Background Due to changing population, culturally diverse clients with different perceptions of illness and health are present in healthcare settings. Therefore, it is increasingly important for nursing students to have high levels of cultural competence in order to meet diverse client needs. A training program is essential to enhance students’ cultural competence. This study aimed to design, implement, and evaluate a cultural care-training program to improve cultural competence of undergraduate nursing students. Methods This exploratory mixed methods study used six steps proposed in the Talbot and Verrinder model to design a training program. In the first step, a conventional qualitative study was conducted and 18 participants were interviewed using purposive sampling. In the second and third steps, literature review and the classic Delphi technique were used for initiation and finalization of the program. The fourth, fifth, and sixth steps were completed by implementing, monitoring, and evaluating the cultural care program (five two-hour sessions) among 73 nursing students using a quasi-experimental design. Finally, effectiveness of program was evaluated through the cultural care inventory before and 1 month after the program. Data were analyzed via SPSS25, independent samples t- test, paired t- test, chi-square test, analysis of covariance, and multivariate linear regression tests. Results A systematic model was used to identify key elements of a cultural care program, including main topics, educational objectives and contents, assignments and activities for students, teaching and evaluation methods. The curricular objectives and educational contents were implemented in five sessions to produce measurable results. The quantitative step showed that nursing students’ cultural competence in the intervention group (184.37 ± 22.43) improved significantly compared with the control group (153.19 ± 20.14) (t = 6.24, p = 0.001) after intervention. Conclusion A cultural care training program can be designed by the model applied in this study in order to improve cultural competence of nursing students. This training program will be effective if students’ learning needs, appropriate assignments, and acceptable teaching methods are addressed. Therefore, nurse educators can design comprehensive training programs to improve nursing students’ cultural competence in different cultures and contexts. This training program is highly efficient because it is applicable in many disciplines of nursing education.

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Background: Nursing students experience ethical conflicts and challenges during their clinical education. These may lead to moral distress and disturb the learning process. Objectives: This study aimed to explore and to evaluate the nursing students’ ethical challenges in the clinical settings in Iran. Research design: This was a mixed-methods study with an exploratory sequential design. Participants and research context: A total of 37 and 120 Iranian nursing students participated in the qualitative and quantitative phases, respectively. Ethical considerations: The ethical committee of Kerman University of Medical Sciences, Iran, approved the protocol of the study. Findings: Three main categories were extracted from qualitative data including Low attention of nurses to the patients’ preferences; Lack of authority; and Inadequate support. A total of 97% of the students had more than one ethical challenge in clinical settings and 48% of them stated that their challenges did not resolve. The total score of perceived ethical challenges was 62.03 ± 9.17, which was moderate. The highest mean score related to the “Low attention of nurses to the patients’ preferences” subscale. Discussion: The finding confirmed most of the existing results of other international researches about the frequency and kinds of baccalaureate nursing students’ ethical challenges. Conclusion: Identifying student ethical challenges helps teachers to manage their clinical learning process better. This study may provide a view for the nurses, clinical educators, and managers toward nursing students’ ethical challenges and their impact on nursing students’ clinical experiences.

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BackgroundSuffering congenital heart disease leads to physical and mental disabilities in children. Children's self‐care can result in appropriate care behaviors for limiting disease‐induced problems. Given the ability of children to care for themselves, we investigated self‐care statues in children who are suffering from congenital heart disease.MethodThis study was conducted using a mixed‐method approach and a sequential explanatory design. A cross‐sectional study was conducted to assess self‐care status in 124 CHD children who were living in Kerman, Iran. In the qualitative phase, the researchers interviewed 13 of these children and three parents using semi‐structured in‐depth and face‐to‐face approaches.ResultsThe mean of self‐care scores in these school‐age children was optimal (10/7 ± 2/6). In the qualitative phase, three main themes were extracted: captive to health issues physical and mental sufferings and wishing for peace of mind.ConclusionThe results showed that self‐care status in these children was optimal. As the main pillar of patient education, nurses can help enhance self‐care behaviors and reduce the complications and problems induced by the disease by implementing educational and support interventions for children with CHD and their families.

Objectives Environmental stimuli in neonatal intensive care units can disrupt the physiological stability and sleep of infants. It is essential to perform nursing interventions to reduce the adverse effects of such stimuli. This study aimed to compare the effect of recorded lullabies and mothers’ live lullabies on physiological responses and sleep duration of preterm infants. Methods This study was a randomized clinical trial. The participants were 90 preterm infants selected using convenience sampling. In the intervention groups, music (recorded lullabies and mother’s live lullabies) was played for 14 days, 20 min a day, while the control group did not receive any intervention. The data were collected using physiological criteria and infant sleep checklists before, during, and after the intervention. The data were analyzed using SPSS software (Version 21.0). Results The mean scores of physiological parameters (O2 saturation and heart rate) were not significantly different in the three groups before, during, and after the intervention (p>0.05). However, there was an improvement in O2-saturation and a decrease in the heart rate in two intervention groups. The mean duration of the infants’ overnight sleep was not statistically significant between the groups before the intervention (p>0.05). However, there was a statistically significant difference in the intervention groups after the intervention, (p<0.05), and the infants’ overnight sleep was longer in the recorded-lullaby group than the other two groups. Conclusions Although performing interventions, including recorded lullaby and mother’s live lullaby did not differ significantly with that of the control group in physiological criteria, it can be clinically important. In addition, recorded-lullaby increased the infants’ overnight sleeping. Thus, it is suggested that further studies be conducted to confirm the effect of recorded lullaby and mother’s live lullaby interventions on physiological parameters and sleep duration of hospitalized infants.

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Background Clinical education is an essential part of nursing education. Selected clinical teaching methods influence the quality of education. Simulation-based mastery learning has been used to improve clinical skills among nursing students and may provide a novel way to enhance nursing skills. This study aimed to assess the effect of simulation-based mastery learning on the clinical skills of undergraduate nursing students from 2017 to 2019. Methods This quasi-experimental study was conducted with two groups (the control and intervention). A hundred and five students were selected by random convenience sampling, and written consent was obtained. The intervention group participated in a simulation-based mastery learning intervention, and the control group received no intervention except for traditional training. The students of both groups completed the demographic information questionnaire and the checklist before and after the intervention. The results were analyzed by SPSS version 21 and descriptive and inferential statistics. Results The results showed no significant differences between the two groups before the intervention (p> 0.05). In addition, students’ performance in the intervention and control groups improved significantly at the post-test compared with the baseline (p< 0.05). Furthermore, the Cohen test implied that the simulation-based mastery model used by the intervention group was significantly more effective than the traditional training used by the control. Conclusion These findings showed that mastery learning was more effective in improving clinical skills in undergraduate nursing students. The results suggest that other nursing and health programs can be developed by implementing a mastery-based learning model.