Nursing Students in Ireland Show Moderately High Cultural Awareness, but Ethnic Gaps Emerge

Cultural competence has quietly become one of the most consequential skills in modern healthcare. As patient populations grow more diverse, the ability of nurses to understand, respect and respond to cultural differences can shape everything from communication at the bedside to whether patients trust the care they receive. A new cross-sectional study published in PLOS One by Jennifer Sullivan and Sahar Hammoud examines how well undergraduate nursing students in Ireland are being prepared for this challenge, and the results reveal both encouraging strengths and uncomfortable disparities within the classroom itself.

The research team set out to measure cultural awareness among nursing undergraduates at a single higher education institution in Ireland, using a validated and standardised instrument known as the Cultural Awareness Scale, or CAS. The CAS is designed to capture more than a single headline number. It breaks cultural awareness into four subscales, allowing researchers to probe distinct dimensions of how students experience and perceive culturally related content in their education, from general educational experiences to specific encounters with diverse patient populations and peers. A total of 116 undergraduate nursing students took part in the survey, providing a snapshot of how this cohort perceives its own preparation for multicultural care.

Methodologically, the study followed a descriptive cross-sectional design, meaning it captured perceptions at a single point in time rather than tracking change over the course of a degree. Because the CAS produces scores that are not normally distributed, the researchers turned to non-parametric statistical tests. The Mann–Whitney U test was used to compare scores between two independent groups, such as students born in Ireland versus those born elsewhere, while the Kruskal–Wallis test extended this comparison across three or more groups, for example when examining differences by age band or year of study. The team also calculated effect sizes, reported as r values, which indicate how large the observed differences were in practical terms rather than simply whether they cleared the threshold of statistical significance.

The headline finding was broadly positive. Overall CAS results showed that students’ level of cultural awareness was moderately high, with only slight variations across the four subscales of the instrument. This pattern is consistent with previous research that has used the CAS in other nursing student populations, suggesting that Irish undergraduate nursing education is, at least on the surface, delivering a reasonable foundation in cultural awareness. For a healthcare system serving an increasingly multicultural population, that baseline matters: nurses who enter the workforce with stronger cultural awareness are better positioned to deliver safe, person-centred and responsive care to patients from a wide range of backgrounds.

But the more provocative findings emerged when the researchers examined how scores varied according to socio-demographic characteristics. Students born in Ireland recorded higher scores on all four subscales compared with students born outside Ireland, although these differences did not reach statistical significance. The direction of the gap is nonetheless noteworthy. International and migrant students, who often bring their own lived experience of navigating cultural difference, reported systematically lower perceptions of culturally inclusive educational practices than their Irish-born peers. The authors caution that the sample size limits the statistical power available to detect such differences, and they frame this as a pattern that warrants further investigation rather than a definitive conclusion.

The starkest disparities appeared when students were compared by ethnic identification. Participants who identified as White scored significantly higher on the General Education Experience subscale than participants categorised as people of colour, with mean scores of 64.54 versus 42.66, a difference captured by the Mann–Whitney U test at U = 837, p = 0.002, and a moderate effect size of r = −0.29. The same pattern held for the Total Awareness score, where White students averaged 63.32 compared with 45.86 for students of colour, yielding U = 939.5, p = 0.012, and r = −0.23. In plain terms, students from minority ethnic backgrounds perceived their nursing education as meaningfully less culturally inclusive than their White classmates did, and the effect sizes suggest these were not trivial differences.

Why would students of colour rate the same educational environment so differently? The study itself does not test explanations, but the finding resonates with a broader body of literature on minority stress, belonging and curriculum design in professional education. When cultural competence is taught primarily as content about other people, students from minority backgrounds may find the material less relevant to their own experience, or may notice that the curriculum frames culture as something possessed by patients rather than something that shapes classrooms, faculty and institutions as well. Lower perceived inclusion can also reflect everyday experiences of being a statistical minority in a cohort, which can colour how students evaluate teaching practices, peer interactions and institutional commitment to diversity.

The implications for nursing education are significant. Ireland’s nursing workforce and student body have become notably international, and healthcare employers increasingly expect graduates to work competently with patients and colleagues from many cultural traditions. If students from migrant or minority ethnic backgrounds consistently perceive their training as less inclusive, educators may need to look beyond simply adding cultural content to the syllabus. The authors argue that the findings highlight the need for further research to explore these patterns and to inform the development of culturally responsive nursing education, an approach that treats cultural competence as a two-way process embedded in teaching methods, assessment, placement experiences and institutional culture rather than a standalone module.

There are important caveats to keep in view. The study was conducted at a single institution with 116 participants, so the results cannot be generalised to all nursing students in Ireland or elsewhere. Cross-sectional designs capture perception at one moment and cannot establish causation; it remains unclear whether the observed gaps reflect differences in the curriculum, in students’ prior experiences, or in how different groups interpret the survey items themselves. The non-significant differences between Irish-born and non-Irish-born students may partly reflect limited statistical power in a modest sample. Self-reported instruments like the CAS also measure perceived cultural awareness, which may not map perfectly onto observable clinical behaviour with patients.

Even with those limitations, the study adds a valuable data point to an expanding international conversation about how healthcare professionals are trained for diversity. The moderately high overall scores suggest that the foundations are being laid, while the significant ethnic differences in perceived inclusion serve as a reminder that averages can conceal inequities. As the authors conclude, the association between ethnic background and perceptions of culturally inclusive educational practices deserves closer scrutiny, both to understand its causes and to ensure that the nurses of tomorrow, whatever their origin, graduate feeling equally prepared and equally included in a profession whose core promise is care without discrimination.

Subject of Research: Cultural awareness and competence among undergraduate nursing students in Ireland

Article Title: Assessing cultural awareness and competency in nursing education: A cross-sectional study of undergraduate nursing students in Ireland

Article References: Sullivan, J., & Hammoud, S. (2026). Assessing cultural awareness and competency in nursing education: A cross-sectional study of undergraduate nursing students in Ireland. PLOS One, 21(10), e0359851. https://doi.org/10.1371/journal.pone.0359851

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0359851

Keywords: cultural competence, nursing education, cultural awareness scale, cross-sectional study, undergraduate nursing students, Ireland, health disparities, culturally responsive teaching, Mann-Whitney U test, Kruskal-Wallis test, multicultural healthcare, PLOS One