Heliyon 5 (2019) e02650

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Heliyon
journal homepage: www.heliyon.com

Research article

An analysis of evidence-based practice courses in Korean nursing

education systems
Chi Eun Song a, *, Weon Gyeong Kim a, You Jin Lim b
a
Department of Nursing, Nambu University, Gwangju, South Korea
b
Department of Nursing, Gwangju Health University, Gwangju, South Korea

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: This study aims to examine the current status of evidence-based practice (EBP) courses and EBP-related
Education courses in Korean nursing education systems.
Evidence based practice Method: Subject institutions were 159 institutions including 99 universities and 60 colleges with a bachelor's
Nursing
degree program accredited by the Korean Accreditation Board of Nursing Education. Two researchers indepen-
Undergraduate
Curriculum
dently collected data from the subject institutions based on the curricula published on the website of each uni-
versity or college, and the collected datasets were cross-checked to ensure data accuracy.
Results: EBP courses were found in a small portion of institutions (13.2%). Research courses were offered in most
institutions (98.7%), but they were usually provided to third- or fourth-year students.
Conclusion: Understanding the concept of EBP and knowledge of nursing research and statistics are both pre-
requisites to strengthening the EBP competence of nursing students. Therefore, it is imperative to equip them with
the required knowledge prior to their clinical practicum.

1. Introduction with theoretical learning, in-school practice, and clinical practice

(Finotto et al., 2013). In the case of the U.K., EBP education is obligatory
Evidence-based practice (EBP) is a competence essential for nurses in at nursing colleges. Various teaching methods are adopted for students to
the 21st century (Albarqouni et al., 2018). EBP helps nurses make improve performance as well as belief in the value of EBP (Reid et al.,
appropriate clinical decisions with the best current evidence, nurses' 2017).
expertise, and patients' values and preferences (Melnyk and The Korean Accreditation Board of Nursing Education emphasizes the
Fineout-Overholt, 2019). Through EBP, it is possible to secure patient importance of establishing an education system based on learning per-
safety and improve the quality of nursing as well as reduce the gap be- formance in order to improve the quality of Korean nursing education.
tween theories and the practice of nurses (Svejda et al., 2012). Therefore, Since 2004, nursing bachelor's degree programs have been evaluated
EBP is an important competence for baccalaureate nursing students and through a five-year certification system. The Korean Accreditation Board
can be developed through systematic curriculum management in college of Nursing Education presents 12 indices of nursing bachelor's degree
education. program performance, none of which is related directly to EBP compe-
Around the globe, diversified efforts are put forth toward improving tence. However, learning performance relevant to EBP competence may
the EBP competence of nursing students. For example, curricula are be evaluated in terms of integrated nursing skill application, nursing
revised to operate more research courses that reflect the concept of EBP process application based on critical thinking, clinical inference, and
more thoroughly (Bloom et al., 2013), and EBP education models are nursing research planning and direct implementation. Each school needs
developed to enhance this competence more effectively (Moch and to operate curricula for required learning achievements from entrance to
Cronje, 2010). In addition, clinical experience, in addition to theoretical graduation. Curriculum revision can be done autonomously at each
knowledge, is important for nursing students in securing EBP compe- university. But due to the limited credits required for graduation, there
tence. For this reason, a three-year EBP course is operated in connection may be restrictions on course opening.

* Corresponding author.
E-mail address: [email protected] (C.E. Song).

https://doi.org/10.1016/j.heliyon.2019.e02650
Received 16 August 2019; Received in revised form 3 October 2019; Accepted 9 October 2019
2405-8440/© 2019 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
C.E. Song et al. Heliyon 5 (2019) e02650

