Abstract
Background:
In a culturally diverse world, nursing students often feel ill-equipped to manage the nuanced socio-cultural and physiological complexities of maternal-infant care, particularly breastfeeding support. Adaptive intelligence in health education calls for innovative strategies that prepare students to deliver sensitive, effective care across varied cultural contexts. High-fidelity simulation (HFS) offers a dynamic platform for such adaptive learning, yet its tailored use in fostering breastfeeding self-efficacy and culturally responsive skills remains underexplored.
Objective:
This study evaluated the impact of a culturally contextualized HFS intervention on nursing students’ breastfeeding self-efficacy, knowledge, and clinical confidence, while exploring how simulation fosters adaptive learning for diverse healthcare settings.
Methods:
A mixed-methods pilot randomized controlled trial was conducted with 67 undergraduate nursing students at a local university. Participants were randomized into an intervention group (n=34) receiving supplemental scenario-based HFS, or a control group (n=33) receiving standard curriculum with low-fidelity training. Quantitative measures included the Breastfeeding Self-Efficacy Scale (BSES), knowledge/confidence assessments, and the Simulation Design Scale (SDS). Qualitative data were collected via focus group interviews and analyzed thematically.
Results:
The intervention group demonstrated significantly higher breastfeeding self-efficacy, knowledge, and clinical confidence post-training (p<.001). Qualitative analysis revealed four key themes:
(1) Bridging Theory and Culturally Informed Practice,
(2) Communication and Professional Identity in Diverse Contexts,
(3) Simulation as a Safe Space for Adaptive Skill-Building, and
(4) Sensory and Emotional Fidelity as Enablers of Immersion. <
Notably, HFS helped mitigate gender-related discomfort among male students and provided a psychological foundation for managing cross-cultural care scenarios. However, limitations in tactile and auditory fidelity were noted as barriers to full immersion.
Conclusion:
Culturally enriched HFS effectively enhances nursing students’ readiness for maternal-infant care in a diverse world. By offering a psychologically safe environment to navigate cultural, gender, and clinical complexities, simulation serves as a critical tool for developing adaptive intelligence in future healthcare professionals. To maximize impact, future simulations should integrate higher sensory fidelity and structured debriefing focused on cultural competence.