Cultural competence among nursing students in Peru: a sequential mixed methods study

Cultural competence is a fundamental pillar in nursing for reducing health disparities and ensuring equitable care. However, in multicultural countries such as Peru, significant gaps persist regarding how university education articulates theory with actual operational competencies. The aim of this study was to analyze the level of cultural competence and its conceptualization among nursing students in Lima, Peru. A two-stage sequential explanatory mixed-methods design was used across two private universities with distinct socioeconomic profiles in Metropolitan Lima ( \(\:N=\text{3,424},n=560\) ). Quantitative CCATool data were analyzed using pooled descriptive statistics to establish an overall baseline profile and stratified non-parametric tests to evaluate institutional variations. The qualitative phase explored student experiences through semi-structured interviews ( \(\:n=9\) ). Data revealed a markedly asymmetrical self-reported competency profile. Quantitatively, self-reported cultural knowledge recorded the lowest mean score, contrasting with high self-assessed scores in cultural sensitivity and awareness. Qualitatively, students demonstrated a proactive disposition to challenge institutional racism and validate local worldviews. However, this self-perceived ethical empowerment clashed with persistent implicit clinical stereotypes and severe self-identified language barriers in native languages. To compensate for formal training gaps, students relied on individual empathy and intuition. A critical dissonance exists between the strong ethical sensitivity of nursing students and their technical and linguistic preparation. It is urgent for higher education institutions to transition toward integrated, transversal, and intersectional curricula that include the formal teaching of native languages and cultural mediation tools. Future observational studies are needed to evaluate how self-reported ethical awareness translates into demonstrated clinical practice.