Mon, Dec 8, 2025
[Archive]
Volume 18, Issue 4 (2025)
JMED 2025, 18(4): 52-62 |
Back to browse issues page
Ethics code: IR.LUMS.REC.1402.011
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Beiranvand S, Gholami M, Hasanvand S, Mokhayeri Y. The effects of blended learning on nursing students' cultural competence and empathy: a quasi-experimental study. JMED 2025; 18 (4) :52-62
URL: http://edujournal.zums.ac.ir/article-1-2557-en.html
URL: http://edujournal.zums.ac.ir/article-1-2557-en.html
1- Department of Nursing, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran , shorangizbiranvand@yahoo.com
2- Department of Nursing, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
3- Department of Nursing, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
4- Department of Health and Nutrition, Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
2- Department of Nursing, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
3- Department of Nursing, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
4- Department of Health and Nutrition, Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
Abstract: (147 Views)
Background & Objective: Along with the recent trend of globalization, nursing students need to have high cultural competence to provide nursing care services to patients with diverse cultural backgrounds. The purposes of this study were to explore the effects of blended learning on nursing students' cultural competence and empathy.
Materials & Methods: In this pretest-post-test quasi-experimental study with control group, 65 senior third-year undergraduate nursing students were selected using whole enumeration sampling. They were divided into two groups: intervention (n = 30) and control (n = 35) non-randomly. Content of the blended learning program was based on the framework of the Campinha-Bacot cultural competence model. The intervention group completed the educational course that had three parts (face-to-face lecture, storytelling, and case-based learning). It was carried out once weekly for three weeks, with each session lasting 2 hours. A two-hour in-person workshop using a lecture method was held according to the approved undergraduate nursing curriculum. The outcomes, including cultural competence and empathy, were measured using the Perng and Watson’s (2012) Cultural Capacity Scale and the Jefferson Scale of Empathy Health Profession Students before and two weeks after the intervention. The data were analyzed using descriptive statistics, independent t-test, paired t test and ANCOVA analysis with Stata-17 software.
Results: Most of the participants were single (n = 58, %95), male (n =33, %54) and in the sixth semester of the bachelor of nursing (n = 34, %56). An analysis of covariance (ANCOVA) between the groups showed a statistically significant difference between the changes in the mean scores of all subscales of cultural competence and cultural competence total score (F = 22.19, p < 0.001, mean difference and standard deviation 14.96 ± 9.31). No significant difference was found for the changes in the mean scores of all subscales and the empathy total score in two groups (F = 1.19, p = 0.31 mean difference and standard deviation -2.45 ± 14.36).
Conclusion: The findings of this study showed that the blended learning program may be effective in improving cultural competence among nursing students. It is recommended that nursing program managers add multicultural educational programs into curricula they use.
Materials & Methods: In this pretest-post-test quasi-experimental study with control group, 65 senior third-year undergraduate nursing students were selected using whole enumeration sampling. They were divided into two groups: intervention (n = 30) and control (n = 35) non-randomly. Content of the blended learning program was based on the framework of the Campinha-Bacot cultural competence model. The intervention group completed the educational course that had three parts (face-to-face lecture, storytelling, and case-based learning). It was carried out once weekly for three weeks, with each session lasting 2 hours. A two-hour in-person workshop using a lecture method was held according to the approved undergraduate nursing curriculum. The outcomes, including cultural competence and empathy, were measured using the Perng and Watson’s (2012) Cultural Capacity Scale and the Jefferson Scale of Empathy Health Profession Students before and two weeks after the intervention. The data were analyzed using descriptive statistics, independent t-test, paired t test and ANCOVA analysis with Stata-17 software.
Results: Most of the participants were single (n = 58, %95), male (n =33, %54) and in the sixth semester of the bachelor of nursing (n = 34, %56). An analysis of covariance (ANCOVA) between the groups showed a statistically significant difference between the changes in the mean scores of all subscales of cultural competence and cultural competence total score (F = 22.19, p < 0.001, mean difference and standard deviation 14.96 ± 9.31). No significant difference was found for the changes in the mean scores of all subscales and the empathy total score in two groups (F = 1.19, p = 0.31 mean difference and standard deviation -2.45 ± 14.36).
Conclusion: The findings of this study showed that the blended learning program may be effective in improving cultural competence among nursing students. It is recommended that nursing program managers add multicultural educational programs into curricula they use.
