Comparison of Nursing Curricula in Croatia and Turkey:

Analysis Using the SPICES Model

1,2Snježana Čukljek

3 Rukiye Akarsu Höbek 1,4Biserka Sedić 1,2Biljana Filipović

3 Betül Ünsal

1 University of Applied Health Sciences, Zagreb, Croatia

2 Faculty of Health Studies, University of Rijeka, Rijeka, Croatia

3 Yozgat Bozok University, Yozgat Merkez/Yozgat, Turkey

4 Faculty of Dental Medicine and Health Osijek, University of Osijek, Osijek, Croatia

Article received: 15.01.2025.

Article accepted: 21.02.2025. https://doi.org/10.24141/2/9/1/4 Author for correspondence:

Biljana Filipović

University of Applied Health Sciences, Zagreb, Croatia E-mail: biljana.filipovic@zvu.hr

Keywords: nursing curriculum, Croatia, Turkey, SPICES model, comparative analysis, nursing education

Abstract

Introduction. The SPICES model promotes a modern educational framework through Student-centered learning, Problem-based learning, Integrated teach- ing, Community-based education, Elective studies, and Systematic approaches. This model is pivotal for adapting nursing education to evolving global healthcare demands.

Aim. To perform a comparative analysis of the nurs- ing curricula in the Republic of Croatia and the Re- public of Turkey using the SPICES model.

Methods. A cross-national comparative study focus- ing on the undergraduate nursing programs at desig- nated universities in Croatia and Turkey. Official cur- riculum documents, course descriptions, and relevant literature from both countries were collected and analyzed according to the six domains of the SPICES model. A comparative table was constructed to eluci- date the adherence to and deviations from the model in each curriculum.

Results. Both countries’ curricula reflect elements of the SPICES model, but are predominantly influenced by traditional educational practices. The Croatian cur- riculum shows greater interdisciplinary integration, in line with EU directives, whereas Turkey’s curriculum is progressing towards better compliance with inter- national standards through ongoing accreditation efforts. Variations were particularly noted in the ex- tent of elective course offerings and problem-based learning applications.

Conclusions. The study concludes that updating the nursing curricula in Croatia and Turkey to more closely follow the SPICES model could significantly improve the quality of nursing education. Such en- hancements are likely to equip nursing professionals with better skills and knowledge, ultimately leading to improved patient care outcomes. The anticipated further accreditation in Turkey could foster the adop- tion of innovative educational strategies in line with the SPICES model.

Introduction

The quality of nursing care is directly connected to the quality of nursing education. Research shows that robust educational programs are essential for preparing nurses to effectively manage the com- plexities of modern healthcare (1). It is crucial that nursing curricula remain dynamic, incorporating cur- rent knowledge and technologies to develop pro- fessionals who are competent and equipped to lead improvements in healthcare practices (2). As such, it is crucial to develop curricula that equip nurses with the necessary skills, knowledge, and attitudes to effectively contribute to healthcare improvement

(3). Nursing education curricula must cover essential areas, including foundational medical knowledge, clinical skills, patient care, communication, and ethi- cal principles. A well-designed curriculum is a criti- cal component in ensuring that nurses are not only able to provide high-quality care to their patients, but also continue to grow professionally. Moreover, the quality of a nursing curriculum significantly influ- ences both the professional success of nurses and the overall quality of patient care (4). Research has shown that concept mapping can play a pivotal role in developing critical thinking among nursing students. A systematic review and meta-analysis conducted by Yue et al. indicates that concept mapping has a posi- tive impact on both the affective dispositions and cognitive skills related to critical thinking in nursing education. However, further high-quality research is needed to comprehensively evaluate this method (5).

