Developing Cultural Competence Learning of the Nursing Students Using Simulation Strategies: An Integrative Review

Marivic Ilarde

Our Lady of Fatima University, Valenzuela, Philippines and St. Paul University Philippines, Tuguegarao, Philippines.

Ma. Theresa Salinda *

St. Paul University Philippines, Tuguegarao, Philippines and Far Eastern University, Manila, Philippines.

Vilma S. Vasquez

Far Eastern University, Manila, Philippines.

Daryl Jake S. Fornolles

Far Eastern University, Manila, Philippines.

Glenda T. Morano

Far Eastern University, Manila, Philippines.

Francis Vicent L. Acena

Our Lady of Fatima University, Valenzuela, Philippines.

Jhal B. Espinosa

Our Lady of Fatima University, Valenzuela, Philippines.

*Author to whom correspondence should be addressed.


Background: Cultural competence serve as foundation and pillar to health care in endeavoring elimination of health disparities. Health care services is essential in providing care. Culturally sensitive and high-quality services plays major role in promoting optimum level of wellness [1]. The process of awareness culturally enables nurses to transform interventions into positive health outcomes (Smith, 2018). Self-awareness plays important role in developing social skills towards promoting quality of care.

Purpose: The objective of this study is to review literature which provide evidence that presents cultural competency among nursing students with the use of simulation activities which is being integrated to nursing program. In addition, it help to understand students experiences in rendering care to the patient addressing cultural diversity.

Methods: The researchers conducted integrative literature review which follow process utilizing Ebscohost and Goggle Scholar databases particularly CINAHL,ERIC and Academic research were considered articles published from 2016 up to the present, a total of 12 articles were extracted.

Results: Most of the studies are quantitative (n = 12). 1 study is qualitative. 6 of the quantitative studies used a one-group pre-post-test design (n = 5), 1 study used a two-group pre-post design and quasi-experimental design was used, 6 study used post-test design in a form of survey. The empirical studies identified ranged from 8 to 460. The studies were conducted mostly in the USA (n = 10), one in Australia, and one study was done in 2 different countries, USA and Thailand .

Conclusion: Nursing as advocate of care plays vital role in promoting care through enhancing knowledge, skills, attitude in rendering care. Cultural competency of nurses serve as aid in understanding cultural differences that will enhance quality of care and services.

Keywords: Cultural competency, learning, simulation, strategies

How to Cite

Ilarde , Marivic, Ma. Theresa Salinda, Vilma S. Vasquez, Daryl Jake S. Fornolles, Glenda T. Morano, Francis Vicent L. Acena, and Jhal B. Espinosa. 2023. “Developing Cultural Competence Learning of the Nursing Students Using Simulation Strategies: An Integrative Review”. Asian Journal of Research in Nursing and Health 6 (1):68-79.


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Alpers LM. Distrust and patients in intercultural healthcare: A qualitative interview study. Nurs Ethics. 2018; 25(3):313-23. DOI: 10.1177/0969733016652449, PMID 27284017.

Antón-Solanas I, Huércanos-Esparza I, Hamam-Alcober N, Vanceulebroeck V, Dehaes S, Kalkan I et al. Anto ́n-Solanas, et al. Nursing lecturers’ perception and experience of teaching cultural competence: A European qualitative study. Int J Environ Res Public Health. 2021; 18(3). DOI:10.3390/ijerph18031357, PMID 33540907.

Andrews, S. The case study Companion. 2021. DOI:10.4324/9780367854492

Behnke, C. Using Simulation to educate Rural NP Students about cultural congruence. The Journal of Nurse Practitioners; 2021. DOI: 10.1016/j.nurpra.2020.11.019

Butler M, et al. Improving cultural competence to reduce health disparities. Rockville, (MD): Agency for Healthcare Research & Quality; 2016.

Caspar S, Ratner PA, Phinney A, MacKinnon K. The influence of organizational systems on information exchange in long-term care facilities: An Institutional Ethnography. Qual Health Res. 2016;26(7):951-65. DOI: 10.1177/1049732315619893, PMID 26758177.

Campinha-Bacote J. A model and instrument for addressing cultural competence in health care. J Nurs Educ. 1999;38(5):203-7. DOI: 10.3928/0148-4834-19990501-06, PMID 10438093.

Heckman et al. The role of unregulated care providers in managing heart failure patients in long-term care facilities J. Clin. Nurs. 2017;26(5–6):849-861.

Marja, S. Cultural competence learning of the health care students using simulation pedagogy: An integrative review. Nurse Education in Practice; 2021. DOI: 10.1016/j.nepr.2021.103044

Cantey J. Ending the culture Negative Sepsis in Neonatal ICU; 2017.

