The Impact of Culture Diversity in Nursing Care among Students

The Impact of Culture Diversity in Nursing Care among Students

Oluwafemi Bosede and Ma. Christina B. Ortega

Masters in Public Health, Virgen Milagrosa University Foundation, San Carlos, Pangasinan, Philippines

DOI: https://dx.doi.org/10.47772/IJRISS.2025.905000469

Received: 12 May 2025; Revised: 14 May 2025; Accepted: 17 May 2025; Published: 23 June 2025

ABSTRACT

Cultural diversity has increasingly become a fundamental basis, especially in populated educational institutions where international students strive for cultural adaptability and growth. This study aims to investigate international student cultural experiences with nursing care, challenges, and adaptability and in culturally diverse settings. A qualitative-phenomenological research design was used. The study covers 16 international students’ nurses who participated in the study, using a semi-structured interview guide. The researchers recorded and transcribed the interview using Collaizi’s phenomenological descriptive method.  The findings showed that international students’ nurses, aged 19 to 24, primarily encountered challenging moments that stemmed from their cultural competence, a factor that positively impacts their clinical practice. They experienced cultural bilingualism, and this tends to be a feature that unites international students as they accept their differences and embrace their similarities. They embraced the local cultural difference, though it was a challenging moment for the international students. The international students also experienced self-culturation and growth. Critical thinking and problem solving were also important factors for the international students, as they are considered a fundamental basis for dealing with academic issues. The result also revealed that awareness and cultural diversity were the features embraced by the international students. Cultural integration into the educational syllabus can significantly help students deal with cultural diversity, according to the findings. The cultural diversity among international nursing students has presented a challenging moment for them. They experienced a challenging period, grappling with issues related to cultural competence, cultural bilingualism, self-culturation and growth, critical thinking and problem solving, as well as awareness and cultural diversity. The international student nurses who embraced cultural integration into the educational syllabus can significantly help students deal with cultural diversity, according to the findings. Thus it is recommended that the students are required to have a common aim and also to learn how to apply their learning competency skills which they have acquired to solve health problems,that they have to have an effective communication wih their clients in order to have a fair view of how their clients are faing.

Keywords: International nursing student, cultural diversity, educational setting, nursing care.

INTRODUCTION

The healthcare system has been facing challenges due to the fast-paced globalization and the distinct cultural diversity among the population. In other words, this challenge creates opportunities for healthcare professionals to provide more quality and competent care for patients (Daniel & Lucas, 2024).

Since culture is a collective way of feeling, thinking, and relating to beings, cultural competence tends to be considered a skill that is often taught and trained and is often described as a crucial factor for working with diverse patients (Stubbe, 2020). An international study exposed the challenges and dissatisfactions nurses encounter when tending to patients from ethnic backgrounds that are culturally and racially diverse (Cioffi, 2005). Similarly, in a workplace with diverse cultures, the nursing manager team faces challenges in enhancing and promoting competence (Teixeira, 2020).

According to a study, most nurses have difficulty dealing with culturally diverse patients from health institutions (Cioffi, 2005). According to the World Health Organization, most high-income nations depend on foreign-trained nurses to handle the various cultural difficulties that arise in the healthcare system (Drennan &Ross, 2019). An empirical number revealed that more than 40% of nurses in the US are foreign-born, and the UK tends to have a higher percentage—roughly 18% in 2021 (Nashwan, 2024). Research has indicated that cultural differences cause health inequalities and barriers to healthcare services for Canada’s indigenous communities (Marrone, 2007).

Because of the Philippines’ expanding population and varied cultural backgrounds, most Filipinos struggle with a lack of education and other necessities, which presents difficulties for healthcare providers because they are unable to effectively interact with patients and comprehend their needs (Villegas & Villegas, 2023). Patients frequently suffer because of nurses’ lack of cultural competency since it restricts their access to quality care. For example, most nurses might be unable to provide patients with the proper care if they are unfamiliar with their cultural beliefs. A study revealed that health care professionals, such as nurses, often harbor stigmatizing attitudes due to their failure to recognize the influence of culture, which significantly affects patient care in the Philippines (Barral et al., 2023).

This investigation aims to make a substantial contribution to the educational system by evaluating the impact of nursing care in culturally diverse settings. This study explores international student cultural experiences with nursing care, challenges, and adaptability in culturally diverse settings. The study’s findings, according to the researcher, will assist student nurses better grasp cultural diversity and communication traits and identify typical cross-cultural communication errors, enabling them to improve their communication abilities in healthcare.

