Introduction

The world has become increasingly diverse in terms of race, ethnicity, and culture, and multiracial and multicultural coexistence within a single country has led to linguistic, religious, and cultural conflicts, as well as socioeconomic problems such as refugees, terrorism, and poverty.1 In the case of South Korea, as of 2023, the number of foreigners living in the country accounted for 4.89% of the total population.2 South Korea is also participating in the globalization of migration and is a multicultural society.3 Thus, having an open attitude toward different cultures is increasingly important in recognizing and accepting cultural diversity while maintaining one’s cultural identity.4 In recent years, K-culture—a collection of cultural products like K-pop and K-movies from Korea (ie, “K-series”)—has become a global phenomenon, achieving significant success in international markets. However, it has faced criticism for perpetuating stereotypes and prejudices due to a lack of understanding of racial, religious, and cultural differences.5 Educators in Korea focus on increasing multicultural inclusiveness among students through multicultural understanding education.6 Despite these efforts, multicultural education often fails to achieve its goals due to problems such as insufficient cultural understanding, discrimination, and unequal support.7 Education that lacks a foundation in cultural understanding can increase social distance.8

Researchers use social distance to measure the level of prejudice toward different social groups and the level of acceptance of different racial groups.9 Uygur et al10 found that greater social distance leads to greater rejection of foreigners and negatively affects multicultural acceptance skills. Studies of Korean adults’ perceptions of social distance toward foreign immigrants and workers show that most people do not have very close relationships. About 70% maintain a moderate distance, and more than 5% reject foreigners.11 This phenomenon of social distance negatively affects multicultural acceptance and hinders progress toward a multicultural society.11 Therefore, Korean educators must emphasize cultural diversity education that promotes mutual understanding of the intrinsic values of different cultures. However, it is not always easy to recognize and understand one’s culture based on the language and customs, let alone embrace the positive aspects of a third culture.12 This recognition requires formal aspects such as institutionalization and policies related to multiculturalism, and fundamental improvements through educational efforts.13

Education is crucial in realizing multiculturalism, which recognizes the value of diversity, seeks unity in the coexistence of different cultures, and reduces social distance in Korea’s unique multicultural society.7 In Korea’s social context, it is urgently necessary to offer education that promotes multicultural understanding, reduces socio-psychological barriers hindering empathy between people, encourages acceptance of cultural diversity, and promotes social networking across racial groups.14 In particular, Korean nursing students frequently encounter foreigners during their clinical practice,15 substantially exposing them to multiculturalism. This situation highlights the importance of nursing students possessing deep multicultural knowledge and empathy. Multicultural understanding and acceptance are crucial for nursing students, as they must deliver care that respects and accommodates cultural differences when working with clients from diverse backgrounds in clinical settings.16 Culturally competent nurses respect clients’ perspectives and enhance cultural safety, strive to create a non-discriminatory environment, and ultimately contribute to health equity.17 To achieve this level of competence, it is essential to provide nursing students with comprehensive multicultural awareness training.

In this respect, qualitative rather than quantitative research appears to be an appropriate methodology to share the experience of nursing students who have to coexist with various minority groups in the clinical setting, including their prejudices, negative feelings, and social distance toward them,15 and their inability to respond appropriately to the rapid changes in a multicultural society. Grounded theory research methodology can explain the research phenomenon as a systematic process of human thoughts and behaviors in interactions with others, shaped by symbols, to derive a substantive theory;18 therefore, it can provide comprehensive data on the process of nursing students’ changes in perspectives toward multiculturalism. Against this backdrop, this study explores how nursing students’ attitudes toward individuals from different cultures evolve after receiving education on multicultural understanding, using grounded theory to analyze this process and meaning system. Simultaneously, it examines the social distance nursing students feel toward people of different races and cultures and their perceptions of diversity to provide foundational insights for multicultural education aimed at the younger generation.

Methodology Study Design

This qualitative study investigates participants’ perceptions of multicultural education and the types of social distance they experience. Using the grounded theory methodology of Corbin and Strauss,18 we explored how participants in multicultural education interpret social distance, the contextual conditions under which they accept or reject it, and the factors that facilitate or hinder this process. Grounded theory emphasizes processes and interactions, making it suitable for extracting central categories from participants’ experiences and understanding the relationships between these categories. By applying this methodology, we aimed to uncover the underlying meanings of social distance, identify the conditions influencing its acceptance, and recognize the supporting and obstructing elements involved, thereby effectively analyzing and understanding the impact of multicultural education.