Oikarainen A, et al. Assessment of nursing students' competence in clinical practice: A systematic review of reviews. International Journal of Nursing Studies; 2019. Available:

Kim Y, Noh G, Im Y. Effect of step-based prebriefing activities on flow and clinical competency of nursing students in simulation-based education. Clinical Simulation in Nursing. 2017;13(11): 544-51. DOI: 10.1016/j.ecns.2017.06.005

Levett-Jones T Lapkin. A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Education today; 2014. DOI:10.1016/j.nedt.2013.09.20

Li L. Social-emotional learning amidst COVID 19 school closure: Possitive findings from efficacy study of adventures abroad the S.S. GRIN Program; 2021.

Cruz JP, Aguinaldo AN, Estacio JC, Alotaibi A, Arguvanli S, Cayaban ARR, et al. A Multicountry Per- spective on Cultural Competence among Baccalaureate Nursing Students. J Nurs Scholarsh. 2018; 50(1):92-101. DOI: 10.1111/jnu.12350, PMID 28960801

Da Costa Brasil G, et al. Use of the design and self-confidence scales in the assessment of maternal-child realistic simulation. Rev Enferm Ref. 2018; 4(19):117-25.

Torraco R. Writing intergrative reviews: Guidelines and example; 2015.

Fioravanti M, et al. Creative learning through the use of simulation to teaching nursing students screening, brief invention, and referral to treatment for alcohol and other drug use in culturally competent manner; 2018.

Fuselier J, et al. Nursing Studentd’ manikins of color simulation Laboratories.Clinical Simulation in Nursing; 2016. DOI: 10.1016/j.ecns.2016.01.01

Garrido M, Simon R. Cultural Nursing androgogies with foreign- educated physicians enrolled in BSN to MSN program. Journal of Cultural Diversity. 2016; 23(3):99-106.

Jones, Cultural Emphtay in pysiotheraphy students: A pre-test and post test study utilizing virtual simulation; 2019.

Kessler S. Effectiveness of cultural competence education in Baccalaurete Nursing; 2021.

Kock A, et al. Importance of cultural sensitivity in todays Work Place; 2021

San, E. Effect of the diverse standardized patient simulation (DSPS) cultural competence Education strategy on Nursing Students’ Transcultural Self- Efficacy Perceptions. J. Transcult Nurs; 2018.

Turkelson C, Cooper D. Using simulation to educate rural NP student about cultural congruence. The Journal for Nurse practitioner. 2021;17:4 1:476-480.

De Guzman et Al. Cultural Competence; An Important Skill Set for the 21st CenturyIndex: youth & Families, Families; 2016.

Hickerson, A. Learning in public: Faculty and student opinions about social media in the Classroom. Sage Journals. 2018. DOI: 10.1177/107769581666063

Kohli HK, et al. Historical and theoretical development of culturally competent social; 2010.

Muhammed. Patients’ Satisfaction with Primary Health Care centers’ Services, Majmaah, Kingdom of Saudi Arabia; 2015.

Wurth K, et al. Their view: Difficulties and challenges, patient’s and physician in cross- cultural encounters and a medical ethics perspective. BMC Med Ethics. 2018;19:1-10.

Henderson S, Horne M, Hills R, Kendall E. Cultural competence in healthcare in the community: A concept analysis. Health Soc Care Community. 2018;26(4):590-603. DOI: 10.1111/hsc.12556, PMID 29516554.

Lee SE, Lee MH, Peters AB, Gwon SH. Assessment of patient safety and cultural competencies among senior baccalaureate nursing students. Int J Environ Res Public Health. 2020;17(12). DOI: 10.3390/ijerph17124225, PMID 32545746.

Maier-Lorentz MM. Transcultural nursing: Its importance in nursing practice. J Cult Divers. 2008;15(1):37-43. PMID 19172978.

Polit and Beck. Nursing research: Generating and assessing evidence for nursing practice. 9th ed. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins; 2012.

Rassouli M, Zamanzadeh V, Valizadeh L, Ghahramanian A, Asghari E. Limping along in implementing patient-centered care: qualitative study. Nurs Pract Today. 2020;7(3):217-25. DOI: 10.18502/npt.v7i3.3350

Sharifi et al. Cultural competence in nursing: A concept analysis Int. J Nurs; 2019.

Smith ML, Foley MR. Transforming clinical education in obstetrics and gynecology: gone is the day of the sage on the stage. Obstet Gynecol. 2016; 127(4):763-7. DOI: 10.1097/AOG.0000000000001356, PMID 26959215.

Tang C, Tian B, Zhang X, Zhang K, Xiao X, Simoni JM, et al. The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. J Adv Nurs. 2019;75(4): 749-59. DOI: 10.1111/jan.13854, PMID 30209816.

Wang Y, Xiao LD, Yan P, Wang Y, Yasheng A. Nursing students’ cultural competence in caring for older people in a multicultural and developing region. Nurse Educ Today. 2018;70:47-53. DOI: 10.1016/j.nedt.2018.08.012, PMID 30145534.

Whittemore R, Knafl K. The integrative review: Updated methodology. J Adv Nurs. 2005;52(5):546-53. DOI: 10.1111/j.1365-2648.2005.03621.x, PMID 16268861.

Work practice’, Journal of Teaching in Social Work. 30(3):252–271.