Abstract
Background: Globalization has increased the use of English as a common language in healthcare settings (Cheng et al., 2025). Additionally, nursing programs have increased the number of students who speak English as an additional language (EAL; Henry, 2023). EAL students often encounter unique challenges in nursing programs, including struggles with communication and cultural norms that can impact success (Henry, 2023). Simulation-based learning is an effective method to develop nursing students’ knowledge and skills (Alharbi et al., 2024). Despite its growing use, there was no comprehensive synthesis of research exploring EAL nursing students’ experiences with simulation-based learning at the time of this review. Addressing this gap is critical to inform inclusive simulation activities.
Purpose: This integrative review synthesized current research on EAL prelicensure nursing students’ experiences with simulation-based learning to inform educational practices.
Methods: Whittemore and Knafl’s (2005) integrative review framework guided this study. A systematic search of five electronic databases yielded eight primary research articles that met the inclusion criteria. Studies were appraised for methodological rigor, and data were analyzed to identify themes.
Results: Six major themes emerged: communication, cultural impacts, peer and faculty roles, psychological safety, clinical preparation, and coping strategies. Findings suggest that EAL nursing students may have increased stress during simulations due to language barriers and cultural differences (Adedokun et al, 2022). However, psychologically safe environments can reduce anxiety and improve skill acquisition (Wu et al., 2023). Peer support, culturally responsive faculty, and inclusive learning environments are key to reducing barriers during simulations (Adedokun et al., 2022).
Implications: This review highlights the need for culturally responsive simulation design, increased peer support, and faculty development. Improving EAL students’ simulation experiences can enhance clinical competence and reduce educational disparities. These findings inform nursing educators in creating inclusive, psychologically safe simulation environments.
Conclusion: Simulation-based learning is effective for EAL nursing students when paired with culturally responsive, supportive practices. Future research should focus on identifying best practices for designing and evaluating simulation experiences for EAL learners.
Notes
References:
1. Adedokun, C., Tang, J., & Cavanaugh, C. (2022). English-as-a-second-language baccalaureate prelicensure nursing students’ perception of simulation experience. Journal of Professional Nursing, 41, 149–156. https://doi.org/10.1016/j.profnurs.2022.05.004
2. Alharbi, A., Nurfianti, A., Mullen, R. F., McClure, J. D., & Miller, W. H. (2024). The effectiveness of simulation-based learning (SBL) on students’ knowledge and skills in nursing programs: A systematic review. BMC Medical Education, 24, 1099, https://doi.org/10.1186/s12909-024-06080-z
3. Cheng, C., Wang, Q., Bai, J., & Christensen, M. (2025). Challenges, support, and strategies concerning learning among nursing students who have English as an additional language: A meta-synthesis. Nurse Education Today, 144, 106408. https://doi.org/10.1016/j.nedt.2024.106408
4. Henry, A. (2023). English-as-an-additional language nursing students: A literature review. Teaching and Learning in Nursing, 18(4), 527–533. https://doi.org/10.1016/j.teln.2023.07.001
5. Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(2), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
6. Wu, J. G., Miller, L., Huang, Q., Wang, M. (2023). Learning with immersive virtual reality: An exploratory study of Chinese college nursing students. RELC Journal, 54(3), 697–713. https://doi.org/10.1177/00336882211044860
Sigma Membership
Alpha Alpha
Type
Poster
Format Type
Text-based Document
Study Design/Type
Integrative Review
Research Approach
Mixed/Multi Method Research
Keywords:
Simulation, Teaching and Learning Strategies, English as a Second Language, Nursing Students
Recommended Citation
Ross, Megan, "Simulation Experiences of EAL Prelicensure Nursing Students: An Integrative Review" (2026). International Nursing Research Congress (INRC). 58.
https://www.sigmarepository.org/inrc/2026/posters_2026/58
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-04
Simulation Experiences of EAL Prelicensure Nursing Students: An Integrative Review
Toronto, Ontario, Canada
Background: Globalization has increased the use of English as a common language in healthcare settings (Cheng et al., 2025). Additionally, nursing programs have increased the number of students who speak English as an additional language (EAL; Henry, 2023). EAL students often encounter unique challenges in nursing programs, including struggles with communication and cultural norms that can impact success (Henry, 2023). Simulation-based learning is an effective method to develop nursing students’ knowledge and skills (Alharbi et al., 2024). Despite its growing use, there was no comprehensive synthesis of research exploring EAL nursing students’ experiences with simulation-based learning at the time of this review. Addressing this gap is critical to inform inclusive simulation activities.
Purpose: This integrative review synthesized current research on EAL prelicensure nursing students’ experiences with simulation-based learning to inform educational practices.
Methods: Whittemore and Knafl’s (2005) integrative review framework guided this study. A systematic search of five electronic databases yielded eight primary research articles that met the inclusion criteria. Studies were appraised for methodological rigor, and data were analyzed to identify themes.
Results: Six major themes emerged: communication, cultural impacts, peer and faculty roles, psychological safety, clinical preparation, and coping strategies. Findings suggest that EAL nursing students may have increased stress during simulations due to language barriers and cultural differences (Adedokun et al, 2022). However, psychologically safe environments can reduce anxiety and improve skill acquisition (Wu et al., 2023). Peer support, culturally responsive faculty, and inclusive learning environments are key to reducing barriers during simulations (Adedokun et al., 2022).
Implications: This review highlights the need for culturally responsive simulation design, increased peer support, and faculty development. Improving EAL students’ simulation experiences can enhance clinical competence and reduce educational disparities. These findings inform nursing educators in creating inclusive, psychologically safe simulation environments.
Conclusion: Simulation-based learning is effective for EAL nursing students when paired with culturally responsive, supportive practices. Future research should focus on identifying best practices for designing and evaluating simulation experiences for EAL learners.
Description
This integrative review examined how nursing students who speak English as an additional language experience simulation-based learning. Findings reveal challenges surrounding language barriers and cultural differences. However, supportive, inclusive environments decreased anxiety and improved skill acquisition. Recommendations include culturally responsive simulation design, faculty training, and peer support to enhance learning outcomes.