Participants

We selected participants for this study following the purposive sampling method. We recruited 12 second-year nursing students from a university with a multicultural understanding curriculum through postings on the university bulletin board. These participants voluntarily agreed to engage in the multicultural education program.

For initial data collection, we conducted focus group interviews (FGIs) with groups of three participants, each lasting one to two hours. These interviews, conducted before finalizing the research questions and directions, allowed participants to discuss their multicultural experiences openly. The researcher refrained from expressing personal opinions and employed semi-structured questions to minimize bias. The questions included: “What specific thoughts, attitudes, or behaviors did you experience in your multicultural education”, “What did you learn from the multicultural understanding course”, and “How do you think you have changed since before the course?”

Data analysis identified “social distance” as the central phenomenon influenced by multicultural education. We determined related interactions, causal conditions, and contextual factors. To enhance the depth of responses, we included open-ended questions that facilitated more comprehensive discussions with participants. In the theoretical sampling phase, we recruited additional participants based on recommendations from the initial group to address areas requiring further information. We recruited six additional participants through snowball sampling, which included three extreme case samples.

By comparing and analyzing the interviews, we better understood the causal, intervening, and contextual factors related to social distance. We continued to collect and analyze data simultaneously, identifying a saturation point where no new concepts or categories emerged. This iterative process enabled us to refine our understanding of the impact of multicultural education on participants’ perceptions and experiences.

Data Collection and Procedure

The participants took an eight-week, two-hour multicultural course in their college curriculum. The content of the education included prejudice and negative images of other cultures, prejudice and negative images of multicultural families, eliminating racial prejudice and discrimination, addressing rejection and prejudice against different appearances, and eliminating prejudice against different groups such as gender, disability, and religion. In addition, the course provided education on theories and activities to understand the meaning of culture and cultural diversity, to identify the causes and patterns of increasing diversity, and to develop sensitivity and respectful attitudes toward various cultures.

We selected participants from a university with a multicultural curriculum and collected data through interviews from June 2015 to February 2016; interviews lasted approximately one to two hours. We posted a notice and recruited nursing students with multicultural training to participate in the study. Nursing students who initially participated in the multicultural understanding education program as “theoretical representatives” were the first chosen participants for the study. Their numbers gradually increased until we completed in-depth face-to-face interviews with 15 participants. To ensure the universality of their statements, we also interviewed three additional participants who had previously participated in multicultural education programs. We conducted the interviews using “extreme case sampling”.19

After transcribing the interview data, we collected secondary data through telephone calls to ensure the adequacy of the interview transcripts. The first author, with specialized training in qualitative research methods, was primarily responsible for data collection. The first author and the corresponding author conducted data collection and analysis simultaneously, using semi-structured interview questions. The introductory question was, “Please feel free to tell me about your multicultural experiences”. The transition questions included, “What are some specific thoughts, attitudes, and behaviors that you have had in your multicultural experiences”, “If you have taken a multicultural understanding course, what have you learned from it”, “What do you think has changed for you since you took the multicultural understanding course”, and “What is the most important thing to you in our interview today?” The closing questions included, “In closing, please feel free to share any other comments about your experiences related to the research topic” and “Did the participant’s intention in the interview match the researcher’s understanding?” We interviewed participants in an empty classroom at the university after arranging for a convenient interview time and place.

Data Analysis Methods

This study’s researchers simultaneously conducted data analysis with data collection, transcribing the analyzed data following the grounded theory method proposed by Strauss and Corbin.18 The data analysis involved three coding stages: open, axial, and selective. Axial coding involves analyzing the emerging categories according to the paradigmatic model of grounded theory. Since an important goal of selective coding is to derive highly abstract core categories and their types, we concluded the analysis with an overall understanding of the theoretical framework and its relationship with other categories to achieve this goal. The results reflect only the points on which both researchers agreed. In addition, the researchers enhanced the integrity of the study by having the subjects check and correct the contents reflected in the study.

