{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:24:25Z","timestamp":1792059865333,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Nursing Review"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To assess the level of cultural competence among European nursing students after their first clinical experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A descriptive, cross\u2010sectional study was conducted in 18 countries and 66 higher institutions with a sample of 2932 nursing students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Cultural Competence Assessment (CCA) tool was used in its original version (English) and its validated versions in Spanish, Italian, Portuguese, Turkish, and Lithuanian. The CCA includes 25 items, Likert\u2010type normalized in a 0\u2013100\u2010point scale with two dimensions: Cultural Awareness and Sensitivity (CAS) subscale and Cultural Competence Behavior (CCB) subscale. An online anonymized questionnaire was used to collect the variables. The influence of background and acquired factors in CCA was analyzed with multivariate regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean level of cultural competence of the European undergraduate nursing students after their first supervised internships is at a good level. Significant associations were found between cultural competence level and language of the questionnaire, gender, religious community, current year of education, leisure stays abroad, and international experiences at home, but having friends from other countries or cultures was the most important factor to explain CCA. The explained variance of CCA by these factors was low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The international perspective of cultural competence among undergraduate nursing students at the starting point of their clinical experience provided by this study serves as an important preview of where European nursing education currently stands as a baseline scenario for designing, providing, and assessing adequate educational strategies for being a culturally competent nurse at the point of graduation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the profession and patient care<\/jats:title>\n                    <jats:p>The study highlights specific factors that contribute to higher levels of cultural competence. These insights can be used to further improve nursing education by providing more opportunities for students to engage with diverse cultures, resulting in enhanced cultural competence, which can lead to better patient care and higher satisfaction in diverse environments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>The findings can guide future research and curriculum development, emphasizing the importance of creating educational strategies to enhance cultural competence. By understanding the predictors of cultural competence, educational institutions can design targeted interventions that improve the quality of care and patient satisfaction in multicultural settings, as well as helping to reduce health inequalities and promote a more inclusive healthcare environment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>This research is reported in accordance with the STROBE guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Public Contribution<\/jats:title>\n                    <jats:p>A wide network of European higher education institutions was contacted. Nursing students from those willing to participate were voluntarily involved in this study by answering the CCA questionnaire.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/inr.70068","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:09:32Z","timestamp":1753880972000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cultural Competence of Nursing Students After Their First Supervised Internships: An International Cross\u2010Sectional Study"],"prefix":"10.1111","volume":"72","author":[{"given":"Laura","family":"Visiers\u2010Jim\u00e9nez","sequence":"first","affiliation":[{"name":"Health Sciences Department Comillas Pontifical University, San Juan de Dios School of Nursing and Physical Therapy  Madrid Spain"},{"name":"San Juan de Dios Foundation  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Lara","family":"Mart\u00ednez\u2010Gimeno","sequence":"additional","affiliation":[{"name":"Health Sciences Department Comillas Pontifical University, San Juan de Dios School of Nursing and Physical Therapy  Madrid Spain"},{"name":"San Juan de Dios Foundation  Madrid Spain"},{"name":"SALBIS Research Group, Faculty of Health Sciences, University of Le\u00f3n  Ponferrada Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"R\u00edos\u2010D\u00edaz","sequence":"additional","affiliation":[{"name":"Health Sciences Department Comillas Pontifical University, San Juan de Dios School of Nursing and Physical Therapy  Madrid Spain"},{"name":"San Juan de Dios Foundation  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7955-2757","authenticated-orcid":false,"given":"Sylvain Marcel","family":"Lybrecht\u2010Llinares","sequence":"additional","affiliation":[{"name":"San Juan de Dios Foundation, San Rafael\u2010Nebrija University Centre  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2793-3228","authenticated-orcid":false,"given":"Mar\u00eda Isabel","family":"Baeza\u2010Monedero","sequence":"additional","affiliation":[{"name":"Health Sciences Department Comillas Pontifical University, San Juan de Dios School of Nursing and Physical Therapy  Madrid Spain"},{"name":"San Juan de Dios Foundation  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"(On behalf of the CCA\u2010EUnurse Consortium)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0259802"},{"issue":"2","key":"e_1_2_13_3_1","first-page":"142","article-title":"Cultural Competence Assessment Instrument: Initial Italian Validation and Proposed Refinement","volume":"86","author":"Caricati L.","year":"2015","journal-title":"Acta Biomed"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.936181"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nepr.2018.01.007"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jnu.12350"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006199\u2010200509000\u201000006"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912\u2010022\u201000849\u20107"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2014.10.021"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nepr.2020.102926"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nepr.2019.07.009"},{"issue":"3","key":"e_1_2_13_12_1","first-page":"99","article-title":"Conceptualizations of Culture and Cultural Care Among Undergraduate Nursing Students: An Exploration and Critique of Cultural Education","volume":"21","author":"Kalischuk R. 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