In light of rapidly changing global dynamics, sig- nificant shifts have occurred in societal structures, healthcare services, and nursing education. To keep

pace with these developments, nursing education must remain dynamic and continually evolve. The COVID-19 pandemic has highlighted the need for flexibility and rapid adaptation in nursing education globally. As healthcare systems grappled with un- precedented demands, some countries implemented accelerated training programs for nurses to meet ur- gent workforce needs. To keep pace with these de- velopments, nursing education must remain dynamic and continually evolve (6). Developing nursing cur- ricula is an ongoing, iterative process that involves adapting existing activities and assignments, and at times requires a complete restructuring of the cur- riculum to ensure that it remains relevant and effec- tive in addressing healthcare needs (7). The ongoing improvement, updating, and strengthening of nurs- ing curricula are necessary to ensure the provision of advanced and high-quality nursing care. Studies that focus on curriculum revisions and updates play a pivotal role in educating qualified nurses who can meet the growing and diverse needs of the health- care profession (8).

To create comprehensive nursing curricula, educa- tional institutions must regularly assess various aspects of their programs. One effective method of such assessment is comparative studies. These studies examine the curricula of different countries, facilitating scholarly exchanges and enabling the lo- calization of findings to improve existing programs or develop new ones. The insights gained from com- parative studies also provide valuable guidance for those designing and implementing nursing curricula, helping to ensure that these programs are aligned with the specific healthcare needs of society (9,10). The selection of Croatia and Turkey for this compara- tive analysis stems from their active involvement in the Erasmus program, which encompasses not only nursing students but also faculty members. This participation facilitates educational exchanges that provide a rich context for evaluating and understand- ing the nuances of nursing education across different regulatory and cultural landscapes.

The SPICES model, which stands for Student-cen- tered learning, Problem-based learning, Integrated teaching, Community-based education, Elective studies, and Systematic approaches, offers a modern framework essential for adapting nursing education to global healthcare demands. This model promotes a flexible, engaging, and holistic educational approach crucial in preparing nursing students to face contem-

porary health challenges (11). In Turkey, programs like those at Yozgat Bozok University are designed to balance theoretical knowledge with practical applica- tions. Croatian nursing programs, exemplified by the University of Applied Health Sciences Zagreb, adhere to a standardized core curriculum set by the Minis- try of Education, in line with EU directives, to ensure consistent and high-quality education that prepares students for professional practice within and beyond Croatia.

Although several comparative studies in the litera- ture focus on nursing curricula, most involve compari- sons between Iran and other countries (9,12). How- ever, a comparison between Croatia, a member of the European Union, and Turkey, a country that serves as a bridge between the Middle East and Europe, of- fers a unique opportunity to explore the differing ap- proaches to nursing education in these two regions.

Aim

This study aims to conduct a comparative analysis of the nursing curricula in the Republic of Croatia and the Republic of Turkey, with the aim of identifying key differences and similarities that can inform fu- ture curriculum development.

Methods

Study design

This study employed a descriptive-comparative de- sign, guided by the SPICES model, to compare the nursing curricula of undergraduate nursing programs in the Republic of Croatia and the Republic of Turkey. In Croatia, the undergraduate nursing program follows a standardized core curriculum set by the Ministry of Education and implemented nationwide. This provides a basis for comparison with the nursing curriculum

in Turkey, allowing for an examination of how each system addresses the challenges of modern health- care education. The SPICES model emphasizes six key domains: Student-centered learning, Problem-based learning, Integrated or inter-professional teaching, Community-based education, Elective studies, and a Systematic or planned approach (11). This model served as the conceptual framework for the compari- son between the two educational systems.

Data collection

Data were obtained from official curriculum docu- ments, course descriptions, and relevant academic literature from the University of Applied Health Sci- ences Zagreb in Croatia and Yozgat Bozok University in Turkey. The data collection process was structured to identify and extract information related to the key components of each institution’s nursing curriculum, with a particular focus on the six domains outlined by the SPICES model.

Data analysis

The collected data were systematically analyzed and categorized according to the six domains of the SPIC- ES model. This analysis involved a detailed compari- son of similarities and differences between the two curricula within each domain.

The courses included in this analysis were selected based on their alignment with specific elements of the SPICES model. Each course was categorized ac- cording to the educational strategies it most effec- tively exemplified, highlighting the degree to which each course adhered to the principles of student-cen- tered learning, problem-based learning, integrated or inter-professional teaching, community-based edu- cation, elective studies, and a systematic approach.