Rigour

We used Sandelowski’s20 four criteria for evaluating qualitative research to increase the study’s reliability and validity. First, to enhance credibility, we developed a close relationship with the participants and continuously observed and tried to identify meaningful words, phrases, and sentences in their experiences. Additionally, by conducting a peer review, we reached a saturation point where no new data emerged. We divided the interview data between two researchers and excluded repeated or differently interpreted sections from the original data. Second, to ensure fittingness, we also provided transcripts to the participants to ensure they were consistent with their experiences. We derived and verified a coefficient of agreement to measure the coding consistency between the two coders. The coefficient of agreement was approximately 92.1%, indicating high consistency and reliability. Third, for auditability, we described the research in detail, including specific descriptions of the research, access to participants, and the data collection process, and endeavored to follow the procedures thoroughly. Fourth, confirmability means that the results are neutral and unbiased, indicating no researcher subjectivity or bias during the interviews and data analysis, yielding neutral results.

Ethical Considerations

The Institutional Review Board of G University (IRB No. 1041485–2015-03-HR-002-01) approved this study. We obtained written consent from all participants before we engaged them in interviews. We also explained participant confidentiality, the data recording for analysis, and the secure use of the interview results. We informed participants that they could refuse to participate in the study at any time. After participants completed the study, we gifted them USD 10. We coded and stored the collected data de-identified to ensure data anonymity.

Results

The study’s participants were all female sophomores in college, and 66.7% identified with a religion. Of the participants, 72.2% reported being satisfied with their major, 16.7% had foreign friends, and 11.1% had visited or stayed abroad. As for foreign language competence, 61.1% said they could speak simple words, and 33.3% had voluntary work experience with foreigners (Table 1).

Table 1 General Characteristics

As a result of the data analysis using the grounded theory method, we derived 25 categories and ten subcategories from 135 concepts. In a model that recombined ten categories through axial coding (Table 2), the central phenomenon was “distance”, and the core category was “reducing prejudice against people from different cultures”. We divided the changes in the core category into three stages: confusion, acceptance, and growth (Figure 1).

Table 2 Themes and Categories from Ground Theory Analysis

Figure 1 Cultural barrier reduction process for nursing students.

Casual Conditions

The casual conditions in this study were “feeling uncomfortable about difference”, “closed-mindedness about race”, and “media image traps”, found to affect the central phenomenon.

Feeling Uncomfortable About the Difference

Participants experienced discomfort and incomprehension when they saw multicultural people in their daily lives within their societies or when close family members encountered and interacted with members from multicultural families.

Chinese international students live on the same floor in the dormitory, and it is a little bit awkward, the food culture and stuff like that; it smells a lot like spices and is a little bit uncomfortable (Participant 16)

I was visiting city hall the other day, and there were many Southeast Asian people there. I thought, ‘Oh, people like that come to places like this, too,’ and then one of them walked by me, and it might have been the smell of sweat, probably because he was sweating a lot that day, but I think he smelled a lot of sweat, and I think we still have that prejudice about looks and that kind of thing. (Participant 7)

Closed-Mindedness About Race

Participants realized that their preconceived notions of different races constrained them when encountering people of different races. Also, they felt they had ambivalent attitudes or uncomfortable feelings toward them. These racialized images were often wrong or reinforced more negatively in their daily encounters.

In addition to White or Black people, I also have Asian international students living on the same floor, and when I think of that particular country, people say they do not wash their hair and things like that, but when I share a bathroom with them, they actually wash more often, and even hand-wash their clothes, so I think there are still prejudices. (Participant 18)

Media Image Traps

Participants said they experience multiculturalism second-hand via the messages and perspectives conveyed through media such as newspapers and movies. They said they develop stereotypical images when they encounter biased reports or articles about a particular country or race and that repeated media exposure imprints these stereotypical images.

