Simulation of cultural conflict situations to enhance cultural competence in nursing students: A mixed-methods study

초록

Background: As the cultural diversity in healthcare settings increases, nurses encounter cultural conflicts related to patients’ religious beliefs and values. This study developed a simulation-based program that reflects cultural conflicts and examined its effects on nursing students’ intercultural communication competence, transcultural self-efficacy, and cultural competence. Methods: Convergent mixed-methods design was used with 46 nursing students. Intercultural communication competence, transcultural self-efficacy, and cultural competence were measured before and after the intervention then analyzed using paired t-tests. The open-ended responses were analyzed using inductive content analysis. Results: Self-reported intercultural communication competence, transcultural self-efficacy, and cultural competence significantly improved after the intervention, with small to medium effect sizes. Qualitative analysis identified: “experiences of performing intercultural communication” and “expanded cultural awareness and intention to apply culturally appropriate nursing care". Changes in the students’ understanding of religious beliefs and patient autonomy were also observed. Conclusion: Simulation-based education that reflects cultural conflicts may improve nursing students’ self-reported intercultural communication, transcultural self-efficacy, and cultural competence in highly diverse healthcare environments. © 2026 International Nursing Association for Clinical Simulation and Learning

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