The assessment of course alignment with the SPICES model was conducted by faculty members from both the University of Applied Health Sciences Zagreb in Croatia and Yozgat Bozok University in Turkey. Fac- ulty members evaluated the courses with respect to their learning outcomes, content, teaching methods, and assessment criteria, ensuring that each course was appropriately classified according to the SPICES elements it best represented. The final step in the analysis involved interpreting the data to identify key points of convergence and divergence between the curricula.

Ethics

The study was conducted in accordance with the es- tablished ethical standards for educational research. Given that no personal or sensitive data were col- lected and the study was based solely on publicly available curriculum information, ethical approval was not required. The study did not involve human participants, ensuring compliance with ethical guide- lines and the protection of personal data.

Results

The results of the comparative analysis are displayed in two tables. Table 1 summarizes the alignment of Yozgat Bozok University’s courses with the SPICES model, categorizing courses under the headings of Student-centered Learning, Problem-based Learning, Integrated Teaching, Community-based Education, Elective Studies, and Systematic Approach. Table 2 presents information for the University of Applied Health Sciences Zagreb, showing how each course fits into the SPICES framework.

Student-based strategy

The student-based strategy, as one of the key com- ponents of the SPICES model, shifts the responsi- bility for learning to the student, fostering active learning. This approach contrasts with the tradi- tional, teacher-centered model and promotes high- er-order cognitive skills, including critical thinking. The five stages of the student-based strategy are as follows:

• Stage 1: The student follows a prescribed pro- gram with no consideration of individual needs or preferences.

• Stage 2: The course coordinator considers the students’ needs and preferences during course planning but maintains the prescribed program.

• Stage 3: The course coordinator tailors courses based on both institutional preferences and student input, while students are responsible for implementing learning activities.

• Stage 4: Students actively participate in both planning and implementation phases of the curriculum.

• Stage 5: Students are involved in all stages, from planning and implementation to assess- ment (13).

  At Yozgat Bozok University in Turkey, the curriculum remains largely educator-centered. Faculty mem- bers define learning objectives and course content, conveying theoretical knowledge through lectures and practical sessions. While students play an active role in clinical practice (particularly in case manage- ment and patient care planning), the overall learning process is still predominantly guided by instructors. Based on this structure, the Turkish curriculum aligns with Stage 2, where student preferences are con- sidered, but the educational process remains largely predefined.

  The University of Applied Health Sciences Zagreb in Croatia operates at Stage 2 of the student-based strategy. In Croatia, the curriculum complies with EU Directives 2005/36 and 2013/55, which mandate specific competencies for nursing graduates. While students have limited input on course content, they are expected to engage actively with learning mate- rials, especially during clinical placements (14, 15).

  
  

  Problem-based strategy

  The problem-based strategy emphasizes solving re- al-life problems as a central aspect of learning. This approach promotes active learning, enabling stu- dents to apply theoretical knowledge in practical set- tings, thus fostering analytical and problem-solving skills. The five stages of problem-based learning are:

• Stage 1: General rules and concepts are taught without practical examples.

• Stage 2: Administrative rules are introduced, but there is no structured program for their application.

• Stage 3: The applied rules are introduced through examples or problem-solving exercises.

• Stage 4: Problem-solving becomes the focus of learning activities.

• Stage 5: Real-world problems are used to teach inferential rules and concepts (13).

In Turkey, problem-based learning is not systemati- cally applied across the curriculum. However, in key

professional courses, such as obstetrics, psychiat- ric health, and paediatric nursing, problem-solving methods are occasionally employed in small group settings. The Turkish curriculum aligns with Stage 2, where administrative rules are taught, but no struc- tured problem-solving program exists.

In contrast, the University of Applied Health Scienc- es Zagreb in Croatia employs problem-based learn- ing at Stage 3. Real-life examples and problems are integrated into the curriculum, particularly in clini- cal courses, allowing students to apply theoretical knowledge to practical situations. This approach en- hances critical thinking and problem-solving abilities, preparing students for real-world nursing challenges.

