Cultural empathy development through simulation-based education: a qualitative exploration of Saudi nursing students’ and academics’ experiences

Cultural empathy development among nursing students requires innovative educational approaches that facilitate deep understanding and perspective-taking. While simulation-based interventions show promise, the lived experiences and perceptions of students and educators regarding cultural empathy development remain underexplored in Middle Eastern contexts, particularly where healthcare increasingly serves diverse populations. Guided by an interpretivist–constructivist paradigm, this qualitative descriptive study was conducted in 2022 at the College of Nursing, King Saud University, Riyadh, Saudi Arabia, as part of a larger mixed-methods project. Eight focus groups were held with 58 first-year nursing students following a cultural empathy simulation activity, and six semi-structured interviews were conducted with nursing academics who observed the simulation. Focus groups were conducted in Arabic and translated into English; interviews were in English. Braun and Clarke’s six-phase thematic analysis framework guided data analysis. Student focus groups generated four themes: (1) Growing awareness of culturally and linguistically diverse (CALD) patient needs, (2) Imagining walking in CALD patients’ shoes, (3) Exploring barriers and solutions when working with CALD patients, and (4) Reflecting on the value and importance of cultural sensitivity in nursing. Academic interviews yielded three themes: (1) Expanding simulation in the Saudi curriculum with emphasis on cultural sensitivity, (2) Learning to connect and empathise with CALD patients’ feelings, and (3) Preparing first-year students for culturally empathetic practice. Participants described the simulation as transformative, offering experiential learning beyond traditional didactic approaches. Culturally focused simulation experiences can facilitate profound shifts in students’ cultural awareness and empathetic understanding. Findings highlight the value of experiential learning, guided reflection, and safe environments for developing culturally competent healthcare professionals.