Article Type : Orginal Research |
Subject:
Education
Received: 2025/08/6 | Accepted: 2025/11/14 | Published: 2025/11/19
Received: 2025/08/6 | Accepted: 2025/11/14 | Published: 2025/11/19
References
1. Albougami AS, Pounds KG, Alotaibi JS. Comparison of four cultural competence models in transcultural nursing: a discussion paper. Int Arch Nurs Health Care. 2016;2(4):1-5. [DOI:10.23937/2469-5823/1510053]
2. Almutairi AF, McCarthy A, Gardner GE. Understanding cultural competence in a multicultural nursing workforce: registered nurses' experience in Saudi Arabia. J Transcult Nurs. 2015;26(1):16-23. [DOI:10.1177/1043659614523992] [PMID]
3. Amiri R, Heydari A. Nurses' experiences of caring for patients with different cultures in Mashhad, Iran. Iran J Nurs Midwifery Res. 2017;22(3):232-236.
4. Arbour M, Kaspar RW, Teall AM. Strategies to promote cultural competence in distance education. J Transcult Nurs. 2015;26(4):436-440. [DOI:10.1177/1043659614547201] [PMID]
5. Attenborough J, Abbott S. Using storytelling in nurse education: the experiences and views of lecturers in a higher education institution in the United Kingdom. Nurse Educ Pract. 2020;44:102762. [DOI:10.1016/j.nepr.2020.102762] [PMID]
6. Bauer K, Bai Y. Using a model to design activity-based educational experiences to improve cultural competency among graduate students. Pharmacy (Basel). 2018;6(2):48. [DOI:10.3390/pharmacy6020048] [PMID] []
7. Cai D, Kunaviktikul W, Klunklin A, Sripusanapan A, Avant PK. Identifying the essential components of cultural competence in a Chinese nursing context: a qualitative study. Nurs Health Sci. 2017;19(2):157-162. [DOI:10.1111/nhs.12308] [PMID]
8. Choi JS, Kim JS. Effects of cultural education and cultural experiences on the cultural competence among undergraduate nursing students. Nurse Educ Pract. 2018;29:159-162. [DOI:10.1016/j.nepr.2018.01.007] [PMID]
9. De Beer J, Chipps J. A survey of cultural competence of critical care nurses in KwaZulu-Natal. SAJCC. 2014;30(2):50-54. [DOI:10.7196/SAJCC.188]
10. Fisher RJ, Katz JE. Social-desirability bias and the validity of self-reported values. Psychol Mark. 2000;17(2):105-120.
https://doi.org/10.1002/(SICI)1520-6793(200002)17:2<105::AID-MAR3>3.0.CO;2-9 [DOI:10.1002/(SICI)1520-6793(200002)17:23.0.CO;2-9]
11. Hafeez M, Akhter Y. Effects of blended learning in comparison of traditional learning to provide safer learning environment-a comparative review. IJERSC. 2021;2(6):1604-1615. [DOI:10.51601/ijersc.v2i6.209]
12. Hashemipour M, Karami M. Validity and reliability of the Persian version of JSPE-HP questionnaire (Jefferson scale of physician empathy-health professional's version). J Kerman Univ Med Sci. 2012;19(6):201-211.
13. Henderson S, Horne M, Hills R, Kendall E. Cultural competence in healthcare in the community: a concept analysis. Health Soc Care Community. 2018;26(4):590-603. [DOI:10.1111/hsc.12556] [PMID]
14. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359-364. [DOI:10.1097/ACM.0b013e3182086fe1] [PMID]
15. Hsiao CY, Tsai YF, Kao YC. Psychometric properties of a Chinese version of the Jefferson Scale of Empathy-Health Profession Students. J Psychiatr Ment Health Nurs. 2013;20(10):866-873. [DOI:10.1111/jpm.12024] [PMID]
16. Jongen C, McCalman J, Bainbridge R. Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res. 2018;18(1):232. [DOI:10.1186/s12913-018-3001-5] [PMID] []
17. Johnson JM, MacDonald CD, Oliver L. Recommendations for healthcare providers preparing to work in the Middle East: a Campinha-Bacote cultural competence model approach. J Nurs Educ Pract. 2017;7(2):25-30. [DOI:10.5430/jnep.v7n2p25]
18. Khachian A, Zarei MR, Haghani H, Khani F. The correlation between the cultural competence of nurses with their care behaviors in the teaching health centers affiliated to Iran university of medical sciences. Iran J Nurs. 2020;33(124):70-81.