Statement of the Problem:

1. What is the impact of nursing care in culturally diverse settings?
2. What is the international student cultural experiences with nursing care, challenges, and adaptability in culturally diverse settings?

METHODS

This explorative study utilized a qualitative-phenomenological research design. It investigates the care experiences of international student’ nurses in relation to their adaptability to different cultural backgrounds. International students’ nurses from Virgen Milagrosa University Inc.

The study focused on international students’ nurses.The researchers recruited 16 international  students’ nurses to participate in the study. To address any form of bias, the researchers employed the purposive sampling techniques to ensure that the participant’s selection meets the inclusion criteria set. The researchers collected data by conducting interviews with the participants over a period of 30 to 45 minutes. August 2021 marked the beginning of the full data collection phase, which ran until November 2021.

The researchers transcribed the audio recorded, presented it in narrative form, and organized it into themes and subthemes with the assistance of a multi-disciplinary nursing and linguistics team. They served as the analysts. They reviewed the transcribed findings and provided an analysis and explanation. The author disassociated herself from the participants. The author highlighted important points from the data and presented the relevant quotation using the Collaizi’s method.

The researcher obtained approval from VMUF officials and the graduate school’s research committee. The research committee of the VMUF authorized the study’s formal conduct based on the ethical considerations covered in a letter. Interestingly, the researcher had no trouble getting permission to conduct the investigation. Formal authorization was given for the cover letter. Informed consent and voluntary involvement, anonymity, confidentiality, respect and dignity, and the option to withdraw at any time are among the ethical standards for the study. The importance, goals, and risks of the study were underlined by the researcher. After fully informing the participants about the study’s goals and obtaining their written consent, the researcher was able to gain the respondents’ full participation and consent. Transparency was maintained by the researcher by making all the data anonymous. To ensure correct data collection, the researcher gave the respondents enough direction to ensure they comprehended the questions’ aim and meaning.

RESULT

Demographic Profile of the Respondents

Table 1 demonstrated that there were (68.8%) within the ages of 19-24 and then (12.5%) within the ages of 31-35. The majority (62.5%) were in level III, with the least (18.8%). It showed that (81.3%) were Nigerians, while (6.3%) were Monrovians. They all speak the official language, English (100%).

Cultural Competence

Participants claimed that being exposed to various cultures gave a plethora of knowledge, such as accepting diversity and realizing that every culture has distinctive qualities that make it stand out from the rest. They added that, occasionally, engaging with individuals from various cultures allows them to see life from a different angle, which positively impacts life. They develop fresh perspectives on issues and new methods for approaching and resolving them when they study other cultures. Additionally, they felt that exposure to many cultures fostered healthy attitudes, personal development, and respect for equality. The international students responded as follows:

“Interestingly, a growing number of Filipinos are more than willing to educate me about their culture, which has a significant impact on the nursing profession. It facilitates smooth and quality conversations among international student nurses who care for patients from diverse cultural backgrounds.” (3 NS Yr.2)

“Establishing rapport with different ethnic groups of people in the environmental setting helps us as international nursing students understand their way of life and the nature of food.” (4 NS Yr.4)

Cultural Bilingual Struggles

In addition to gaining knowledge-based perspectives on their surroundings, participants also develop skills in communication. Participants gain skills that will enable them to function well in their new learning environment as they engage with individuals from different cultural backgrounds. Most participants said they had improved their ability to communicate clearly and actively listen. Their ability to be astute observers is another skill they have developed. Gaining proficiency in this area improved their understanding of appropriate behavior and cultural sensitivity. They also thought that learning strategically and developing new abilities could be accomplished by maintaining an open mind, engaging in active listening, and looking for opportunities in various contexts. Additionally, most international students responded as follows:

“It helps us, as international students, develop a spirit of adventure by showing curiosity and seeing opportunities in different situations. This international cultural language promotes fluent Filipino-speaking, avoids slang, and practices active listening, which enhances active patient care.” (5 NS Yr.2)

“It helps us develop an understanding of other cultures, or cultural awareness’, and allows us to have more meaningful interactions with those around us, but this comes with a struggle. We develop respect and empathy for others, as well as celebrating the differences and similarities.” (6 NS Yr.4)