Integration strategy

The integration strategy in the SPICES model seeks to connect different educational content, promoting coherence and a deeper understanding of the mate- rial. This can be achieved through horizontal integra- tion (linking related disciplines) and vertical integra- tion (connecting theoretical knowledge with practical application). The five stages of integration are:

• Stage 1: Courses are independent in terms of objectives, content, instructors, and methods.

• Stage 2: Coordination exists between related courses, with instructors sharing information and consulting with each other.

• Stage 3: Temporary or continuous coordination is achieved, integrating content and assess- ment across disciplines.

• Stage 4: Boundaries between disciplines begin to blur, with multidisciplinary courses imple- mented.

• Stage 5: Interdisciplinary and multidisciplinary courses are fully integrated into the curricu- lum (13).

At Yozgat Bozok University in Turkey, courses are de- livered independently, with little horizontal or vertical integration. Students follow a curriculum designed independently by the Nursing Department, with in- put from internal and external stakeholders. The curriculum is largely organized by semester, and stu- dents must complete at least two out-of-field courses. Clinical practice is conducted under the supervision of instructors, and students complete a year-long in- ternship following their three-year coursework. The Turkish curriculum aligns with Stage 1 of the integra-

tion strategy, where courses remain distinct in terms of objectives, content, and teaching methods.

At the University of Applied Health Sciences Zagreb in Croatia, the integration strategy aligns with Stage

2. Here, courses are coordinated to ensure students understand how different subjects interrelate. Al- though there is no full integration of content across disciplines, efforts are made to highlight the connec- tions between related subjects, such as anatomy and physiology, enhancing the overall learning experience.

Community-based education strategy

The community-based education strategy integrates theoretical knowledge with practical experiences in community settings, helping students address real health problems. This strategy encourages students to engage with local populations, fostering creativity and critical thinking about public health issues. The five stages of community-based education are:

• Stage 1: Courses are unrelated to community problems.

• Stage 2: Courses focus on third-level care (hospital-based).

• Stage 3: Courses emphasize sociology and community issues.

• Stage 4: Courses are community-based, with real-world application of knowledge.

• Stage 5: Courses are integrated across disci- plines, with community engagement at the core of learning (13).

In Turkey, community-based education is incorpo- rated through courses such as community health nursing, transcultural nursing, and health sociology. Students gain practical experience in primary fam- ily health centers and schools, contributing to public health during clinical rotations. Turkey’s curriculum aligns with Stage 3, where courses emphasize soci- ology and community health issues.

In Croatia, community-based education is implement- ed at Stage 4, with a strong focus on real-world ap- plications. Students participate in clinical rotations in community health centres and engage in public health initiatives, linking theoretical knowledge with practical outcomes. The curriculum ensures students are well-prepared to address the health needs of lo- cal populations.

Elective strategy

The elective strategy allows students to tailor their education by selecting courses that align with their personal interests and professional goals. The five stages of the elective strategy are:

• Stage 1: All courses are compulsory.

• Stage 2: Students can select certain aspects, such as consultants or exam schedules.

• Stage 3: Students have additional choices in examination content.

• Stage 4: Certain topics and assessment meth- ods are elective.

• Stage 5: Students choose their learning meth- ods (13).

  In Turkey, 33.3% of the courses are elective, with the remaining curriculum consisting of compulsory cours- es. Students’ feedback is incorporated into curriculum updates. Based on this structure, Turkey is aligned with Stage 1, where most courses are compulsory.

  At the University of Applied Health Sciences Zagreb in Croatia, the curriculum corresponds to Stage 2. Stu- dents have the option to choose from a range of elec- tive courses, such as teamwork in nursing and oncology nursing, which allow them to specialize in areas of inter- est while completing a largely predetermined program.

  
  

  Systematic strategy

  The systematic strategy involves a structured and planned educational approach, ensuring that course objectives, content, teaching methods, and assess- ments are clearly defined. The six stages of system- atic strategy include:

• Stage 1: Course information (objectives, con- tent, methods, and assessment) is inaccessi- ble to students.

