1157207

research-article2023
SMO0010.1177/20503121231157207SAGE Open MedicineLi Chen and Zheng

SAGE Open Medicine

Original Article

SAGE Open Medicine

The satisfaction of the undergraduate Volume 11: 1­–9

© The Author(s) 2023
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nursing classroom teaching quality based sagepub.com/journals-permissions
DOI: 10.1177/20503121231157207
https://doi.org/10.1177/20503121231157207

on the Kano model in China journals.sagepub.com/home/smo

Jiu-Li Chen1 and Li-Na Zheng2

Abstract
Objectives: To investigate the satisfaction of the undergraduate nursing classroom teaching quality based on the Kano
model and provide a reference for improving the overall quality of educational services.
Methods: A total of 621 sophomores and juniors of nursing at Hubei University of Medicine were selected to conduct
questionnaires based on the Kano model using convenient sampling.
Results: The 16 items are all a one-dimensional factor. The satisfaction and importance are 0.77 to 0.86 and −0.58 to −0.80,
respectively. In the quadrant analysis chart, there are four items in the dominant area, three items for improvement, three
in the observation area, and six in the retention area.
Conclusion: Analyzing the satisfaction of nursing undergraduates’ classroom teaching quality can help us effectively
understand the intrinsic needs of students and improve the overall quality of nursing undergraduates’ curriculum teaching
services.

Keywords
Nursing, classroom teaching, quality evaluation, student satisfaction, the Kano model

Date received: 13 September 2022; accepted: 27 January 2023

Introduction knowledge in the university. Therefore, students are the cus-

Since the late 1990s, due to the rapid development of higher
education, the teaching quality of higher education has
become an essential concern of society.1 Teaching quality is
the cornerstone of higher education based on society, the
lifeline of sustainable development, and the primary factor
affecting the continuous improvement of the quality of edu-
cation and teaching in colleges and universities.2,3 With the
rapid development of society and the economy, people’s pur-
suit of quality higher education has become a higher level,
and teaching quality has unconsciously become an inherent
requirement for the development of colleges and
universities.
The World Trade Organization has incorporated educa-
tion into the service industry, and higher education service
has received more and more attention.4–6 Many educational
quality principles are founded on a comprehensive identifi-
cation and comprehension of “customer” requirements.7
Currently, the general opinion on “who are the customers of
higher education institutions” is that the “customers” of
higher education institutions are the individuals who acquire
tomers of educational services, and schools are the main
bodies that directly provide educational services.8 Quality
factors trigger emotional responses (i.e., satisfaction and dis-
satisfaction), which in turn generate behavioral intentions
and responses.9 Education serves educators and students,
and it ultimately serves the development of society. Teaching
quality is the extent of the high level and effectiveness of
teaching, which is ultimately reflected in the quality of the
students trained. Students are the customers of educational
services and are the subjects who perceive the quality of uni-
versity teaching services.10 Student satisfaction is an indirect
measure of the quality of the educational process, and the
1
School of Nursing, Hubei University of Medicine, Shi Yan, Maojian
District, China
2
Taihe Hospital, Hubei University of Medicine, Shi Yan, Maojian District,
China
Corresponding author:
Li-Na Zheng, Taihe Hospital of Hubei University of Medicine, She is
located on 32 Renmin South Rd., Shi Yan, 442000, China.
Email: 550715360@qq.com