I was watching the news, and there was this guy; I think it was a Southeast Asian guy, and there was a gathering of people from his country. They were drinking and hanging out, and all of a sudden, they were fighting and throwing bottles and stabbing people and killing people and stuff like that. It makes you feel like those people we see in the media are threatening, and they are just angry and stabbing people like nothing is wrong with them. At some point, you get prejudiced, and you’re scared of people who have a different nationality or skin color than you. (Participant 8)

Central Phenomenon: Distance

In the process of understanding people from different cultures, participants were “uncomfortable about difference”, had “closed-mindedness about race”, and were prone to “media image traps”. The central phenomenon related to these experiences was “distance”. Participants experience intercultural social distance when they encounter cultures different from themselves. One’s experiences can determine their social distance toward different cultures, including the participants’ values. In this sense, social policy changes and multicultural awareness interventions are important, and multicultural understanding education is necessary to change participants’ subjectivity and unconscious.

It is a problem for us to feel distance toward people from different cultures, but it is another thing for them to feel distance toward us. For example, White people are confident when they come up to us. But the Black people, the Chinese people, the Vietnamese people, I think there is something timid about them, there is something like that. They keep their distance from us, too. (Participant 6)

Contextual Conditions

In this study, the contextual condition creating the central phenomenon (“distance”) was “viewing them as foreigners rather than as nationals”. This interpretation reflects the participants’ special and entrenched sense of nationality.

Viewing Them as Foreigners Rather Than as Nationals

Participants frequently used the words neighbors and friends, but not nationals, with a clear distinction. For some participants, the long-standing myth of ethnic homogeneity still made them hesitant to include foreigners in the national category.

I think our country is very nationalistic, and we do not like other countries very much. I think there should be an open mindset at a time like this, but our nationalism is a bit strong, so we do not feel that close to others yet. (Participant 9)

Intervening Conditions

The conditions that directly influenced action/interaction strategies to resolve distance as a central phenomenon were “different levels of understanding of multiculturalism” and the “need for a multicultural learning process”.

Different Levels of Understanding of Multiculturalism

Participants indicated they could learn through contact with people from different cultures that they are not different from themselves, can be friends with them, and help each other. However, those lacking experience and no chance to meet with people from different cultures showed only superficial experience or interest in multiculturalism, suggesting that they understand multiculturalism differently.

Although multicultural families are increasing these days, they are not around me. If we have something in common with them, I think we can reduce the distance, but there seems to be not much in common, which makes a distance. (Participant 5)

I do not have any prejudice against a multicultural family, so I can treat them the same. However, when I think of multicultural families, it is usually foreign workers or Southeast Asians, so it is too limited. In fact, not only in Korea but also in other countries, whether they are doing well or not, they are called multicultural families, but there was such prejudice that I lived like this until now. I thought getting educated on multicultural understanding would be an opportunity to understand the characteristics of each country and change my definition of multicultural families. (Participant 2)

Need for a Multicultural Learning Process

Participants reported having little training or exposure to multiculturalism despite the rising multicultural awareness in Korea. They believe that multicultural understanding education can contribute significantly to social integration by reducing prejudice and stereotypes against other cultures and respecting different races’ ways of thinking and living. They also said that they would like multicultural education to start at a younger age and that they can change themselves through such education.

I am not sure if there is education on this, but my brother is in the first year of middle school, and I think he has been studying only Korean, English, and math and does not care that much about social sciences. While Korean, English, and math are important, I thought there should be one subject on multicultural understanding as society is becoming multicultural. (Participant 3)

Action/ Interaction Strategy

Participants’ behavioral strategies to reduce the distance as the central phenomenon included awakening to culture and race and thinking about the pros and cons of multicultural policies.

Awakening to Culture and Race

The participants said that multicultural education has allowed them to open their minds and hearts to people from different cultures and feel close to them. They recognized that they had burdens or preconceived notions in their actions or words and wanted to change their ideas about people from different cultures by imagining situations in which they might find themselves.

We are in Korea right now, but when we go to other countries, we are people from a different culture to them. My friend is going to the Philippines to take language courses, and that’s how Filipinos might treat my friend, just like we treat multicultural people. So, I need to open up and be close to them. (Participant 4)

My cousin on my mother’s side comes from a multicultural family. Since my aunt is from another country, I’ve known her since I was young, so the environment feels familiar, and she even uses a dialect similar to Korean kids. People tend to focus too much on differences like skin color; there’s nothing particularly special about it. (Participant 17)

Thinking About the Pros and Cons of Multicultural Policies

Participants felt there were pros and cons to the government’s multicultural policies. Experiencing multiculturalism in various aspects helped them recognize the discomfort people of different cultures felt and identify improvement areas. While focusing on the positive, they also have concerns about what they might lose. While thinking about reducing the distance between people of different cultures from various perspectives, they considered what areas and policy changes would create a positive impact.