• Stage 2: Course information is provided to stu- dents.

• Stage 3: Course content and assessments are directly linked to objectives.

• Stage 4: Objectives are tailored to assessment needs.

• Stage 5: Continuous assessment and feedback are provided (13).

In Turkey, nursing education starts after a competi- tive university entrance exam. Students are vac-

cinated and evaluated for health conditions before starting clinical practice. The curriculum is structured, but course information is clearly communicated to students. Turkey’s curriculum aligns with Stage 2 of the systematic strategy.

In Croatia, the curriculum is at Stage 3, with clear alignment between course content, learning out- comes, and assessment methods. The national ac- creditation agency regularly evaluates nursing pro- grams, ensuring compliance with ESG standards and further enhancing the quality of education (16).

Discussion

This study aimed to compare the nursing curricula at the University of Applied Health Sciences Zagreb in Croatia and Yozgat Bozok University in Turkey us- ing the SPICES model as a framework for analysis. The SPICES model, originally developed over 30 years ago, remains highly relevant today, particularly in contexts where curriculum reform is needed or where innovative approaches to teaching and learn- ing are being introduced. The model continues to be regarded as one of the most valid educational strate- gies for both developing new educational programs and revising existing ones (17 – 20).

Research by Navab et al. (2019) underscores the im- portance of adapting nursing curricula to meet the evolving needs of communities, drawing on the suc- cessful experiences of leading nursing schools that have implemented the SPICES model (21). Such adap- tations help ensure that nursing education remains responsive to societal needs, particularly in prepar- ing future nurses to meet the challenges of contem- porary healthcare. Globalization has significantly in- fluenced the nursing profession by impacting areas such as nursing development, migration, and special- ization. This shift necessitates that nursing curricula address global health challenges and prepare nurses for roles that transcend national boundaries. As high- lighted in recent literature, globalization brings both advancements in nursing practice and challenges, including ethical considerations and the need for cul- tural competence in patient care (22).

A comparative study conducted on the implementa- tion of the SPICES model in the nursing curricula of Tehran (Iran), West (Canada), and Hacettepe (Turkey) universities highlights significant differences in how the model is applied across regions. The findings suggest that the West Nursing Faculty in Canada has more successfully implemented the model compared to the Iranian and Turkish institutions (23). These re- sults highlight the potential for improvement in the application of the SPICES model in countries like Tur- key and Iran.

The comparison of the two nursing curricula revealed that while both countries are making efforts to align their nursing education with the SPICES framework, significant differences remain in how these educa- tional strategies are implemented.

An internationally educated and professional nurs- ing workforce is crucial for achieving positive health outcomes. Despite global efforts to improve nursing education, substantial diversity remains in educa- tional standards both within and across countries

(24). In response, an international framework of guidelines has been developed to enhance consist- ency and quality in nursing education worldwide, as highlighted by the World Health Organization’s State of the World’s Nursing 2020 report (25) This framework promotes three core pillars: standardized learning outcomes for nursing graduates, program standards, and institutional standards, while al- lowing adaptability to local socio-cultural contexts. Global standards in nursing education, such as those promoted by WHO, are crucial for reducing disparities in healthcare quality across different regions. These standards ensure that nursing curricula are not only responsive to local healthcare needs but also aligned with best practices in nursing education worldwide, thereby fostering an internationally competent nurs- ing workforce. The framework’s flexibility supports the integration of globally informed best practices into locally relevant curricula, which could be benefi- cial for countries like Croatia and Turkey as they aim to improve and harmonize their nursing education systems. In Croatia, compliance with EU Directives 2005/36 and 2013/55 plays a critical role in en- suring that nursing education adheres to European standards. This alignment leads to a more structured and standardized curriculum with clear expecta- tions for both educators and students (14, 15). On the other hand, Turkey, despite adopting the SPICES model through its national accreditation process, still

faces challenges in fully integrating certain SPICES strategies, particularly in fostering problem-based learning and student-centered education. Study by Hong and Yu demonstrated that the implementation of unfolding case-based learning in lectures signifi- cantly improves nursing students’ critical thinking abilities (26). These findings suggest that integrat- ing such innovative approaches into current curricula, especially in Turkey, where traditional methods still dominate, could enhance the development of critical thinking and decision-making skills.