Recent studies on the EBP competence of clinical nurses in Korea indicate 2.4. Analysis
that there is an urgent need for reorganization of existing nursing
curricula. According to one survey conducted among general hospital The program years and semesters, the number of courses were
nurses regarding factors affecting the level of EBP preparation and analyzed and converted into frequency and percentage data.
evidence-based practical competence, 70% of the subjects answered that
they did not know EBP. Nurses showed the lowest level of knowledge 3. Results
regarding how to convert required information into clinical questions.
Their level of belief in research finding applicability was also low, and 3.1. EBP courses and EBP-related courses offered
they found it difficult to interpret statistical data. These survey results
indicate that research capability was the factor with the most significant EBP courses were offered in 21 of the 159 schools (13.2%): in 13 of
effect on EBP competence. However, about 78% of the subjects recog- the 99 universities (13.1%) and in eight of the 60 colleges (13.3%).
nized the necessity of research grounds in practical clinical settings (Ryu Nursing research courses were offered in 157 institutions overall
et al., 2016). In a survey conducted among nurses who had been men- (98.7%): in 98 universities (99.9%) and in 59 colleges (98.3%). In
tored by a preceptor (a role model for new nurses), regarding their belief, addition, 28 out of those 157 schools (17.8%) offered nursing research
knowledge, and performance level of EBP, about 61% of the subjects courses during two or more semesters. Nursing process courses were
answered that they knew little or nothing about EBP even though 66% of offered in 138 of the institutions (86.6%): in 80 universities (80.8%) and
the subjects had completed research courses (Yoo and Oh, 2012). in 58 colleges (96.7%). Nursing informatics courses were offered in 89 of
These findings imply that Korean nursing education needs to be the institutions (56.0%): in 57 universities (57.6%) and in 32 colleges
changed in the context of EBP, with demands for this curriculum change (53.3%). Statistics courses were offered in 79 institutions (49.7%): in 47
increasing in Korean nursing education circles as well (Oh et al., 2016). universities (47.5%) and in 32 colleges (53.3%). These results are shown
As far as we know, there have been no papers that have specifically in Table 1.
analyzed the EBP curriculum of all Korean nursing colleges. Accordingly,
the target of this study is to examine the actual condition of EBP and
3.2. Program years and semesters in which EBP and EBP-related courses
EBP-related course operation among nursing colleges in Korea and pro-
were offered
vide a basis for curriculum revision based on the data of program
learning performance presented by the Korean Accreditation Board of
Results of the analysis of years and semesters for which each course
Nursing Education. The findings of this study are anticipated to be used
was offered in target institutions are presented in Table 2. For some in-
to design education programs for improving the EBP competence of
stitutions, this information could not be found on their web pages. EBP
nursing students.
courses were offered in the second semester of the fourth year in nine
institutions (42.9%) out of 21 and in the first and second semesters of the
2. Method third year in five institutions (23.8%). Nursing research courses were
offered in the first semester of the fourth year in 55 institutions (35.3%)
2.1. Study design out of 156, in the first semester of the third year in 35 institutions
(22.4%), and in the second semester of the third year in 32 institutions
This was a descriptive study that examined EBP courses and is (20.5%). Nursing process courses were offered in the second semester of
intended to provide a basis for revising curricula designed to improve the second year in 81 institutions (58.7%) out of 138 and in the first
EBP competency among Korean nursing students. semester of the second year in 49 institutions (35.5%). Nursing infor-
matics courses were offered in the second semester of the third year in 18
2.2. Research target institutions (21.2%) out of 85, in the second semester of the second year
in 16 (18.8%), in the first semester of the second year in 15 (17.6%), in
Research targets included institutions with five-year nursing bache- the first semester of the third year in 14 (16.5%), and in the second se-
lor's degree programs that have been certified by the Korean Accredita- mester of the fourth year in 13 (15.3%). Statistics courses were offered in
tion Board of Nursing Education. The targets were identified from the first semester of the second year in 19 institutions (24.4%) out of 78,
information posted on the Korean Accreditation Board of Nursing Edu- in the second semester of the second year in 18 (23.1%), and in the
cation website as of June 12, 2018. Among the171 institutions listed, 107 second semester of the first year and the first and second semesters of the
were universities and 64 were colleges. third year in nine (11.65%).