Cultural Acclimatization  

The student nurses appear to be aware, conscious, and fully aware of the cultural barriers, having adapted to the culture and environment in which they find themselves. In terms of appropriation, students avoided stereotypes by respecting and acknowledging diversity in a positive light, which helps them get familiar with the culture. Refraining from stereotypes gives meaning and richness to diversity. They responded as follows:

“Some culturally recognized practices and behaviors may not be appropriate in another culture, according to me. Therefore, understanding cultural differences and adapting to them can prevent conflicts and enhance our relationships with others; people value cultural acclimation.” (7 NS Yr.4)

Self-Cultural Development and Its Challenges

Students must first be deeply aware of who they are and accept the differences in other people and cultures to grow personally. Continuous growth paves the way for reaching life’s milestones and success. While some responses mentioned the locations of these growths, others explained how and why they were made.

“Yes, I am gaining knowledge, skills, and experience that will benefit me in my career and in life in general. Moreover, acquiring new skills in communication and problem solving, along with achieving my goals, has been a challenging journey, as adjusting to multiple cultural norms in a foreign land is always challenging.” (8 NS Yr.2)

Language Fluency and Utilization

Language is an essential tool in communication and significantly contributes to learning experiences. During this research, most of our correspondents expressed dissatisfaction and unfulfilled desires due to language-related issues, which they perceived as a barrier to learning and communication. This issue also arises from the frequent communication of essential information in Tagalog, even though some instructors offer more effective explanations in the local dialect. All our respondents had similar experiences with incomplete, incoherent, or ununderstood information.

“It’s not something I really like, and I wish they used a language we, the foreigners, could understand.” (12 NS Yr.2)

“Sometimes receiving vital information in Tagalog negatively affects me, but I’m also aware that sometimes using the local language helps the teacher explain things to the student better.” (10 NS Yr.2)

“For the teachers, it limits the knowledge they are trying to pass across in a way, and when making important announcements, they should try and communicate in English.” (11 NS Yr.4)

Reciprocity and Awareness of Cultural Diversity

A sincere awareness of the cultures of others requires a lack of bias in the evaluation of culture. This entails learning new abilities and competencies and honoring traditions and morals. The goal of exposing nursing students to a variety of cultures is to develop their cultural sensitivity so they can provide better care in the future. A culturally aware person accepts and acknowledges others who are different, fostering deeper relationships with those around them. In addition, we celebrate our differences and similarities, foster empathy, and respect for others, and remove personal prejudices and unfavorable ideas about other communities. Among international students, the majority reported:

“I suggest accepting individuals’ differences with dignity and embracing their similarities tends to establish a harmonious ground for cultural integration, and this ideology often contributes to mutuality and fosters patient care.”(1 NS Yr.2)

“Interactive sessions with my Filipino classmates and colleagues were a very good measure of adaptability and cultural feasibility.” (2 NS Yr.2)

Challenges and Approaches: Curriculum Integration

Cultural discrepancies can be an essential element of the nursing profession, especially when the curriculum contains the fundamental cultural basis for educational acquisition, particularly in a multicultural healthcare institution. They establish the framework for professional expectations and work to define professional development and learning plans that will help assimilate new nurses into practice and experienced nurses into new specialties. Neglecting the professional competency in the culture of nurses can pose challenges for the organizations. A diverse learning environment can address the barriers to stereotypes. Here are the responses:

“It’s fascinating to have the ethnic syllabus incorporated into the curriculum, which gives students the ability to effectively use professional terms in a foreign language to assess, analyze, and evaluate a diagnosed patient’s illness. It is challenging when students cannot readily cope with the use of professional terms (i.e., foreign) in nursing care practices.” (13 NS Yr.4)

Improving Problem-Solving and Critical Thinking

Despite the crucial benefits of learning and adopting different cultural backgrounds, this can aid international students in navigating complex healthcare scenarios that often require critical thinking and problem-solving skills. International students can achieve this by improving their communication skills and adapting to specific cultural language and barriers, which will enable them to improve their problem-solving ability. Most respondents in this study expressed their challenges.

“At times, I find it challenging to speak because some of my Filipino classmates are shy about using English, even in health facilities. I sometimes find it difficult to speak the local dialect of Tagalog in healthcare settings because most people (i.e., Filipino patients) shy away from talking to us. They would rather speak Tagalog, preferably. Yes, it’s very difficult for me; sometimes I do miss vital information in patient care because of the language barrier.” (12 NS Yr.2)

“It is unfortunate that most times I get trapped in healthcare issues that require critical thinking and analysis based on my perspective, and seeking help poses challenges, especially when my personal thought is required to comprehend the information for better patient evaluation.” (12 NS Yr.4)

Global Perspective

Nurses need exposure to a variety of cultural contexts to effectively handle global health challenges and function in culturally diverse settings, both at home and abroad. To fully understand this cultural divide, international students must navigate it. The responders shared their experiences in this section.

