Journal of health research in community

Introduction
Hospitals are places where people from all walks of life, with different cultures and attitudes, seek care. Therefore, it is essential for nurses to have the ability to communicate effectively with patients. To achieve this, acquiring cultural skills and competencies is necessary for them. The concept of cultural competence in nurses involves understanding patients’ values and beliefs, along with the ability to provide effective healthcare services in accordance with these values and the cultural needs of clients. This leads to client satisfaction, positive care outcomes, and improved health. The ability to provide care with an awareness of clients’ cultural needs is a fundamental part of nurses’ communication skills. Given the high ethnic and cultural diversity in Sistan and Baluchestan province and the key role of nurses in the frontlines of healthcare delivery, this study was conducted to assess the level of cultural competence and identify its associated factors among nurses working in hospitals in Zahedan. 

Methods
This cross-sectional, descriptive-analytical study was conducted on 350 nurses working in teaching hospitals in Zahedan, Iran, in 2024. Data were collected using two instruments: a demographic information questionnaire and the Cultural Competence Assessment tool for Nurses. All teaching hospitals in the city were included in the study. Subsequently, individual-level sampling was performed using a simple random sampling method with proportional allocation based on the number of nurses in each hospital. Informed consent was obtained from all participants before the questionnaires were distributed. The collected data were entered into SPSS software, version 16 for statistical analysis, and both descriptive and inferential statistical analyses were used. 

Results
The mean score of cultural competence among nurses was 164.19±26.44. The results showed that among the dimensions of cultural competence, “cultural skill” had the highest mean score (58.95±11.03), while “cultural awareness” had the lowest (31.69±6.27). Cultural competence was significantly associated with several variables, including age (P=0.008), gender (P=0.006), ability to speak a language other than one’s mother tongue (P=0.001), studying outside one’s place of residence (P=0.01), having work experience in multi-ethnic regions (P=0.004), experiencing a cultural difference between study and work settings (P=0.002), and satisfaction with caring for patients from different ethnicities (P=0.008). 

Conclusion
In conclusion, the study findings revealed that nurses in Zahedan demonstrate moderate cross-cultural practical skills but require significant enhancement in cultural awareness. The primary facilitators of these competencies were identified as younger age, proficiency in a second language, and direct exposure to culturally diverse environments. Accordingly, improving cultural competence among nurses necessitates the development of multifaceted educational interventions incorporating both theoretical and experiential learning, the provision of language training and mediation services, and structured opportunities for intercultural engagement. These comprehensive approaches are fundamental not only for advancing nurses’ cultural competence across diverse geographical contexts but also for optimizing nursing care quality, patient safety, and satisfaction outcomes. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Zahedan University of Medical Sciences (Code: IR.ZAUMS.REC.1403.353).

Funding
This research is the result of a student project at Zahedan University of Medical Science (Grand No.: 11588).

Authors contributions
Ideation, methodology, project management, supervision, initial draft writing, review writing and editing: Fatemeh Sotoudehzadeh; Data collection, data organization, methodology, initial draft writing: Saeedeh Hassani and Niloufar Hoti; Data organization, data analysis, methodology, initial draft writing and editing: Zahra Arab Borzo.

Conflicts of interest
The authors declared no conflicts of interest. 

Acknowledgments
The authors extend their gratitude to all individuals and organizations who contributed to the completion of this research.


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