2.3. Materials and procedure 3.3. Number of EBP courses and EBP-related courses offered

Curricula were analyzed based on the information posted on the Among 159 institutions, 61 offered three courses (38.4%), 48 offered
website of each institution. This information was openly accessible to four courses (30.2%), and 45 offered two courses (28.3%). A single
everyone. Therefore, there was no need to receive approval from an course was offered by three institutions (1.9%), and two offered five
ethics committee. Target courses included EBP courses and EBP-related courses (1.3%).
courses. EBP-related courses were selected among materials relevant to
nursing research, nursing statistics, nursing informatics, and nursing Table 1
processes based on the literature review (Oh et al., 2016). Data were EBP courses and EBP-related courses that were offered.
collected using an Excel-based analysis framework. Analysis items School type EBP Nursing Nursing Nursing Statistics
included school names, locations, course names, program years and se- research process informatics
mesters for such subjects, and so forth. To ensure data accuracy, two n (%) n (%) n (%) n (%) n (%)
researchers collected the same information from each university and
Total (N ¼ 21 157 (98.7) 138 (86.6) 89 (56.0) 79
college separately, and then collected data was cross-checked for data 159) (13.2) (49.7)
integrity. Data analysis was conducted on entries from 159 institutions University (N 13 98 (99.9) 80 (80.8) 57 (57.6) 47
including 99 universities and 60 colleges, excluding 12 of the 171 total ¼ 99) (13.1) (47.5)
educational institutions due to insufficient or unavailable information on College (N ¼ 8 59 (98.3) 58 (96.7) 32 (53.3) 32
60) (13.3) (53.3)
those institutions' websites.

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C.E. Song et al. Heliyon 5 (2019) e02650

