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The Use of Simulations for the Development of Cultural Competencies in Nursing Education

The selection of the literature was based on the relevance and quality of
the articles selected. The quality of the articles was assessed using the Joan-
na Briggs Institute (JBI) critical appraisal tools: the JBI Systematic Reviews
Checklist, JBI Checklist for Quasi-Experimental Studies and JBI Checklist for
Qualitative Research. The articles were primarily separately evaluated by two
researchers, with a third author involved in case of differences in the ratings
for each study. Each article could be graded on one of four levels: inadequate,
sufficient – C, good – B, excellent – A. If an article was graded as inadequate,
it was excluded from further analysis. Following an assessment of the quality
of the articles, it was determined that 11 studies were of excellent quality, four
were of good quality, and two were of sufficient quality.

Data Analysis
The data were analysed using an inductive, descriptive synthesis approach
(Polit & Beck, 1). The research questions served as the foundation for iden-
tifying relevant expressions within the data, which were subsequently tabu-
lated. To synthesize the findings, tabulation was employed to identify simi-
larities and differences, organizing the data into categories that were named
based on their content.

Results
In the final analysis, we included 17 studies investigating the effectiveness
and established use of simulations as a teaching and learning method for the
acquisition of cultural competencies.

Types of Simulators and Educational Content Related to Cultural
Competence in Nursing Students
In this part of the results, we focused on the type and purpose of the research,
the specific simulation techniques used, the educational content covered in
the scenarios, and the main findings. Table  shows the main characteristics
of the individual studies included in the final analysis.
The simulation methods employed in this integrative literature review were
diverse (Table ). The simulations included high-fidelity simulations, stand-
ardized patient simulation, virtual simulations, screen-based simulations, and
role play. A study on low-fidelity simulation (Phillips et al., 1) demonstrat-
ed the significance of the visual representation of task trainers, such as the
skin colour used in the training device, for cultural learning. Furthermore, it
was essential to reinforce the simulation environment with culturally specific
elements. In another study, cultural competency was practised in the con-

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