In terms of the institutional aspect, there seems to be an outline. However, in terms of details, there is a lack of properly implemented or available regulations and laws. Over time, the number of multicultural families will increase, and I think we need to pay attention to the details in the institutional aspect. (Participant 8)

It does not seem to be a good idea to have a policy of unconditional support that might antagonize the public. For example, in high school, I wrote a multicultural case report and surveyed my classmates for their opinions. I remember several people saying, ‘Oh, it seems like multicultural students have an easy time getting into college, and that is why I am against it.’ I would like to see many policies that would help them more efficiently instead of extending unconditional support. (Participant 10)

I feel like I accept people regardless of race, but cultural differences that are very distinct from our own still seem strange and incomprehensible to me. I haven’t fully come to terms with them yet. (Participant 14)

Consequences

“Respect for cultural diversity” and “reaching out to people from different cultures” were the participants’ attitudes toward multiculturalism. Reducing stereotypes and social distance requires accepting each student as they are rather than imposing a standard. It is crucial to approach diverse cultural groups with an open mind and to build genuine social connections. This perspective can lead to the acceptance of multiculturalism and allow socializing with other races.

Respect for Cultural Diversity

The participants said that they had been turning a blind eye to people they encountered from other countries. However, after attending the lecture, they could abandon their prejudices and felt ready to understand and accept various races and cultures. The participants shattered their distance toward people from different cultures through actual encounters, and they had the opportunity to accept others through learning. We found that while social distance impedes empathetic understanding in Korean society, education helps reduce this distance and allows people to accept cultural diversity and form social relationships with people of other races.

Every day on my way home, I walk by the First and the City industrial complex and see many Black people and Cambodians; I am not sure, but many people like that. I see a lot of foreign laborers, and I feel a little uncomfortable when they sit next to me on the bus, but with this class, I feel like I need to break my prejudices a little bit before I become a nurse. (Participant 3)

Reaching Out to People from Different Cultures

The participants tried to reduce the distance by first approaching people from different cultures and thinking about the different cultures they encountered daily through multicultural education. This program enhanced the participants’ respect and sensitivity to different cultures and cultivated their independent judgment and self-criticism without relying on stereotypes.

We discussed multicultural understanding, but honestly, I think it’s important to understand the family. I also think it’s important to understand the kids in the family, so I actively went to the Multicultural Family Support Center. I went there with a prejudice that multicultural students would not know anything, but surprisingly, they looked just like us. And I went there to educate them about things like the language and culture of their parents’ country of origin, so I think I learned more. (Participant 3)

Core Category

The study’s core category is “reducing prejudice against people from other cultures”. The participants expressed the distance they felt toward people from different cultures as “feeling uncomfortable about difference”, “closed-mindedness about race”, and “media image traps”. Intervening conditions were “different levels of understanding of multiculturalism” and “need for a multicultural learning process”. The contextual condition included “viewing people with other appearance and language as foreigners”. They also recognized the need for change, awakened to culture and race, thought about policy pros and cons, and changed through interaction.

The participants’ homogeneous nationalism negatively impacted multiculturalism, and it became clear that multicultural education still faces unresolved challenges. This situation suggests a need for improving multicultural education. On the other hand, the increased interest and curiosity about different cultures is a positive sign, which indicates that multicultural education has the potential to positively change individuals’ perceptions, thus demonstrating its successful aspects. The participants also tried to narrow the gap by approaching people from other cultures daily, including studying. These efforts indicate that this program enhanced the participants’ respect and sensitivity toward other cultures and cultivated their independent judgment and self-criticism without relying on stereotypes.

