Discussion
anxiety
This study aimed to develop and evaluate a mobile app-based cultural care training program specifically designed for nursing students in Iran. The study results indicated that the implementation of this program led to significant improvements in cultural capacity and humility among the nursing students.First, to develop the training program, the researchers followed the five stages of the ADDIE instructional model. This systematic instructional model proved to be effective in guiding the development process of the mobile app-based cultural care training program. In contrast, previous studies that developed cultural care training programs did not adhere to any instructional models and often lacked reporting on their development processes [One notable contribution of our study is the provision of detailed information about the curriculum development process. This ensures that nurse educators and other healthcare providers can easily follow the program and adapt it to different cultural contexts. Additionally, the mobile app-based format of the training program allows for convenient in-service training for healthcare providers in various cultures and settings. The utilization of instructional design models is crucial for curricular designers as it enables them to make informed decisions about their designs. Instructional models provide a systematic and reflective process through which instructional principles are applied to develop effective teaching and learning programs. This involves differentiating materials, activities, resources, and evaluation methods. By employing instructional design models, designers gain knowledge about learning theories, conduct systematic learner analysis, employ management techniques, utilize information technology efficiently, and evaluate the teaching and learning process. These models guide designers in constructing instructional programs that consider the needs of learners, objectives, learning outcomes, teaching methods, and evaluation strategies. While there are various instructional design models available, most of them incorporate the essential phases of the ADDIE model. Designers should select instructional design models based on specific learning situations and tailor their designs to address those needs. Nursing schools, in particular, experience evolving social, cultural, and environmental opportunities, making it impractical to rely on a single model for designing training programs. Therefore, nurse educators should familiarize themselves with diverse instructional design models to choose the most appropriate one for their classes and courses [Second, in the development of our training program, we utilized the Purnell Model of Cultural Competence and Foronda's Cultural Humility Scale as two theoretical frameworks. This decision was supported by the findings of several studies that also employed the Purnell Model and Foronda's Cultural Humility Scale in their cultural care training programs [Third, in the step of evaluation, the results showed that the mobile app-based cultural care training program significantly improved the cultural capacity in the intervention group compared to the control group. The findings of our study align with previous research conducted in different countries, which evaluated the impact of training programs on the cultural competence of healthcare providers, including nursing students. While these studies did not utilize the cultural capacity scale, they employed various teaching methods [Chang et al. (2017) conducted a study where they provided cultural competence training to health professionals through Facebook. The results of their 12-month follow-up study indicated that this training approach improved the cultural competence of health professionals. The findings suggested that Facebook could be utilized as a training delivery platform for providing personal and social learning, as well as cultural competency content in continuing education [In a mixed-method study, researchers investigated the impact of a cultural competency course with field experience and a stand-alone cultural competence course on undergraduate nursing students. The quantitative phase of the study revealed that both educational methods significantly enhanced the cultural competence of nursing students when compared to the control group. However, there was no significant difference observed between the two teaching methods.During the qualitative phase, the experiences of the stand-alone cultural competence course group yielded three main themes: journey to cultural competence, satisfaction of the cultural competence course, and suggestion for improvements. The students found the Purnell model to be an appropriate framework for cultural assessment in diverse patient populations. They expressed that the course had transformed their perspective on individuals from other cultures. They became familiar with the importance of empathy, sympathized with patients, respected their cultural beliefs, and accepted their health beliefs and behaviors. Additionally, some students were able to overcome their apprehensions regarding language barriers, different cultures, and feelings of unfamiliarity or limitation. As a result, they developed a positive outlook towards culturally diverse individuals [Another mixed-method study examined the impact of two training methods, lecture, and lecture with standardized patient simulation, on the cultural competence of undergraduate nursing students. The results indicated that both training methods led to an increase in cultural competence among the students, with no significant difference observed between the two approaches. The qualitative findings of the study revealed that after undergoing lectures with standardized patient simulation, students experienced a decrease in anxiety when interacting with culturally diverse patients, and their comfort levels in patient interactions improved [In contrast to the present study, several studies have reported that cultural competence training programs did not yield a significant impact on overall cultural competence or specific areas such as participants' attitudes and skills. These findings highlight the importance of carefully planning and organizing cultural education programs with the aim of effectively enhancing the development of cultural competence [Fourth, in the step of evaluation, the results also showed that the mobile app-based cultural care training program significantly improved cultural humility in the intervention group compared to the control, and the students were sometimes culturally humble. Our findings are consistent with the results of previous studies. Sánchez-Ojeda et al. (2021) demonstrated that completion of a cultural orientation training course led to a reduction or elimination of prejudiced and negative attitudes towards immigrants among nursing students [Another study by Ndiwane et al. (2017) incorporated cultural humility content into an advanced health assessment course for nursing students using simulation. The students expressed satisfaction with the training content and obtained the highest scores for the standardized patient scenarios after completing the objective structured clinical examination [In a systematic review conducted by Foronda et al. (2018) on cultural competence and cultural humility in simulation-based training, four themes emerged from the results related to learning from the simulation: cultural sensitivity and competence, insight, and understanding, communication, and confidence and comfort. However, none of the studies mentioned cultural humility specifically. The researchers emphasized that cultural humility in simulation-based education was not adequately addressed, indicating the need for modifications and changes in the educational content of simulation-based training [The review of the aforementioned studies reveals both similarities and differences in the acquisition of cultural competence and humility across various contexts. Therefore, it is crucial to have a comprehensive understanding of the existing platform, needs, and strategies before implementing an effective intervention to enhance the cultural care competence of nursing students. Additionally, examining relevant literature can aid in designing comprehensive and efficient training programs. Nursing students acquire cultural competence, capacity, and humility through their experiences at university, during their studies, and through their work experiences. It is important to recognize that nursing education has the responsibility of preparing future nurses to develop cultural capacity and humility from their early student days. This process should continue through continuous on-the-job training, as nurses learn how to provide culturally diverse care with humility. Furthermore, the advancements in technology available today offer opportunities to enhance learning experiences for students through the use of modern communication tools.