Table 2 developed a three-year EBP course connecting nursing disciplines to

Years and semesters for which EBP courses and EBP-related courses were offered. laboratory and clinical training with the aim to help students enhance
Year- EBP Nursing Nursing Nursing Statistics their EBP process application skills. In the U.K., since EBP education
semester research process informatics became obligatory during all three years of every undergraduate nursing
N ¼ 21 N ¼ 156 N ¼ 138 N ¼ 85 N ¼ 78 degree program, students' professed belief in and use of EBP improved in
an assessment of the practical application of a blended learning strategy
1-1 0 (0.0) 0 (0.0) 1 (0.7) 0 (0.0) 2 (2.6)
1-2 0 (0.0) 0 (0.0) 2 (1.4) 3 (3.5) 9 (11.5)
using lectures, small group teaching, and an online eResource (Reid et al.,
2-1 0 (0.0) 6 (3.8) 49 (35.5) 15 (17.6) 19 2017). The University of Wisconsin-Eau Claire has developed
(24.4) Student-Enabled Practice Change (UPEC) curricular models to help stu-
2-2 0 (0.0) 12 (7.7) 81 (58.7) 16 (18.8) 18 dents develop competence and become EBP leaders (Moch and Cronje,
(23.1)
2010).
3-1 5 35 (22.4) 5 (3.6) 14 (16.5) 9 (11.5)
(23.8) The results of this research indicate that among nursing colleges and
3-2 5 32 (20.5) 0 (0.0) 18 (21.2) 9 (11.5) universities in Korea, EBP courses and nursing research courses were
(23.8) most commonly part of the third-year and fourth-year semesters. Nursing
4-1 2 (9.5) 55 (35.3) 0 (0.0) 6 (7.1) 6 (7.7) process courses were most often included in the second-year semesters.
4-2 9 16 (10.3) 0 (0.0) 13 (15.3) 6 (7.7)
(42.9)
Particularly regarding the EBP courses, about 43% were provided in the
second semester of the fourth year. Malik et al. (2017) emphasize that
students' experience of EBP processes in practical clinical settings is
4. Discussion important for EBP competence improvement. Moch et al. (2010) also
emphasize the importance of providing education programs that help
The intent of this study was to provide a basis for revising curriculum students develop scientific research process skills, critical thinking, and
to improve EBP competence among Korean nursing students. To this end, information literacy skills, especially through practical clinical training
the actual condition of EBP course and EBP-related course operation so that students' belief in and attitude toward EBP can be improved. Since
among nursing schools in Korea (universities and colleges) was clinical training for nursing students' EBP competence is of great
examined. importance, such factors as critical thinking, understanding of research
The results showed that the percentage of nursing schools in Korea and statistics, and acquisition of theoretical knowledge need to precede
opening independent EBP courses among the 159 schools analyzed was clinical education for effective competence development. Among nursing
as low as about 13%. When curricula among 21 institutions in Taiwan colleges and universities in Korea, clinical education is implemented
were compared (Hung et al., 2015), the results indicated that about 86% mostly in the third year. Therefore, acquisition of theoretical knowledge
of them conducted EBP education, about 22% operated independent EBP regarding the concept and process of EBP needs to be practiced early in
courses, and 50% taught EBP concepts in other courses. This study ana- nursing curricula.
lyzes content available on the websites of the target institutions, and it In Korea, there have been few reports on the development and
does not examine whether other courses include education on the effectiveness of Korean EBP education models. However, the necessity of
concept of EBP. However, most institutions focused on courses for state curriculum revision has been recognized, and there are high demands for
examinations while EBP courses were offered by only 15% of schools, EBP courses (Oh et al., 2016). It is expected, therefore, that reporting the
which indicates the necessity and importance of emphasizing EBP edu- evidence of their effectiveness will promote the development of varied
cation in academic circles. education programs for EBP competence enhancement among Korean
According to the Korean Accreditation Board of Nursing Education, nursing students.
curricula in Korean nursing colleges and universities are divided into This study is of significance in that it analyzes the entire nursing
liberal arts courses and majors, and the credits for major courses are curricula of four-year nursing colleges and universities in Korea with
between 70 and 90 points (Education). Thus, there may be limitations to bachelor's degree programs that have been certified by the Korean
offering separate EBP education courses and integrating EBP education in Accreditation Board of Nursing Education. However, data from some
existing courses may be more efficient. The results of this study indicated institutions may not reflect their current status, since only the data
that most institutions offered nursing research courses and nursing pro- available on their websites was referred to and analyzed. We attempted
cess courses. One major factor affecting EBP competence among Korean to find open courses that were classified as elective major courses and not
clinical nurses was research ability (Ryu et al., 2016), and two variables mandatory courses by searching noticeboards, schedules, etc. posted on
affecting Korean nursing students' attitude towards evidence-based the schools' websites as thoroughly as possible, but some available
practice were critical thinking and EBP knowledge (Choi et al., 2016). courses may not be readily found on an institution's website. These
Nursing colleges and universities in Korea need to improve their ed- limitations must to be recognized when interpreting the findings of this
ucation programs by adjusting the existing courses. The University of study.
North Florida School of Nursing in the United States redesigned and Based on the results of this study, we will develop an EBP course that
improved three research courses so that undergraduate students could links campus education and clinical education. Also, the diverse and
complete EBP courses (Bloom et al., 2013). In the first course, EBP con- creative teaching methods and learning contents need to be developed to
cepts and process of literature review are introduced. This course is revise existing course effectively. This is expected to improve the EBP
offered early in the nursing program. The second course is provided to competency of nursing students.
students who have completed their clinical practicum in the first two
semesters. Critical appraisal of a primary research report is emphasized 5. Conclusions
in this course. The third course, open for those in their final semester, is
operated with a simulation approach to afford students the opportunity EBP competence is a fundamental element for professional nurses.
to participate in an evidence-based project. This education program Thus, it needs to be developed systematically through curricula in un-
provides a good example of how education programs can better incor- dergraduate programs. As EBP-related courses were analyzed to identify
porate EBP. a basis for efficient curriculum revision, it turned out that about 13% of
Many colleges and universities around the globe redesign curricula nursing colleges and universities in Korea conducted evidence-based
and measure their effectiveness on a regular basis so that EBP education nursing practice courses. It also turned out that most colleges and uni-
is provided over general nursing curricula from lower to higher program versities included EBP and research courses in higher program years. In
years. The University of Modena and Reggio Emilia in Italy, for example, order to help nursing students develop EBP competence efficiently,