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2 SAGE Open Medicine
level of student satisfaction directly determines the excellent
quality of the teaching and learning services of the univer-
sity.11 Student satisfaction is a subjective assessment corre-
sponding to a match/mismatch between a student’s academic
expectations and the educational experience received.12
Higher education is gradually becoming popular and interna-
tionalized, and the proportion of enrollment expansion in
colleges and universities is increasing yearly. Only by focus-
ing on students and paying attention to students’ satisfaction
can universities promote the development of universities
from passive to active. The United States was the first coun-
try to take the lead in studying student satisfaction. In 1994,
Anderson et al. pioneered the introduction of the American
Customer Satisfaction Index (ACSI) model into higher edu-
cation satisfaction measurement,13 which provided a break-
through and basis for measuring student satisfaction from a
customer satisfaction perspective. ACSI is the most widely
designed national customer satisfaction index in the world.
Subsequently, scholars from various countries use the ACSI
model for reference to build their own higher education sat-
isfaction index model. Compared with foreign countries,
domestic scholars’ research on classroom teaching satisfac-
tion is relatively scarce. In the 1990s, domestic scholars
redefined the concept of higher education satisfaction based
on customer satisfaction. According to Chinese higher edu-
cation, scholars used the ACSI model for reference and
explored establishing the Chinese higher education customer
satisfaction model.14,15 Although there are many studies in
China, most of them are limited to the scope of schools, and
the scale of research is not large enough to form a unified
model for measuring student satisfaction. At the same time,
classroom satisfaction questionnaires are usually formed in
Likert-type scales, which can only analyze the linear rela-
tionship between question indicators and satisfaction; in
reality, the linear relationship between measurement indica-
tors and student satisfaction is not presented.
Since 2011, the nursing discipline has been independent
of the second discipline of clinical medicine and has become
a first-level discipline. Nursing education in medical schools
and hospitals is receiving increasing attention.16 However,
some medical colleges still use an evaluation form to evalu-
ate all medical courses and cannot objectively assess the
teaching of nursing courses. At the same time, much of the
previous research on evaluating satisfaction or dissatisfac-
tion with quality has relied on a bipolar view. Satisfaction
and dissatisfaction lie at opposite ends of the same contin-
uum,17 requiring individuals to evaluate multidimensional
attributes of the service on an asymmetrical one-dimensional
scale. However, this bipolar conceptualization allows for
contradictory or simultaneous satisfaction, and dissatisfac-
tion is not suitable for assessing customer responses, sug-
gesting that feeling satisfied does not preclude the presence
of dissatisfaction and vice versa.
The primary function of the Kano model is to make the
invisible attributes of service quality explicit, classify user
needs, and use the satisfaction degree of functional require-
ments to influence user satisfaction. The Kano model identi-
fies three categories (i.e., delighters, satisfied, and
dissatisfied).9 The features of the satisfaction category indi-
cate that satisfaction and dissatisfaction lie on opposite ends
of a single continuum, consistent with the bipolar view. In
contrast, the characteristics of satisfaction or dissatisfaction
indicate that satisfaction and dissatisfaction are distinct con-
structs consistent with the unipolar view. Since the Kano
model captures the nonlinear relationship between product
performance and user satisfaction, it has been used to assess
the quality of classroom teaching and investigate the satisfac-
tion of nursing students. This article aims to identify students’
expectations of various indicators and objectively reflect the
quality of classroom teaching, thus exploring ways to improve
the quality of classroom teaching in undergraduate nursing
programs.
Aim
To investigate the satisfaction of the undergraduate nursing
classroom teaching quality based on the Kano model and
provide a reference for improving the overall quality of edu-
cational services.
Method
This study is a cross-sectional study.
Participants
Using convenient sampling, 621 sophomores and juniors of
nursing at Hubei University of Medicine were selected to
conduct questionnaires based on the Kano model. This study
has been approved by the ethics committee (the name of the
Independent Ethics Committee is Ethics Committee of
Shiyan Taihe Hospital, the number of the ethical approval is
2022KS42), and all students voluntarily participate and sign
a written informed consent, and the results also do not
include any identifying information.
Sample size calculation. The main estimation process is 5–10
times the number of selected variables, the number of varia-
bles involved in this article is 32, and then the sample size is
estimated to be in the interval of 160–320 cases, considering
the 10% invalid proportion of the questionnaire, and then the
sample size is determined to be 176–352 cases.
To fully understand undergraduate nursing students’ satis-
faction with the quality of classroom teaching, a total of 625
students in the second and third grades of nursing were
selected to conduct a questionnaire survey.
Inclusion criteria
(1) Undergraduate nursing students enrolled in their
sophomore and junior years.
Li Chen and Zheng 3

(2) Those who have attended nursing courses at this
stage.
(3) Able to correctly understand and answer the ques-
tions related to the questionnaire.
(4) Voluntary participation in this study.
Exclusion criteria
(1) Participants were not undergraduate students.
(2) Not having taken a nursing course.
(3) Students who did not want to participate in the study.
leading Japanese expert in quality management, was inspired
by Herzberg’s two-factor theory and proposed the concept of
the Kano model.18 According to the attributes of the product
and users’ satisfaction, the Kano model divides service qual-
ity characteristics into five types (see Figure 1).19
Basic tools of the Kano model:
Since customers’ judgments of quality attributes are highly
individualized, research using hypothesis testing is required. The
three main tools of the Kano model are the Kano questionnaire,
the Kano assessment form, and the Kano survey results form.