Storyline

The study examines how students experience “cultural distance” through their participation in multicultural education. Before this education, participants exhibited tendencies toward distancing themselves from other cultures due to feeling uncomfortable about differences, closed-mindedness about race, and media image traps. These factors caused students to view other cultures as foreigners rather than compatriots.21

During the multicultural education, students observed the different levels of understanding of multiculturalism among their peers. This realization highlighted the necessity for such education and motivated an exploration of how to improve these levels of understanding. Students developed a deeper understanding of multiculturalism and gained new perspectives on different races and cultures. They recognized their biases and stereotypes and actively worked to overcome them, which led to new insights about culture and race. They also critically evaluated the pros and cons of multicultural policies and engaged in strategies such as awakening to culture and race and fostering harmonious interactions.

As a result, students gained greater respect for cultural diversity and began reaching out to people from different cultures. Multicultural education prompted noticeable changes in attitudes, preparing them to become more inclusive and respectful members of society grounded in mutual respect and understanding.

Discussion

This study identified the central phenomenon and core category in the multicultural experiences of nursing students—“distance” is the central phenomenon, and “reducing prejudice against people from other cultures” is the core category. The related three stages were confusion, transition, and growth.

The “confusion stage” of multiculturalism occurs when participants are bewildered by their direct and indirect multicultural experiences or what they observe in the media. The nursing students had ambivalent attitudes toward certain races and cultures, such as Blacks and Southeast Asians, in their direct and indirect experiences. Simultaneously, they said they experienced negative views of certain races and cultures through the media, books, and songs or recognized the subtly embedded stereotyping. For example, South Korean media coverage of K-beauty, a global trend, often raises issues of gender and racial identity concerning skin color when discussing skin whitening.22

On the surface, Korean society accepts the specificity of different cultures but discriminates against specific countries and races. Thus, dual attitudes may be a product of the socio-cultural context. This finding aligns with Mo,23 who reported that newspapers and broadcasters often portray multicultural families and foreigners in a distorted manner, which promotes prejudice and stereotypes. This coverage does not bode well for South Koreans’ opportunities to meet, understand, and embrace other cultures.24 Breaking out of these stereotypes requires opportunities for understanding and maintaining contact with people from diverse cultures at the social level.

In the “transition” stage, participants shifted their perspectives and values about multiculturalism into a new cultural paradigm demanded by the era of internationalization through multicultural understanding. During the course, they realized that other participants, not just themselves, also had similar thoughts and a chance to self-reflect through various cases. The course served as a catalyst and experience that generated empathy and understanding of other cultures, expanded understanding of other races and cultures, and created new perceptions. Specifically, participants were willing to understand social and cultural phenomena from a multicultural perspective and learn how to improve their perceptions. However, some participants tried to adopt an assimilationist approach that forced adaptation to Korean culture. This attitude seems dangerous as it is tantamount to forcing the members of different cultures to adopt the dominant cultural traditions of Korea. Such an assimilationist attitude, which tries to understand other cultures from their perspectives instead of interacting with others, does not help understand or improve cultural and racial conflicts. Vander Zee and Ou25 cite openness and flexibility as components for reducing social distance toward different cultures, and these concepts are also important in raising multicultural awareness.

In addition, participants voiced their opinions on multicultural policies in a small but powerful way, criticizing the standards and systems as somewhat confusing. For example, they suggested approaching the state’s livelihood security and welfare policies through international exchange and cooperation. At the same time, they pointed out that when employment opportunities overlap or become mutually competitive, a “tug-of-war” becomes visible.26 In this instance, it would be difficult to overcome the dissatisfaction toward the recipients of the welfare benefits. As evidenced by Participant 1’s statement, “The reverse discrimination I experienced in high school during college admissions made me feel bad about multiculturalism”. Relative deprivation and real threats can also lead to negative feelings toward individuals who belong to groups of different cultures. In this regard, we cannot overlook the potential negative aspects of a multicultural society. It is necessary to instill awareness to treat foreigners as equal citizens and people to work with, not ostracize them because of a perception that they steal jobs; thus, we need further value education and integration efforts.27