One of the key findings is that Turkey remains largely at Stage 2 of both the student-based and problem- based strategies, where student preferences are con- sidered but the curriculum remains predominantly predetermined and guided by faculty members. In contrast, Croatia demonstrates a more integrated ap- proach, especially in clinical settings where students are encouraged to apply theoretical knowledge in real-world environments. However, even in Croatia, opportunities for greater student involvement in cur- riculum design and decision-making could further en- hance the educational experience.

The differences in how these curricula align with the SPICES model have direct implications for nurs- ing practice in both countries. In Croatia, the focus on community-based education and integrated teaching ensures that students are better prepared to address public health challenges and work in interdisciplinary teams. This approach is likely to result in nurses who are more adaptable and capable of applying their skills in diverse healthcare settings. On the other hand, Turkey’s emphasis on traditional, instructor-led teaching may limit the development of critical think- ing and problem-solving skills in nursing students, which are crucial for handling complex patient care scenarios.

As more nursing programs in Turkey undergo accredi- tation and move towards higher stages of the SPIC- ES model, it is expected that the quality of nursing education will improve, leading to better-prepared healthcare professionals. A recent comparative study on midwifery students in Ethiopia provides empirical support for the effectiveness of the SPICES model in enhancing clinical reasoning. The study found that students educated under the SPICES framework showed significantly better clinical reasoning skills, as measured by the Script Concordance Test (SCT), compared to those trained in traditional curricula. These findings suggest that implementing a SPICES-

based approach may lead to improvements in critical skills necessary for complex patient care, highlight- ing the model’s potential for broader application in nursing education worldwide (27). The SPICES mod- el’s focus on problem-based and student-centered strategies not only aligns with contemporary educa- tional best practices but also promotes lifelong learn- ing, which is essential for adapting to advancements in healthcare. By encouraging active involvement and critical thinking, this model prepares students to tackle complex, real-world challenges they may encounter in diverse healthcare settings. The shift towards active learning and student involvement in the educational process, as promoted by the SPICES model, will likely result in nurses who are more en- gaged in their learning and more capable of meeting the demands of modern healthcare. Future research could further explore the application of the SPICES model in nursing education across diverse cultural and institutional contexts. Comparative studies in- volving additional countries would provide a broader understanding of how educational strategies, such as student-centered learning and problem-based education, influence nursing competencies globally.

Limitations

There are several limitations to this study that should be considered when interpreting the results. First, the analysis was limited to two universities - Yozgat Bo- zok University in Turkey and the University of Applied Health Sciences Zagreb in Croatia – thus restricting the generalizability of the findings. A broader study that in- cludes more universities from both countries would pro- vide a more comprehensive understanding of how the SPICES model is implemented across different institu- tions. Additionally, the study relied on publicly available curriculum documents and did not involve direct obser- vation or qualitative interviews with faculty members or students. Another limitation is the potential cultural differences between the two countries, which may in- fluence how certain educational strategies are imple- mented. For example, the emphasis on problem-based learning may differ significantly based on cultural expectations of teaching and learning, as well as the healthcare challenges unique to each country.

Conclusion

This study provides a comparative analysis of the nurs- ing curricula at the University of Applied Health Sci- ences Zagreb in Croatia and Yozgat Bozok University in Turkey using the SPICES model as a framework. The re- sults highlight both similarities and differences in how the SPICES strategies are implemented in Croatia and Turkey, with Croatia demonstrating a more structured and EU-aligned approach, while Turkey is in the pro- cess of improving its curriculum through accreditation and alignment with international standards. Despite both countries making efforts to modernize nursing education, challenges remain, particularly in the ar- eas of problem-based learning and student-centered approaches, which are more prevalent in Croatia. The findings suggest that further efforts are needed, par- ticularly in Turkey, to fully implement the SPICES model to foster active learning and critical thinking, essential for modern nursing practice.