Survey method
The Kano model. Fundamentals of the Kano model:
The traditional quality model examines perceptions from
a one-dimensional perspective and assumes a linear relation-
ship between quality element performance and customer sat-
isfaction. However, not all quality elements have such a
linear relationship. In 1984, Professor Noriaki Kano, a
Figure 1. The Kano model.
Survey tools. The designed questionnaire was divided into
the following two parts: (1) a self-designed general informa-
tion questionnaire: including gender, age, and grade; (2) a
questionnaire on undergraduate nursing students’ satisfac-
tion with classroom teaching quality based on the Kano
model: Refer to the classroom teaching quality evaluation
scale for undergraduate nursing majors compiled by Zhao
et al.20 (The Cronbach’s alpha coefficient for the total scale
was 0.892, and the Cronbach’s alpha coefficient for each
dimension was 0.886–0.974, so the scale had good reliabil-
ity. The total scale’s content validity index (S-CVI) was
0.954, and the content validity index (I-CVI) of each item
was 0.818–1, so the scale had good content validity.) It
includes four aspects: teacher literacy (4 pairs of items), pre-
class design (3 pairs of items), classroom vitality (6 pairs of
items), and after-school reflection (3 pairs of items), with a
total of 16 pairs of items. For each of the 16 pairs of entries,
two types of questions were asked: forward and backward.
According to the Kano model attribute classification method
(see Table 1), each item has five answers to choose from. The
frequency and percentage of different classifications of each
dimension item are counted based on the respondents’
responses to the positive and negative items, combined with
the Kano classification table, and the quality attribute is
finally determined as the attribute classification with the
highest statistical frequency (Kano classification). Accord-
ing to the attributes of 16 pairs of items, satisfaction and
importance were determined, and a matrix of satisfaction
with classroom teaching quality of undergraduate nursing
students based on the Kano model was drawn.

Table 1. Kano classification table.

Negative questions

Positive questions Item Likes It should be Does not matter Can be accepted Dislikes
Likes Q A A A O
It should be R I I I M
Does not matter R I I I M
Can be accepted R I I I M
Dislikes R R R R Q

