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

manner. In order to conduct an effective interview, students first acquired
cross-cultural knowledge and skills during the simulation experience (Gross-
man et al., 1; Hamilton, 16; Hickerson et al., 18; Ozkara San, 19). They
then applied this knowledge and skill during the interview in order to gath-
er the necessary information about the patient. As observed by Grossman
et al. (1), while statistically significant improvements were noted in the
psychomotor domain (interview), this domain exhibited the lowest pre-test
and post-test scores in comparison to the cognitive and affective domains.
Additionally, as posited by Hamilton (16), the outcomes in the psychomo-
tor domain were also influenced by students’ demographic characteristics,
with those from multicultural families demonstrating enhanced proficiency
in conducting interviews.

Discussion
The process of international migration and globalisation presents a challenge
to the healthcare system in an increasingly diverse society, which must pro-
vide culturally competent care. It is imperative to implement strategies that
can effectively address the linguistic and cultural barriers that exist at the
systemic, organisational and individual levels (Oikarainen et al., 19). Conse-
quently, it is becoming increasingly important for educators and mentors in
clinical settings to impart cultural knowledge to students and create learning
experiences that help them become culturally competent. Cultural compe-
tence is a process that can be effectively learned through appropriate forms
of education (Foisy-Doll, 13). Therefore, the aim of this integrative literature
review was to determine the effectiveness of simulations as a teaching and
learning method in acquiring cultural competencies among nursing stu-
dents.
The integrative literature review revealed that the most prevalent simula-
tor employed for the development of cultural competencies among nursing
students is the standardized patient or a related simulation method, such as
role-playing, in the context of providing care to patients from diverse racial,
religious, and ethnic backgrounds, as well as in the context of culturally com-
petent care for LGBT patients. In recent years, there has also been an increase
in the use of virtual reality as a simulation method for learning cross-cultur-
al nursing. The popularity of using standardised patients can be attributed
primarily to their realism, the accuracy of information delivery (Webster,
14), the provision of high-quality feedback, and the ability to assess stu-
dents (Schram & Mudd, 15). The use of the standardised patient is consid-
ered an optimal method for the development of cultural competencies, as it

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