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C.E. Song et al. Heliyon 5 (2019) e02650

therefore, it is necessary to develop clinical practice programs through statement based on a systematic review and delphi survey. J. Am. Med. Assoc. JAMA
Netw. Open 1 (2), e180281.
which students can experience EBP and to redesign courses to apply
Bloom, K.C., Olinzock, B.J., Radjenovic, D., Trice, L.B., 2013. Leveling EBP content for
various teaching/leaning methods so that basic factors for EBP such as undergraduate nursing students. J. Prof. Nurs. Off. J. Am. Assoc. Coll. Nurs. 29 (4),
critical thinking, knowledge on research utilization, and theoretical 217–224.
knowledge on EBP processes can precede clinical education. Choi, M.H., Kim, Y.H., Son, H.M., 2016. Factors influencing evidence-based practice
attitudes among undergraduate nursing students. J. Korean Acad. Soc. Nurs. Educ. 22
(3), 274–282.
Declarations Finotto, S., Carpanoni, M., Turroni, E.C., Camellini, R., Mecugni, D., 2013. Teaching
evidence-based practice: developing a curriculum model to foster evidence-based
practice in undergraduate student nurses. Nurse Educ. Pract. 13 (5), 459–465.
Author contribution statement Hung, H.Y., Huang, Y.F., Tsai, J.J., Chang, Y.J., 2015. Current state of evidence-based
practice education for undergraduate nursing students in Taiwan: a questionnaire
C. H. Song: Conceived and designed the experiments; Analyzed and study. Nurse Educ. Today 35 (12), 1262–1267.
Korean Accreditation Board of Nursing Education. Evalution criteria of nursing education
interpreted the data; Contributed reagents, materials, analysis tools or certification. Retrieved from http://www.kabone.or.kr/kabon02/index04.php.
data; Wrote the paper. Malik, G., McKenna, L., Griffiths, D., 2017. Using pedagogical approaches to influence
W. G. Kim: Conceived and designed the experiments; Analyzed and evidence-based practice integration - processes and recommendations: findings from
a grounded theory study. J. Adv. Nurs. 73 (4), 883–893.
interpreted the data. Melnyk, B.M., Fineout-Overholt, E., 2019. Evidence-Based Practice in Nursing &
Y. J. Lim: Contributed reagents, materials, analysis tools or data; Healthcare: a Guide to Best Practice, fourth ed. Wolters Kluwer, Philadelphia.
Wrote the paper. Moch, S.D., Cronje, R.J., 2010. Part II. Empowering grassroots evidence-based practice: a
curricular model to foster undergraduate student-enabled practice change...second of
a three-part series. J. Prof. Nurs. 26 (1), 14–22.
Funding statement Moch, S.D., Cronje, R.J., Branson, J., 2010. Part I. Undergraduate nursing evidence-based
practice education: envisioning the role of students...first of a three-part series.
This work was supported by The National Research Foundation of J. Prof. Nurs. 26 (1), 5–13.
Oh, E.G., Yang, Y.L., Yoo, J.Y., Lim, J.Y., Sung, J.H., 2016. Mixed method research
Korea Grant funded by the Korean Government (NRF- investigating evidence-based practice self-efficacy, course needs, barriers, and
2018R1D1A3B07050090). facilitators: from the academic faculty and clinical nurse preceptors. J. Korean Acad.
Nurs. 46 (4), 501–513.
Reid, J., Briggs, J., Carlisle, S., Scott, D., Lewis, C., 2017. Enhancing utility and
Competing interest statement understanding of evidence based practice through undergraduate nurse education.
BioMed Cent. (BMC) Nurs. 16, 1–8.
The authors declare no conflict of interest. Ryu, S.A., Kim, Y.S., Kim, Y.H., 2016. Factors influencing of evidence based practice
competency and evidence based practice readiness in general hospital nurses. J. Kor.
Acad. Nurs. Adm. 22 (5), 448–460.
Additional information Svejda, M., Goldberg, J., Belden, M., Potempa, K., Calarco, M., 2012. Building the clinical
bridge to advance education, research, and practice excellence. Nurs Res Pract 2012,
826061.
No additional information is available for this paper. Yoo, J.Y., Oh, E.G., 2012. Level of beliefs, knowledge and performance for evidence-based
practice among nurses experienced in preceptor role. J. Kor. Acad. Nurs. Adm. 18 (2),
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