Implementation and evaluation of a simulation-based educational intervention with first year nursing students in Saudia Arabia: Mixed methods research.

Abstract

Background: Saudi Arabia needs a more culturally sensitive healthcare workforce to meet the needs of an increasingly multicultural population. While cultural competency training exists, fostering empathy for different cultures remains under-addressed in Saudi nursing education. Simulation-based education is a new approach in this context but limited to basic nursing skills training. Objective: This mixed-methods study investigated the feasibility and effectiveness of a cultural empathy simulation activity for first year Saudi nursing students. Student empathy development and satisfaction with the activity were assessed. Methods: A convergent parallel mixed-methods design was employed. Quantitative data on empathy were collected using the Comprehensive State Empathy Scale (CSES), while student satisfaction was measured using the Satisfaction with Cultural Simulation Experience Scale (SCSES). Qualitative data on experiences and perceptions were gathered through student focus groups and academic interviews. Findings: The quantitative analysis revealed a statistically significant increase in the mean scores of the Comprehensive State Empathy Scale (CSES) following the cultural empathy simulation activity. Specifically, students demonstrated a notable improvement in their ability to understand and share the feelings of individuals from diverse cultural backgrounds (p<0.05). The Satisfaction with Cultural Simulation Experience Scale (SCSES) showed that students were very satisfied, with average scores always above 4.0 on a 7-point scale, indicating they felt the simulation was effective in helping them understand different cultures. Qualitative data from focus groups and academic interviews corroborated these findings. Students reported enhanced awareness of cultural differences, improved communication skills when interacting with culturally and linguistically diverse (CALD) patients, and a greater sense of confidence in providing culturally sensitive care. They highlighted the value of the simulation in fostering perspective-taking, particularly in understanding the emotional and social challenges faced by patients from different cultural backgrounds. Academic interviews emphasised the simulation's role in bridging the gap between theoretical knowledge and practical application by allowing students to actively engage with cultural concepts in a safe and supportive environment. The integration of real-life scenarios and debriefing sessions was perceived as crucial in facilitating deep learning and reflection on cultural biases. Conclusion: This study suggests that cultural empathy simulation activities can significantly improve the teaching of cultural empathy to Saudi nursing students. These activities foster empathy, preparing culturally competent nurses to address the diverse needs of the Saudi healthcare system.