M: must-be factor; A: attractive factor; O: one-dimensional factor; I: irrelevant factor; R: reversal factor; Q: questionable result.
4 SAGE Open Medicine
Questionnaire Survey methods. The survey was conducted in
June 2022.The questionnaires of this study were mainly dis-
tributed and collected online through the questionnaire star
platform.
To ensure the quality of Kano’s questionnaire:
(1) The questionnaire was mainly pushed through the
counselors, which could effectively avoid some hap-
hazard answers;
(2) Before distributing the questionnaire, survey training
was conducted for counselors in each class, with
detailed explanations of the broad purpose of the
questionnaire study, survey notes, rules for complet-
ing the questionnaire, characteristics of the questions
(such as positive and negative questions) and the
meaning of the question items;
(3) The investigators used the students’ course breaks to
distribute the questionnaires. They used uniform
instructional language to guide students in filling out
the questionnaires, emphasizing the completeness of
the questionnaires. If students have questions about
the questions and options of the questionnaire,
explain them in time;
(4) Removed questionnaires with a completion time of
60 s or less;
(5) A part of the questionnaires that were incomplete or
inconsistent were deleted.
Statistical analysis
(1) Descriptive statistic: The survey objects’ general
information is described by the frequency, percent-
age, mean, and standard deviation.
(2) Two-dimensional attribute classification: classify
and summarize the data according to the Kano model
analysis method combined with Excel form, and get
the quality characteristic classification of each
element.
(3) Better–Worse coefficient analysis: The Better–
Worse coefficient analysis method proposed by
Berger evaluates the satisfaction of each function
point by calculating the coefficient. In addition, it is
necessary to draw the importance quadrant of
satisfaction.
Results
Demographics
The survey recovered 625 questionnaires, of which 621 were
valid, so the effective recovery rate was 99.36%. Among
them, 424 (68.28%) were in the second grade, 197 (31.72%)
were in the third grade, 68 were male (10.95%), and 553
(89.05%) were female. The general information of nursing
students is shown in Table 2.
Table 2. General information of nursing students (n = 621).
Item Item Proportion (%)
Gender Male 68 (10.95)
Female 553 (89.05)
Age Under 18 years old 3 (0.48)
18–20 551 (88.73)
21–23 67 (10.79)
Grade Class of 2019 197 (31.72)
Class of 2020 424 (68.28)
Attributes of satisfaction with the quality of
classroom teaching for undergraduate nursing
students
Calculate the proportion of M, O, A, I, and R in each indica-
tor using the Kano classification table criteria. Taking the
maximum value as the index attribute of the item, the clas-
sification table of the quality characteristics of teaching qual-
ity satisfaction is obtained, and the SI and DSI (SI refers to
satisfaction and DSI refers to importance) are calculated
according to the attribute of the item index (see Table 3).
The results showed 16 attributes of satisfaction with
classroom teaching quality of undergraduate nursing stu-
dents, 16 of which are expected needs. That is, respondents’
satisfaction is proportional to the degree of fulfillment of this
demand.21 It can be seen from Table 3 that the item with the
highest SI value is “create a good classroom atmosphere”
(0.86), indicating that student satisfaction will be increased
by 86% after creating a good classroom atmosphere, while
the item with the highest DSI value is “good teacher ethics
and style” (0.80), indicating that if this service is ignored,
patient satisfaction will decrease by 80%.
The matrix diagram is plotted based on each entry’s satisfac-
tion and importance results. The results of the Better–Worse
indices in Table 3 were plotted against the satisfaction matrix
using the Excel tool. The vertical coordinate is the SI value,
the horizontal coordinate is the DSI, and the origin is the SI
and DSI mean. In plotting the quadrant diagram, take the
absolute value of the DSI value. The mean SI value is
0.819375, and the mean DSI value is −0.819375. The mean
of SI and DSI values was used as the coordinate origin, and
the origin was (0.819375, 0.66875). The advantage area,
improvement area, observation area, and reserved area are
located in the first, second, third, and fourth quadrants,
respectively. Among them, 4, 5, 13, 16 in the advantage area;
1, 2, 3 in the improvement area; 5, 7, 14 in the observation
area; 8, 9, 10, 11, 12, 15 in the reserved area (see Figure 2).
Discussion
Students are one of the subjects that determine the quality of
education. Colleges and universities must “listen to the voice
Li Chen and Zheng 5

Table 3. Classification table of quality characteristics of undergraduate nursing classroom teaching.

Quality serial number M A O I R Q Kano classify SI DSI

Function number
1. Good teacher ethics and style 78 60 385 57 2 39 O 0.77 −0.80
2. Elegant manners and etiquette 42 105 366 71 2 35 O 0.81 −0.70
3. Excellent professional knowledge 71 77 386 53 0 34 O 0.79 −0.78
4. Strong teaching ability 44 101 383 60 2 31 O 0.82 −0.73
5. Correct use of teaching methods 40 130 328 92 4 27 O 0.78 −0.62
6. Correct use of teaching means 39 106 385 66 1 24 O 0.82 −0.71
7. Preparation and preview before class 50 137 337 72 2 23 O 0.80 −0.65
8. Create a good classroom atmosphere 25 169 340 61 1 25 O 0.86 −0.61
9. Cultivate students’ interest in learning 23 163 341 67 3 24 O 0.85 −0.61
10. Students’ ability development 29 140 365 60 4 23 O 0.85 −0.66
11. Knowledge extension 28 174 326 71 0 22 O 0.83 −0.59
12. Actively organizing counseling and answering questions 32 158 343 66 1 21 O 0.84 −0.63
13. Curriculum setting 42 132 374 53 0 20 O 0.84 −0.69
14. Course ideological and political 36 129 340 92 3 21 O 0.79 −0.63
15. Open lab courses 27 176 315 74 6 23 O 0.83 −0.58
16. Internships and clinical practice 38 109 384 61 8 21 O 0.83 −0.71