The study emphasizes the importance of continuous- ly updating nursing curricula in response to evolving healthcare needs. By aligning more closely with the SPICES model, both countries can enhance the quality of nursing education, better preparing graduates to meet the demands of contemporary healthcare environments.

Author contributions

Conceptualization (SČ, RAH, BS, BF, BÜ); Data Cura- tion (SČ, RAH, BS, BF, BÜ); Formal Analysis (SČ, RAH, BS, BF, BÜ); Investigation (SČ, RAH, BS, BF, BÜ); Meth- odology (SČ, RAH, BS, BF, BÜ); Project Administration (SČ, RAH, BS, BF, BÜ); Resources (SČ, RAH, BS, BF,

BÜ); Supervision (SČ, RAH, BS, BF, BÜ); Validation (SČ, RAH, BS, BF, BÜ); Visualization (SČ, RAH, BS, BF, BÜ);

Writing – Original Draft (SČ, RAH, BS, BF, BÜ); Writing – Review & Editing (SČ, RAH, BS, BF, BÜ).

Conflict of interest

The authors declare no conflicts of interest.

Acknowledgments

Not applicable.

Funding

This research received no external funding.

References

1. Yue M, Zhang M, Zhang C, Jin C. The effectiveness of concept mapping on development of critical thinking in nursing education: A systematic review and meta- analysis. Nurse Educ Today. 2017;52:87-94. https:// doi.org/10.1016/j.nedt.2017.02.018

2. MacDonnell C, George P, Nimmagadda J, Brown S, Gremel K. A team-based practicum bringing together students across educational institutions and health professions. Am J Pharm Educ. 2016;80(3):49. https:// doi.org/10.5688/ajpe80349.

3. MacDonnell C, George P, Nimmagadda J, Brown S, Gremel KA. Team-based practicum bringing together students across educational institutions and health professions. Am J Pharm Educ. 2016;80:49. https:// doi.org/10.5688/ajpe80349

4. Wakefield M, Williams DR, Le Menestrel S. The future of nursing 2020-2030: Charting a path to achieve health equity. Washington, DC: National Academies Press; 2021. https://doi.org/10.17226/25982

5. Yue M, Zhang M, Zhang C, Jin C. The effectiveness of concept mapping on development of critical thinking in nursing education: A systematic review and meta- analysis. Nurse Educ Today. 2017;52:87-94. https:// doi.org/10.1016/j.nedt.2017.02.018

6. Dewart G, Corcoran L, Thirsk L, Petrovic K. Nursing edu- cation in a pandemic: Academic challenges in response to COVID-19. Nurse Educ Today. 2020;92:104471. https://doi.org/10.1016/j.nedt.2020.104471

7. Williams PA. Fundamental Concepts and Skills for Nursing. 6th ed. St. Louis, Missouri: Elsevier Health Sciences; 2021.

8. Yüceyurt NK, Şenyuva EA, Kaya H. Uluslararası ve Ulusal Çalışmaların Hemşirelik Eğitimine Yansımaları. Yükseköğretim ve Bilim Dergisi. 2023;13(1):1-9. https:// doi.org/10.5961/higheredusci.1163644 Turkish.

9. Khorashadizadeh F, Karimi Moonaghi H. Systematic strategy in nursing curriculum in American, Canadian, Australian nursing and proposed way for applying it in Iranian nursing curriculum: A comparative study. J Med Educ Dev. 2017;12(1&2):2-12.

10. Karimi Moonaghi H, Khorashadizadeh F. Nursing cur- riculum in some developed countries and proposed way of applying it in the Iranian nursing curriculum: A comparative study. J Nurs Educ. 2015;4:38-47.

11. Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: the SPICES model. Med Educ. 1984;18(4):284-97. https://doi. org/10.1111/j.1365-2923.1984.tb01024.x

12. Asgari P, Navab E, Bahramnezhad F. Comparative study of nursing curriculum in nursing faculties of Canada, Turkey, and Iran according to SPICES model. J Educ

    Health Promot. 2019;8:120. https://doi.org/10.4103/ jehp.jehp_392_18

13. Changiz TA. Course evaluation tool based on SPICES model, and its application to evaluation of medical pharmacology course. J Med Educ. 2006;8(2):111-20.

14. European Parliament & Council. Directive 2013/55/ EU amending Directive 2005/36/EC on the rec- ognition of professional qualifications. Available at: https://eur-lex.europa.eu/legal-content/EN/ ALL/?uri=celex%3A32013L0055.

15. European Parliament & Council. Directive 2013/55/ EU amending Directive 2005/36/EC on the rec- ognition of professional qualifications. Available at: https://eur-lex.europa.eu/legal-content/EN/ ALL/?uri=celex%3A32013L0055.

16. European Association for Quality Assurance in Higher Education. Standards and guidelines for quality as- surance in the European Higher Education Area (ESG). Brussels, Belgium; 2015. Available at: https://www. enqa.eu/wp-content/uploads/2015/11/ESG_2015.pdf.

17. Dent JA. Using the SPICES model to develop innova- tive teaching opportunities in ambulatory care ven- ues. Korean J Med Educ. 2014;26(1):3. https://doi. org/10.3946/kjme.2014.26.1.3

18. Karimian Z. Impact of innovative educational tech- nologies on the SPICES model in medical education. Interdiscip J Virtual Learn Med Sci. 2023;14(1):75-9. https://doi.org/10.30476/ijvlms.2023.98690.1223

19. Misganaw E, Yigzaw T, Tezera R, Gelitew A, Gedamu S. The promise of the new educational strategy for curric- ulum development (SPICES) model on the development of students’ clinical reasoning ability. A comparative cross-sectional study. Adv Med Educ Pract. 2022;13:71-

    9. https://doi.org/10.2147/AMEP.S344933

20. Al-Jarshawi MHA, Al-Imam A. A thousand words about modern medical education: a mini-review concerning the theory of education. J Med Sci. 2022;91(2):124-8. https://doi.org/10.20883/medical.e636

21. Navab E, Bahramnezhad F, Gholami M, Asgari P. Devel- opment of the proposed solutions to implement SPIC- ES model strategies in Iranian undergraduate nursing curriculum. J Med Educ. 2019;18(3):e105687. https:// doi.org/10.22037/jme.v18i3.25236

22. Dorri S, Abedi A, Mohammadi N. Nursing educa- tion in the path of globalization: Promotion or chal- lenge? Journal of education and health promo- tion. 2020;9(1):269. https://doi.org/10.4103/jehp. jehp_775_19

23. Asgari P, Navab E, Bahramnezhad F. Comparative study of nursing curriculum in nursing faculties of Canada, Turkey, and Iran according to SPICES model. J Educ Health Promot. 2019;8(1):120. https://doi. org/10.4103/jehp.jehp_392_18

24. Baker C, Cary AH, da Conceicao Bento M. Global stan- dards for professional nursing education: The time is now. J Prof Nurs. 2021;37(1):86-92. https://doi. org/10.1016/j.profnurs.2020.10.001

    
    

25. World Health Organization. State of the world’s nurs- ing 2020: Investing in education, jobs and leadership [Internet]. Available at: https://iris.who.int/bitstream/ handle/10665/331677/9789240004863-ara.pdf

26. Hong S, Yu P. Comparison of the effectiveness of two styles of case-based learning implemented in lec- tures for developing nursing students’ critical think- ing ability: A randomized controlled trial. Int J Nurs Stud. 2017;68:16-24. https://doi.org/10.1016/j. ijnurstu.2016.12.008

27. Misganaw E, Yigzaw T, Tezera R, Gelitew A, Gedamu S. The promise of the new educational strategy for cur- riculum development (SPICES) model on the develop- ment of students’ clinical reasoning ability. A compar- ative cross-sectional study. Adv medical educ pract. 2022:71-9. https://doi.org/10.2147/AMEP.S344933