Practice II, 90 participants (61.2%) reported that the course was offered as 1 credit, 111 participants (75.5%) reported 2 class hours, and 129 participants (87.8%) indicated that it was offered in the second semester of the second year.

Table 2.

Lecture Credits, Lab hours, and Semester of Fundamentals of Nursing Theory and Practice Courses

2. Differences in Importance and Performance of Core Nursing Skills by Major Categories of Learning Objectives in Fundamental Nursing Practice

The mean perceived importance score of fundamental nursing practice learning objectives as reported by instructors was 117.04±10.82 out of a maximum of 135, while the mean performance score was 110.54±14.73, showing a statistically significant difference (p<.001). Significant differences were also found across all six major categories (p<.005). Analysis of individual items revealed significant differences in 24 out of 27 items (p<.05), with performance levels consistently lower than importance levels in all items showing differences. The largest gap was observed in central venous therapy (F25) (t=8.318, p<.001), followed by end-of-life care, including postmortem care (E15) (t=7.391, p<.001), pressure ulcer care (F26) (t=6.982, p<.001), range of motion exercise (D11) (t=6.340, p<.001), measurement of intake and output (B6) (t=6.267, p <.001), and topical medication (F20) (t=6.046, p <.001) (Table 3).

Table 3.

Differences Between the Perceived Importance and Performance of Core Nursing Skills on Learning Objectives by Fundamentals of Nursing Practice (N=147)

3. Analysis of Educational Needs for Core Nursing Skills Based on Learning Objectives in Fundamental Nursing Practice

According to the IPA results, items were plotted into four quadrants based on the mean performance score on the X-axis (4.33) and the mean importance score on the Y-axis (4.09). In the second quadrant, which represents high importance but low performance and thus requires focused education, were fall prevention care (including use of physical restraints) (F16) and pressure ulcer care (F26) (Figure 1). In contrast, the third quadrant, which represents both low importance and low performance and indicates areas that require long-term improvement as learning objectives in fundamental nursing practice, included breathing exercises (including incentive spirometry) (A2), tracheostomy care (A5), measurement of intake and output (B6), range of motion exercise (D11), patient transfer care (including ambulation and mobility) (D12), position change (D13), thermotherapy (E14), end-of-life care (including postmortem care) (E15), topical medication (F20), and central venous therapy (F25). The first quadrant, which represents both high importance and high performance and therefore requires maintenance of the current level of education, included measurement of vital signs (including peripheral oxygen saturation) (A1), oxygen therapy (nasal cannula, non-rebreather mask, etc.) (A3), suction (A4), intermittent tube feeding (B7), intermittent catheterization (C8), indwelling catheterization (C9), enema (C10), use of protective equipment and waste management (F17), medical and surgical asepsis (F18), oral medication (F19), intramuscular injection (F21), subcutaneous injection (F22), intradermal injection (F23), intravenous infusion (F24), and drain management (F27).

Figure 1.

Importance-performance analysis of learning objectives for the fundamentals of nursing practice.

DISCUSSION

This study aimed to present directions for improving the quality of practical education by comparing and analyzing the importance and performance of core nursing skills based on learning objectives as perceived by fundamental nursing practice instructors and by deriving priorities through IPA. Core nursing skills are delivered progressively throughout three years of nursing education, during which nursing students gradually improve their proficiency through stepwise education and repeated practice [2]. In this study, 27 core nursing skills were analyzed according to the quadrants of the IPA results, and the implications of each quadrant are discussed.

Items in the first quadrant were identified as core nursing skills that fundamental nursing practice instructors perceived as highly important and frequently performed in practice education. These included measurement of vital signs (including peripheral oxygen saturation) (A1), oxygen therapy (A3), suction (A4), intramuscular injection (F21), subcutaneous injection (F22), intradermal injection (F23), intravenous infusion (F24), and indwelling catheterization (C9), among a total of 15 items. This indicates that among the 27 skills examined, those of relatively high importance are currently taught in fundamental nursing practice courses. However, nursing students perceive that among the core nursing skills, procedures that are complex and technically demanding procedures such as intramuscular injection, subcutaneous injection, intradermal injection, intravenous infusion, and indwelling catheterization are highly important, but that their actual performance ability remains low [14]. Although instructors often evaluate performance levels as high, previous studies on nursing students have reported insufficient competence. Therefore, diverse stepwise teaching methods and repeated training are considered necessary to enhance proficiency. The performance confidence of lower-year nursing students enrolled in fundamental nursing practice courses is influenced by various factors such as self-efficacy and learning attitude [15], which is consistent with the findings of this study. Thus, beyond merely increasing the frequency of practice in a laboratory setting, it is important to nurture positive learning attitudes and professional confidence. According to the 2024 Annual Patient Safety Report [16], since the enactment of the Patient Safety Act in 2016, the number of reported medication-related safety incidents has continued to increase annually since 2020, reaching a serious level of 49.8% of all incidents by 2024. Moreover, 95.9% of general hospital nurses with over one year of experience reported having made a medication error within the last three months [17]. In the medication-related skills education of nursing students, it is considered necessary to focus on actual reported cases of medication errors as the basis for teaching core medication skills. Most items in the first quadrant overlapped with the 18 core nursing skills specified by KABONE [2]. Previous research has shown that these skills maintain high levels of performance and satisfaction through repeated training and simulation-based teaching methods [18,19]. Therefore, while current educational approaches for these skills should be maintained, best practices in teaching and learning should be adopted and reflected upon to further improve nursing education.