SI = (A + O)/(A + O + M + I), the closer the value is to 1, the higher the satisfaction of students with this demand;
DSI = −1 × (O + M)/(A + O + M + I), the closer the value is to −1, the more important the student considers the need to be. M: must-be factor; A: attrac-
tive factor; O: one-dimensional factor; I: irrelevant factor; R: reversal factor; Q: questionable result. A matrix of satisfaction with the quality of classroom
teaching for undergraduate nursing students based on the Kano model.

Figure 2. Satisfaction and importance matrix.

of the clients” and pay attention to students’ expectations and students and provide a basis for improving students’ satisfac-
feelings. The Kano model is now widely used in higher edu- tion with the classroom. The results of this study show that
cation,22–24 which can effectively identify the needs of college because the Kano model has the advantage of integrating
6 SAGE Open Medicine
many factors such as user expectations, sociocultural and
psychological, and its revelation of the transformation of
types of needs over time; it is natural to conclude that stu-
dents’ requirements also change over time, reflecting their
internal expectations.8 As a result, the Kano model was used
to investigate nursing undergraduates’ satisfaction with class-
room teaching quality, precisely and effectively determine the
quality attributes of students’ demand for nursing profes-
sional classroom teaching services, and identify the key fac-
tors influencing students’ satisfaction.
Analysis of functional attributes of the quality of
classroom teaching
Must-be quality service indicators. Must-be quality service
means that students think the classroom must have these
functions and will evaluate a classroom that does not have
these functions as substandard. At the same time, however,
teachers’ continuous optimization of such functions does not
significantly affect teaching satisfaction, that is, the “health
factor” in teaching. According to the results of the survey,
students do not have the must-be quality attributes for func-
tional evaluation of classroom teaching quality, which may
be due to the fact that, on the one hand, research on class-
room teaching quality evaluation in nursing in China started
late, and students do not have a deep enough understanding
of the location and importance of nursing courses. Jiang
et al. argued that the late start of teaching quality evaluation
research in medical schools in China and the continuous
research time of classroom teaching quality evaluation in
medical colleges is short.25 Lin et al. argued that students are
the main learning body and need to clarify the position and
importance of this professional course in the profession.26
On the other hand, it lies in the many years of educational
philosophy in China, which focuses on “teaching” but not
“learning” and does not highlight the centrality of students.
Sun et al. and Katawazai et al. agree that to truly improve the
satisfaction of undergraduate nursing students with the qual-
ity of classroom teaching; it should highlight students’ lead-
ing position. Change the teaching concept from
“teacher-centered” to “student-centered,” put students at the
center of classroom teaching, and always grasp the “student-
centered” educational idea in teaching activities.27,28 Treat
the students as unique individuals, with their values, ideas,
beliefs, and worldviews.29 A student-centered learning
approach encourages students to take more responsibility for
their learning. In the process of education and teaching,
teachers need to pay attention to the fundamental needs of
students and meet the changing requirements of students to a
greater extent. Effectively put the quality of talent training in
the first place, continuously improve the quality of teaching,
and improve student satisfaction.30 At the same time, nursing
educators must constantly adjust and evaluate their teaching
methods to ensure that every teaching method used in the
nursing curriculum promotes higher level learning, critical
thinking skills, and practical application of knowledge,31 in
order to continuously improve the quality of undergraduate
nursing talent training. Some studies have also shown that
student-centered teaching strategies can enhance patient
safety skill competence in the clinical setting.32
One-dimensional quality service indicators. One-dimensional
attribute refers to the service users expect to provide, which
has a linear relationship with satisfaction. If this attribute
performs well, students’ satisfaction will be high, while those
with poor performance will be dissatisfied. Among the 16
indexes, 16 belong to one-dimensional quality. To improve
students’ satisfaction, we must constantly optimize these
functions. Studied students’ satisfaction from five dimen-
sions—teaching ethics, teaching ability, teaching contents,
teaching methods, and teaching outcomes.33 Liu et al.
improve the teaching quality and students’ satisfaction by
stimulating the classroom teaching vitality, optimizing the
curriculum, enhancing the practicality of teaching content,
and strengthening the practice and practice links.34
