Gender-affirming communication in nursing education: Development and preliminary validation of a CICARE-based digital...

Practical, skill-based training for gender-affirming communication is persistently lacking in nursing education. Curricular content is typically brief and didactic, and there is a significant lack of systematic integration and validated assessment tools to prepare students for inclusive clinical behaviors.

To increase nursing students' competence in gender-affirming communication by developing and preliminarily validating a digital microlearning system grounded in the connect, introduce, communicate, ask, respond, and exit (CICARE) model.

Multiphase developmental research was conducted in accordance with the analysis, design, development, implementation, and evaluation instructional design model.

A university nursing department in northern Taiwan.

Needs assessment involved 20 stakeholders, including lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals and experienced health-care professionals. Usability testing involved 20 senior nursing students.

A triangulated needs assessment was conducted through in-depth stakeholder interviews and a systematic literature review. Qualitative data were analyzed using reflexive thematic analysis. Instructional content was mapped to the CICARE communication framework, experiential learning theory, and microlearning principles. The content validity index was calculated, and system usability was evaluated through student testing.

Five themes identified through reflexive thematic analysis informed the development of corresponding CICARE-aligned digital microlearning modules. Expert review yielded an overall content validity index of 0.87, and usability testing demonstrated high acceptability (mean = 4.98). Qualitatively, students reported that the structured behavioral scaffolding significantly reduced their anxiety regarding pronoun use during gender-affirming interactions.

The CICARE-based digital microlearning system offers a scalable, theoretically grounded intervention to translate gender-affirming communication knowledge into observable clinical behaviors. These findings support the longitudinal threading of the system throughout the nursing curriculum to foster sustained communication competence.