Items in the second quadrant, fall prevention nursing (F16) and pressure ulcer care (F26), were identified as highly important but low-performing skills, indicating the need for improvement. In particular, pressure ulcer care was perceived as more important (M=4.44), but was performed less frequently (M=3.95) than fall prevention care. Unlike the core skills in the first quadrant, which mainly require precise psychomotor actions and technical procedures, these two skills are characterized as requiring comprehensive management through conceptual understanding and cognitive approaches. Therefore, although instructors recognize their importance, these skills appear to be less frequently practiced in level 1 fundamental nursing practice courses because of limited class hours and the need to cover a wide range of fundamental concepts and skills. Previous studies have shown that for second-year nursing students, a one-hour theoretical lecture followed by a scenario-based training session on pressure ulcer assessment was effective in improving knowledge and performance [20]. Simulation-based education has also been used for pressure ulcer care [21] and fall prevention [22,23]; however, these studies were conducted with fourth-year nursing students. Hence, at the Level 1 stage (second-year students), there is a need for more basic procedure-focused education tailored to the learners' level. In clinical settings, the most common medical errors have been reported as pressure ulcers, improper positioning, and medication errors [24,25]. Therefore, education on these nursing skills is considered to have the potential to reduce errors in practice. Thus Fundamental nursing courses for second-year students should introduce fall prevention and pressure ulcer care as foundational knowledge and procedural skills that can later be expanded and connected to advanced practice in higher years. Moreover, given the limited instructional time, it is necessary to adjust the priority of educational content so that students can first acquire essential basic skill competencies.

Items in the third quadrant (Low Priority) included 10 skills such as tracheostomy care (A5), central venous therapy (F25), topical medication administration (F20), and end-of-life care (including postmortem care) (E15). The third quadrant was classified as an area of low educational priority and reduced resource investment; however, some of these skills are highly important in clinical practice. Their low importance and performance ratings appear to reflect the limited instructional hours allocated to fundamental nursing practice, where emphasis is placed primarily on core skills. For example, measurement of intake and output (B6), which provides critical data for assessing fluid imbalance and guiding medication selection and treatment decisions; topical medication administration (F20), including eye drops and suppository insertion; and position change (D13), which is essential for pressure ulcer prevention, are closely related to routine nursing practice. Therefore, these skills should not be excluded from education or practiced less frequently based solely on their lower perceived importance. Particularly, central venous therapy (F25) and end-of-life care (E15) require further consideration. Their classification as low-priority items may be due to limited educational opportunities or insufficient practice design in fundamental nursing courses, rather than their true clinical importance. While simulation-based training has been shown to improve performance, such studies have been conducted with hospital nurses [26], suggesting that this skill may be too advanced to be taught at Level 1. Thus, although its importance is recognized, this skill is considered too difficult to be taught at Level 1 of fundamental nursing education and needs to be included at Levels 2 and 3 instead. In the case of end-of-life care (including postmortem care) (E15), limited opportunities for individual practice and lack of standardized educational resources may have contributed to the lower ratings. In clinical practice, nurses play a central role in supporting the family during the patient's end-of-life stage and providing postmortem care; however, implementing such training in educational settings remains a challenge [27]. Therefore, it is necessary to develop educational strategies that incorporate culturally relevant and realistic end-of-life scenarios. Future research should consider secondary analyses to reclassify third quadrant items as "low frequency but requiring reassessment of importance." Furthermore, even if some of these items are not included in the 18 core nursing skills [2], certain skills should still be addressed in practical education. Rather than excluding them because of their relatively low importance, alternative teaching and learning strategies such as reducing time allocation, instructor demonstrations, video-based observational training, and theory-focused sessions can be adopted. Further research is required to explore the educational effectiveness and appropriate curricular placement of these items.

CONCLUSION

This study is meaningful in that it systematically derived directions for improving fundamental nursing practice education by analyzing instructors’ perceptions of the importance and performance of core nursing skills according to learning objectives using the IPA method. The IPA results indicated that 15 core nursing skills with high importance and high performance were primarily procedure-oriented skills requiring refined psychomotor abilities and manual techniques, suggesting that these are being well taught in fundamental nursing practice courses. In contrast, skills with high importance but low performance—fall prevention and pressure ulcer care—require adjustment of educational priorities within the limited class hours to ensure that students acquire essential competencies in core nursing skills. Establishing a stepwise educational strategy that reflects these priorities will be necessary to strengthen nursing students' skill competencies.

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