Better–Worse quadrant chart analysis of the
quality of classroom teaching demand
Grasp the requirements of expected attributes, increase satisfac-
tion, and eliminate dissatisfaction. The improvement of teach-
ing quality depends on the construction of teaching staff.
Good teaching ability can promote the cultivation of nursing
students’ knowledge and, meanwhile, improve the overall
quality of the teaching team.35 The college needs to take a
variety of methods to improve the development of teachers’
teaching ability, focus on enhancing the knowledge and
teaching practice ability of the teaching staff,36 and encour-
age teachers to carry out teaching academic research and
exchanges in a targeted manner. With the development of
information technology, teachers should be able to handle
modern information technology, adapt to the changes of
information technology, artificial intelligence, and other new
technologies, and carry out education and teaching actively
and effectively.37 The aim is to promote the reform and
development of teacher education in the new era and improve
the quality of teacher education.38 Nursing practice can max-
imize the cultivation of students’ analytical and problem-
solving skills, practical operation ability, and innovation
ability. Schools should combine the nature of the nursing
profession, classify, and set the standards of practice teach-
ing, appropriately increase the proportion of practice teach-
ing, reform and innovate the content of practice teaching,
and improve the conditions of practice teaching.
Enhancing the demand for charming attributes and focusing on
improving student satisfaction. The second quadrant is the
charisma factor. Indicators in this quadrant have a strong
influence on satisfaction but a low ability to eliminate the
effect of dissatisfaction. An exemplary implementation of
Li Chen and Zheng
the corresponding educational service indicators will sur-
prise students and failure to implement these academic ser-
vice indicators will not make students feel dissatisfied. The
three significant indicators of “good teacher ethics and
style,” “elegant manners and etiquette,” and “excellent pro-
fessional knowledge” are the charm elements. Focusing on
these three indicators is conducive to improving students’
satisfaction with the school’s educational services and creat-
ing the characteristics and highlights of the school’s educa-
tional services. A teacher’s role model has a significant
impact on the students; uncivil behavior endangers the phys-
ical and mental health of faculty and students.39 Teachers
should consider the factors that influence education at all
times. Students will be infected and educated with decent
manners and good etiquette in the classroom, which will sig-
nificantly improve the teaching effect, and then achieve the
set teaching goals. The construction of teachers’ morality
and style occupies an essential position in the structure of
college teachers and is the first criterion for evaluating the
quality of teachers.40 Good teachers’ morality and style are
college teachers’ essential qualities and necessary condi-
tions. Strengthen the construction of teachers’ morality and
style, and firmly guide most teachers to stand up with virtue,
learn with integrity, and teach with virtue.41 Teachers are the
mirrors of students’ moral cultivation. Preparing nurses at all
levels to be moral agents is a critical job of the profession,
specifically nursing education.42 Thus, college teachers
should strengthen their moral obligations, abide by the basic
norms of teacher morality, strengthen the construction of
their ethics and style, and improve teacher morality and style
construction. Teachers also should continuously replenish
self-knowledge reserves, master excellent professional
knowledge, improve their professional quality, and improve
the quality of nursing education and teaching to meet teach-
ing needs.
Guarantee the demand for undifferentiated attributes and
weaken the fluctuation degree of dissatisfaction. The third
quadrant is no difference factor. The educational service
indicators in this quadrant have little influence on improving
students’ satisfaction and eliminating dissatisfaction. There-
fore, the school can appropriately reduce the investment in
these educational services with the limited supply of various
resources. “Correct use of teaching methods” is located in
this quadrant. However, Liu et al. think that “teaching meth-
ods” is an item that has a high impact on teaching quality, but
the actual satisfaction evaluation is not high.34 The reason for
the inconsistency with the results of this study is that, on the
one hand, he studied “double first-class” universities, while
in this study, it is a general university; on the other hand, it is
because with the continuous development of computers and
the 2019 coronavirus disease (COVID-19) pandemic, multi-
media has gradually entered the campus classroom, and the
nursing education model is also changing.43 Various teaching
methods, such as MOOCs, micro-course, blended teaching,
7
flipped classrooms, and virtual simulation, are emerging.
Compared with traditional education, multimedia teaching
