The effectiveness of culturally-focused simulation-based education on empathy development among Saudi nursing students: a quasi-experimental study

Abstract

Background: Empathy is a core nursing competency that enhances patient outcomes and satisfaction, yet evidence consistently documents empathy decline during nursing education. Culturally focused simulation offers a promising strategy to address this challenge, particularly in Saudi Arabia’s increasingly diverse healthcare system. Aim: To evaluate the effectiveness and acceptability of a culturally focused simulation-based educational intervention in enhancing empathy among first-year Saudi nursing students. Design: A quasi-experimental single-group pre-test/post-test design. Methods: The study was conducted with 203 first-year nursing students at King Saud University during the 2022–2023 academic year. Participants engaged in a 30-minute immersive simulation comprising pre-briefing, 3D virtual reality scenarios of culturally diverse patients, and structured debriefing. Empathy was assessed before and after the intervention using the Comprehensive State Empathy Scale (CSES), while satisfaction was measured post-intervention with the Satisfaction with Cultural Simulation Experience Scale (SCSES). Both tools were translated into Arabic, validated for this sample, and demonstrated excellent reliability (CSES α = 0.966; SCSES α = 0.976). Data were analyzed using paired-samples t-tests, mixed-design ANOVA, and non-parametric statistics. Results: Empathy improved significantly across all six CSES subscales (p < 0.001), with medium effect sizes observed for empathic concern (d = 0.51) and shared affect (d = 0.66). Students reported high satisfaction with the simulation (overall median = 105, IQR 80–125), particularly in cultural competence and learning from debriefing. Conclusions: Culturally focused simulation-based education is both effective and well accepted in enhancing empathy among Saudi nursing students. Integrating culturally tailored simulations with structured debriefing early in curricula may foster compassionate, culturally competent graduates prepared for diverse healthcare environments.