Transcultural Caring in Nursing Education: Linking Knowledge, Attitudes, and Skills Toward Culturally Safe Practice with Indigenous Peoples in the Philippines
Abstract:
Cultural competence is a vital foundation of nursing practice, particularly when caring for Indigenous populations. This study assessed undergraduate nursing students’ knowledge, attitudes, and skills (KAS) in transcultural caring toward the Aeta community in Pampanga, Philippines. A descriptive quantitative design was employed among BSN students using a validated Cultural Awareness Survey. Data were analyzed through descriptive statistics, focusing on category means and interpretation across KAS dimensions. Findings revealed a high overall cultural competence mean (M = 5.00). Students demonstrated very high knowledge (M = 5.89) and highly positive attitudes (M = 5.44), reflecting effective curricular integration of transcultural concepts. However, skill levels were moderate (M = 3.67), particularly in independent behaviors such as consulting patients about cultural beliefs and respecting culturally influenced decisions. The disparity between strong cognitive–affective readiness and moderate behavioral skills underscores the need for experiential, reflective, and community-based learning. Integrating simulation, guided debriefing, and Indigenous-led engagement can bridge this gap. While students possess strong awareness and positive attitudes toward cultural diversity, curricula must further strengthen practice-based competencies to ensure culturally safe, responsive, and inclusive care for Indigenous communities.
KeyWords:
Aeta community, Cultural competence, Indigenous health, Nursing students, Transcultural nursing
References:
- Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181–184. https://doi.org/10.1177/10459602013003003
- Červený, M., Knapová, L., & Vaculíková, J. (2022). Reflective learning for cultural safety: Bridging the knowing–doing gap in nursing education. Nurse Education Today, 118, 105502. https://doi.org/10.1016/j.nedt.2022.105502
- Driscoll, T. P., Magnuson, M., & Schriever, A. E. (2024). The intersection of transformative learning theory and experiential education. American Journal of Pharmaceutical Education, 88(5), 100908. https://doi.org/10.1016/j.ajpe.2024.100908
- Eisenberg, S., Walles, B., & Long, E. (2024). Theory in action for graduate nurse educator students: An experiential learning project. Nurse Education Today, 135, 106391. https://doi.org/10.1016/j.nedt.2024.106391
- Farokhzadian, J., Abbaszadeh, A., & Abazari, P. (2022). Cultural competence training in nursing education: Effects on students’ awareness and communication skills. BMC Nursing, 21(1), 78. https://doi.org/10.1186/s12912-022-00809-5
- Farsangi, M. A., Joolaee, S., & Ebadi, A. (2023). Mobile-based training to improve cultural humility among nursing students: A quasi-experimental study. Nurse Education in Practice, 70, 103561. https://doi.org/10.1016/j.nepr.2023.103561
- Galan-Lominchar, M. T., Muñoz, C., & Valero-Chillerón, M. J. (2024). Virtual exchange and simulation in nursing education: Enhancing intercultural learning. Nurse Education Today, 131, 106109. https://doi.org/10.1016/j.nedt.2024.106109
- Hardy, A., Bessarab, D., & Geia, L. (2023). Embedding cultural safety and accountability in Indigenous health practice: A national review. Australian Journal of Nursing Practice, Scholarship and Research, 30(2), 45–57. https://doi.org/10.1016/j.aujnpr.2023.02.004
- Hsu, L. L., Chao, C. H., & Huang, Y. T. (2023). Effects of simulation with guided debriefing on reflective learning and cultural competence among nursing students. Journal of Nursing Education, 62(1), 11–18. https://doi.org/10.3928/01484834-20221107-04
- Husebø, S. E., Friberg, F., & Brattebø, G. (2024). Guided reflection and debriefing to strengthen cultural skills in nursing education. Nurse Education Today, 133, 106154. https://doi.org/10.1016/j.nedt.2024.106154
- Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Prentice-Hall.
- Leininger, M. M. (2006). Culture care diversity and universality: A worldwide nursing theory (2nd ed.). Jones and Bartlett Publishers.
- Ličen, S., & Prosen, M. (2023). Integrating transcultural nursing into curricula: Impact on students’ cultural awareness and sensitivity. Nurse Education in Practice, 67, 103568. https://doi.org/10.1016/j.nepr.2023.103568
- Plaza del Pino, F. J., Soriano, E., & Celdrán-Mañas, M. (2022). Simulation-based learning and self-reflection: Effects on intercultural communication in nursing education. Journal of Transcultural Nursing, 33(5), 509–517. https://doi.org/10.1177/10436596221078365
- Poirier, D., Cachagee, S., & Jamieson, K. (2025). Building cultural security in health systems through co-design and governance reform: A scoping review. International Journal for Equity in Health, 24(1), 18. https://doi.org/10.1186/s12939-025-02012-9
- Putra, I. G. N. W., Subedi, B., & Suranata, K. (2025). Clinical learning environments and cultural competence development among student nurses: A cross-national study. Nurse Education Today, 132, 106137. https://doi.org/10.1016/j.nedt.2025.106137
- Rew, L., Becker, H., Cookston, J., Khosropour, S., & Martinez, S. (2003). Measuring cultural awareness in nursing students. Journal of Nursing Education, 42(6), 249–257. https://doi.org/10.3928/0148-4834-20030601-06
- Shahzad, S., Ali, N., Younas, A., & Tayaben, J. L. (2021). Challenges and approaches to transcultural care: An integrative review of nurses’ and nursing students’ experiences. Journal of Professional Nursing, 37(1), 200–214. https://doi.org/10.1016/j.profnurs.2021.10.001
- Shopo, M., Makhene, A., & Mulaudzi, F. M. (2024). Enhancing cross-cultural nursing communication through community-based learning and guided reflection. BMC Nursing, 23(1), 151. https://doi.org/10.1186/s12912-024-01763-5
- Tosun, N., Kaya, A., & Demir, S. (2024). Curriculum enhancement for transcultural competence among nursing students: A longitudinal evaluation. Nurse Education Today, 130, 106099. https://doi.org/10.1016/j.nedt.2024.106099