has the characteristics of diversity, intuition, and interaction,
which enriches the teaching form, attracts students to a cer-
tain extent, and improves participation.44,45 “Course Ideo-
logical and Political” is also located in this quadrant. Zhang
et al. found that students resented the over-injection of ideo-
logical and political elements and hard sensationalism after
integrating course ideology and politics into professional
courses.46 Firstly, the integration of ideology and politics
with nursing courses started late and was only explicitly pro-
posed by the Ministry of Education in May 2020.47 Secondly,
most of the teachers of professional courses lack the element
of “moral education” in the implementation of “ideological
politics in curriculum,” and are only “thinking and politics
for thinking and politics,” and they are unable to motivate
students to think and assimilate it on their own.
Solidify must-be attribute requirements and strongly reduce dis-
satisfaction. The fourth quadrant is the must-be factor. The
indicators of educational services in this quadrant have low
pulling power but a high ability to eliminate dissatisfaction
for students’ satisfaction. There are related educational ser-
vices that will not satisfy students, but if such services are
not provided, students’ dissatisfaction will be significantly
increased. Schools should secure these educational service
base items. Through an empirical study of undergraduate
teaching quality satisfaction in general universities, Li found
that students’ professional interest has the most significant
impact on teaching effectiveness and is an important reflec-
tion of teaching effectiveness.48 Jiang et al. concluded that
interactive participation of teachers and students in the learn-
ing process, teaching feedback from nursing students, and
troubleshooting from teachers could improve teaching qual-
ity.49 Liu et al. found that creating a good classroom atmos-
phere and providing extracurricular learning materials for
knowledge expansion can be an excellent way to improve
student satisfaction.50
At the same time, because the user’s demand attributes
are periodic rather than constant, these characteristics may
be transformed into attractive quality characteristics with the
passage of time and the continuous improvement of func-
tions. Therefore, in improving the education of nursing
undergraduates, we should continuously tap the potential
needs of students, adopt active strategies, and attach impor-
tance to tracking and improving these quality
characteristics.
However, there are still shortcomings: First, there is no
different analysis of students' satisfaction by grade. Secondly,
this survey only focuses on nursing students in this institu-
tion but does not extend the survey to the whole country, so
it is not universal enough. Thirdly, the research results are of
the times because the attributes of the Kano model will
change and develop with time, and the categories and impor-
tance of educational service factors will also change with
8 SAGE Open Medicine
time. Therefore, school education administrators should
establish a dynamic and phased demand survey mechanism
from the students’ perspective and adjust the types and meth-
ods of educational services on time to effectively promote
better employment and overall development of students.
Conclusion
Technological progress is accelerating with the continu-
ous development of the economy and society, and signifi-
cant changes have occurred in the international
environment, which puts forward new talent require-
ments. Traditional teaching in colleges and universities
also faces challenges. Colleges and universities, as talent
training center, can only adapt to social needs and improve
student satisfaction by making changes. This article
applies the Kano model to the evaluation of classroom
teaching quality in nursing from the perspective of stu-
dents’ needs, derives the attributes of the elements affect-
ing the quality of nursing teaching, effectively grasps the
classification of students’ needs, analyzes the critical fac-
tors affecting their satisfaction, and provides a reference
for exploring ways to improve the quality of classroom
teaching in undergraduate nursing.
Acknowledgements
Thanks to Ye Hui for revising the grammar of the manuscript.
Author contributions
J-LC was involved in conception and design, acquisition of data,
analysis and interpretation of data, statistical analysis, supervision,
and writing—original draft. L-NZ was involved in conception and
design, investigation, methodology, and writing—review and
editing.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Ethics approval
This study has been approved by the ethics committee (the name of
the Independent Ethics Committee is Ethics Committee of Shiyan
Taihe Hospital, the number of the ethical approval is 2022KS42).
Informed consent
All students voluntarily participate and sign a written informed
consent.
ORCID iD
Jiu-Li Chen https://orcid.org/0000-0001-9284-0485
Supplemental material
Supplemental material for this article is available online.
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