“I advocate embracing individual differences, as my nursing career may lead me to various locations with diverse cultural languages due to the need for patient care across various nations.” (1 NS Yr.2)

DISCUSSION

The results of the study showed that most of the respondents, third-year Nigerians, were between the ages of 19 and 24 and spoke English as their formal language. This indicates that more Nigerians are attending nursing schools, and as English is frequently their official language by nationality, it could be difficult for them to adjust to different cultural settings. It is consistent with the study by Choi et al. (2020), which delved into the cultural experiences of international students (Asians) in clinical settings and revealed that a deficiency in language flexibility and challenges in meaningful conversation significantly influenced their working relationship.

The findings indicate that international students achieve cultural competence through collaborative coaching, where following their indigenous classmates effortlessly guides their language learning process. The Choi et al. (2020) study also proposed that collaborative coaching serves as a phase of language development for the Asian students in clinical settings. Furthermore, the results align with Lyu, J.’s (2024) research, which demonstrated that educators and institutional backgrounds significantly contribute to enhancing students’ knowledge and speaking abilities, enabling them to excel in various environments.

The struggles of cultural bilingualism among international students revealed that they desired to embrace their cultural differences, which could influence their patient care activities. Recognizing their cultural differences and embracing their similarities presents a significant challenge. The findings align with the findings of the Wagstaff et al. (2023) study, which demonstrated that cultural and linguistic diversity among international student nurses in their practice settings limits their learning opportunities. The study also revealed that language proficiency and cultural barriers often limit opportunities and support.

Cultural adjustment According to the findings, the respondents showed that understanding the different aspects of the culture gave the international students the basis for acceptability. The outcome differs from what Yerken and Luu discovered in their 2022 investigation. That study demonstrated how sociocultural adaption is negatively impacted by cultural distance, language proficiency, length of stay, and acculturation techniques, particularly for overseas students. Furthermore, the Bethel et al. (2020) study revealed that the various educational systems have a detrimental effect on the psychological well-being of international students during cross-cultural transitions. Zheng et al.’s (2014) study revealed a high number of underperformances among students, with a lack of language skills often being the major factor.

The findings revealed that self-cultural development has been an experience most international students have faced with challenges, and Tagunova et al.’s (2021) study’s results support the result because they showed that in a modern educational system, the framework of the global cultural and national cultural identity depended on it since international students received education from several sources and contexts. The cited study also revealed that students’ self-determination occurs when they receive language training that shapes their attitudes. International students faced difficulties with language fluency, which aligns with a study by Sosas (2021) in the Philippines. According to the study, the Philippines has 117 dialects, and Filipinos use the English language infrequently, with most instructors using both English and the local dialect to convey sensitive information to students.

The respondent’s findings showed a theme of enhanced critical thinking and problem solving; however, this implies that international students might suffer when local dialects spread sensitive information, which can be essential for critical thinking. They had trouble, especially when dealing with complex health issues. Cox’s (2014) perspectives on critical thinking validate it instead of implying that students need critical thinking to navigate the complexity of the world.

Findings showed that the respondents experienced awareness and cultural diversity, which in a large sense strike a balance. This suggests that international students have finally come to terms with cultural diversity. This aligns with the findings of Eden et al.’s (2024) study, which demonstrated that promoting inclusivity and diversity awareness of culture in education is crucial for promoting equitable access to knowledge, thereby showcasing the experiences of students from various cultural backgrounds. It also encourages cultural responsiveness in educational environments.

International students struggled to adapt to the deeply embedded local dialect. This suggests that cultural diversity has become a challenge for international students. Therefore, incorporating cultural integration into the educational syllabus can significantly aid in adapting to cultural diversity, as it exposes students to a wider range of cultures for academic integration. This finding is consistent with the Sarı and Yüce’s (2020) study’s findings that revealed multilingualism as a fundamental phenomenon globally accepted in educational institutes, as students tend to use several languages in the educational context and their private lives, and this, however, necessitates teachers to equip themselves with essential skills to deal with cultural differences among students.

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