Exploring the Use of AI-Based Patient Simulations to Support Cultural Competence Development in Nursing Students: A Mixed-Methods Study

(1) Background: Developing cultural competence and reflective communication skills remains a challenge in nursing education. Traditional teaching methods often provide limited opportunities for safe practice of culturally sensitive interactions in emotionally complex situations. Artificial intelligence (AI)–based patient simulations may offer a scalable approach to experiential and reflective learning. (2) Aim: This study explored the educational potential of AI-based patient simulations in supporting nursing students’ self-assessed cultural competence, reflective awareness, and communication confidence. (3) Methods: A convergent mixed-methods pre–post study was conducted among 24 s-cycle nursing students. Participants engaged in individual AI-based patient simulations with simulated patients representing diverse cultural contexts. Quantitative data were collected using an exploratory cultural competence self-assessment scale administered before and after the simulation. Qualitative data included post-simulation reflection forms and AI-student interaction transcripts, analysed using inductive thematic analysis. (4) Results: A statistically significant increase in overall self-assessed cultural competence was observed (Wilcoxon signed-rank test: Z = 4.05, p < 0.001, r = 0.59), with the greatest improvements in communication adaptability and perceived communication sufficiency. Qualitative findings indicated an emotional shift from uncertainty to engagement, heightened awareness of cultural complexity, reflective reassessment of assumptions, and high perceived educational value of AI simulations. (5) Conclusions: AI-based patient simulations represent a promising pedagogical tool for fostering reflective and communication-oriented learning in culturally complex nursing contexts. Their primary value lies in supporting experiential learning, emotional engagement, and the development of cultural humility, suggesting their potential role as a complementary educational strategy in advanced nursing education.