From cultural competence towards cultural safety in nursing education: a scoping review of strategies, barriers and enablers for global health equity

Aim and Objectives: To map how undergraduate nursing education fosters Cultural Competence (CC) and related concepts, including Cultural Safety and Cultural Humility, and to identify educational strategies, barriers, and facilitators influencing curriculum implementation.

Methods: A scoping review was undertaken in CINAHL, PubMed, PsycInfo and ERIC (peer-reviewed; English language; last 10 years). Screening and data charting focused on pedagogical strategies applied to teach CC and related contents, as well as contextual barriers and enablers at student, educator, and institutional levels.

Findings/Outcomes: CC development is most supported through experiential, simulationbased, and problem-based learning approaches, including service-learning, international placements, and collaborative online international learning. Reflective pedagogies were frequently used to foster self-awareness, critical reflection, and intercultural skills. Key barriers included limited curricular time, resources, funding, and educator confidence. Facilitators comprised supportive institutional policies, inclusive organisational cultures, faculty development initiatives, and sustained community partnerships.

Discussion/Conclusion: Factors shaping CC education operate dynamically across multiple levels, indicating that pedagogical effectiveness is closely linked to institutional and policy contexts. While experiential and reflective learning approaches are well-established and effective in developing CC, their meaningful integration into nursing curricula depends on supportive national and institutional frameworks. Inclusive organisational cultures promote equity and openness while faculty education increases their confidence in addressing bias and discrimination and builds trust within learning environments.

Implications for Practice: Preparing nurses for transcultural practice requires educational approaches that critically engage with culture, power, and inequity across diverse care settings. Embedding reflective, experiential, and equity-oriented learning supports nurses to provide culturally safe care to migrant, minoritised, and marginalised populations. Sustaining culturally safe environments further requires ongoing professional development and organisational accountability within healthcare and educational institutions.