19. Kula Y, Cohen O, Clempert N, Grinstein-Cohen O, Slobodin O. Educating nursing students for cultural competence in emergencies: a randomized controlled trial. BMC Nurs. 2021;20(1):143. [DOI:10.1186/s12912-021-00704-1] [PMID] []
20. Li C, He J, Yuan C, Chen B, Sun Z. The effects of blended learning on knowledge, skills, and satisfaction in nursing students: a meta-analysis. Nurse Educ Today. 2019;82:51-57. [DOI:10.1016/j.nedt.2019.08.004] [PMID]
21. Ličen S, Prosen M. The development of cultural competences in nursing students and their significance in shaping the future work environment: a pilot study. BMC Med Educ. 2023;23(1):819. [DOI:10.1186/s12909-023-04800-5] [PMID] []
22. Mahmoodi A, Khani L, Ghaffari M. The Relationship of cultural competence and responsibility with nurses attitude toward patient's right: the mediating role of ethical beliefs. Iran J Med Ethics Hist Med. 2017;9(5):39-51.
23. Marja SL, Suvi A. Cultural competence learning of the health care students using simulation pedagogy: an integrative review. Nurse Educ Pract. 2021;52:103044. [DOI:10.1016/j.nepr.2021.103044] [PMID]
24. Nematollahi M, Farokhzadian J, Nayeri ND, Darban F, Faramarzpour M. Explaining the educational challenges in the path of cultural competence: the experiences of Iranian nursing students. J Prof Nurs. 2022;42:140-147. [DOI:10.1016/j.profnurs.2022.06.011] [PMID]
25. Nuuyoma V, Muvumwaeni S, Chihururu L. Transcultural nursing: a qualitative analysis of nursing students' experiences in a multicultural context in North-Eastern Namibia. BMC Nurs. 2024;23(1):123. [DOI:10.1186/s12912-024-01773-8] [PMID] []
26. Perng SJ, Watson R. Construct validation of the nurse cultural competence scale: a hierarchy of abilities. J Clin Nurs. 2012;21(11-12):1678-84. [DOI:10.1111/j.1365-2702.2011.03933.x] [PMID]
27. Permana B, Pandin MGR. How to Enhance Empathy Nursing Students in Education: literature Review. medRxiv [Preprint]. 2022 [cited 2024 May 15]. Available from: [DOI:10.1101/2022.01.01.22268600]
28. Sharifi N, Adib-Hajbaghery M, Najafi M. Cultural competence in nursing: a concept analysis. Int J Nurs Stud. 2019;99:103386. [DOI:10.1016/j.ijnurstu.2019.103386] [PMID]
29. Shih HI, Cheung CHA, Huang IH, Huang MC, Kao CY. Development of a transcultural nursing program for nursing students in Taiwan. J Med Educ. 2019;23(2):86-97.
30. Shopo KD, Nuuyoma V, Chihururu L. Enhancing cultural competence in undergraduate nursing students: an integrative literature review of strategies for institutions of higher education. J Transcult Nurs. 2025;36(4):412-428. [DOI:10.1177/10436596241301407] [PMID] []
31. Sohrabi Z, Zabihi Zazoly A, Alizadeh S, Norouzi A, Ramezani G, Zhianifard A. The effect of cultural competence training on empathy of medical residents. Strides Dev Med Educ. 2022;19(1):138-144.
32. Soleimani M, Yarahmadi S. Cultural competence in critical care nurses and its relationships with empathy, job conflict, and work engagement: a cross-sectional descriptive study. BMC Nurs. 2023;22(1):113. [DOI:10.1186/s12912-023-01285-x] [PMID] []
33. Stubbe DE. Practicing cultural competence and cultural humility in the care of diverse patients. Focus (Am Psychiatr Publ). 2020;18(1):49-51. [DOI:10.1176/appi.focus.20190041] [PMID] []
34. Williams B, Brown T, Boyle M, Dousek S. Psychometric testing of the Jefferson Scale of Empathy Health Profession Students' version with Australian paramedic students. Nurs Health Sci. 2013;15(1):45-50. [DOI:10.1111/j.1442-2018.2012.00719.x] [PMID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