Nursing students, not just ordinary college students, are highly likely to care for patients from diverse cultural backgrounds; therefore, it is even more important for them to have specialized knowledge about different cultures. However, a one-sided view of multiculturalism can be dangerous to patients and caregivers whom they encounter. The ultimate transformation of participants will not be about reducing their distance from multiculturalism per se but about learning to understand and work within a socio-cultural context concerning socio-cultural phenomena. Therefore, it is necessary to understand the process of developing prejudice for each group, which is possible through multicultural information and cultural experiences, to find the factors to incorporate into the university curriculum, as in the study by Kim et al.28

As nursing students, participants must provide culturally competent care to patients from diverse backgrounds in clinical settings, considering cultural differences.29 Addressing and reducing prejudice and stereotypes while adopting multicultural attitudes that respect diverse cultural perspectives and lifestyles is critical.16,30 Nurses with high levels of multicultural competence can significantly enhance “cultural safety” by creating a respectful, non-discriminatory environment for patients.31 According to Elana Curtis,17 nurses who have received multicultural education demonstrate a deeper understanding and respect for patients’ cultural backgrounds, leading to increased trust and improved outcomes.

Cultural safety is an environment that respects and does not discriminate against patients’ cultural backgrounds, contributing to improved health equity.32 Clark et al33 highlighted the detrimental effects of racism on health equity and emphasized the need for education and policies to address these issues. The ultimate transformation for participants is not merely reducing their distance from multiculturalism but learning to understand and work within the socio-cultural context related to socio-cultural phenomena. Therefore, it is necessary to understand how prejudice develops for each group and identify elements to incorporate into the university curriculum through multicultural information and cultural experiences.

The stage of “growth” is understanding cultural differences and respecting cultural diversity, which allows us to maintain important attributes of our culture while accepting and integrating important aspects of the new culture. This stage is essential for cultural acceptance, competence, and attitudes to understand and embrace different cultures. To this end, Yum34 argued that multicultural acceptance involves cognitive factors such as recognizing cultural differences and being unbiased, emotional factors such as empathizing with other cultures’ perspectives on life, and behavioral factors such as intercultural interaction. Integrating these factors, participants experienced the “respect for cultural diversity” and “reach out to people from different cultures”. This change experience suggests that multicultural education has provided them with an increased awareness to critique and examine cultural and racial attitudes toward people of different cultures.

Participants showed more tolerance toward members of different cultures that maintained their unique traditions and lifestyles. Participants’ educational experiences renewed their preconceived notions from the past in that their past experiences and interpretations shape their current perceptions of multiculturalism, and the course established a new perception of a multicultural society. We see this demonstrated in the participants’ attitudes of “reaching out to people from different cultures”, leading to reduced social distance toward multicultural groups. Lee and Chung35 and Sahal et al36 confirm this finding, contending that education is important in multicultural understanding and reducing distance.

The results of this study are limited to students who have taken multicultural understanding classes in one region and may not be generally applicable as each country is composed of many different cultures and races. However, changes among university students—who, as future leaders, play a crucial role in driving development and integration in a multicultural society—are essential for gauging shifts in societal values in Korea. With these changes, universities should ensure that Korean society can accept the diversity of other cultures, which has become visible through the emergence of new groups, and provide thoughtful measures to pursue communication through social relationships with people of other races. Future multicultural education and diverse experiences must include emotional empathy and acceptance, not just intellectual understanding.

Conclusion

This study used a grounded theory approach to explore nursing college students’ perception changes toward multiculturalism. Participants immersed in a multicultural society, where it is essential to coexist with increasingly diverse minority groups, had experienced prejudices, negative emotions, and social distance due to difficulties adapting to rapid social changes. However, they were able to shift their attitudes over time. They shifted from viewing multiculturalism as the culture of others to adopting an attitude that embraces diversity and actively engages with multiculturalism.

These research findings suggest that developing policies related to multicultural education and supporting nursing students in effectively adapting to multicultural environments is critical. Curriculum improvements should incorporate multicultural education programs and provide practical, multicultural experiences throughout the educational process. Additionally, nursing students should receive more systematic and hands-on multicultural training. Developing programs that enhance intercultural sensitivity and prepare students for interactions with patients from diverse cultural backgrounds is essential. This approach will enable students to address the real-world challenges in multicultural settings.

Ultimately, changing nursing students’ perceptions of multiculturalism is critical in equipping them to understand and respect diverse cultures and races as future healthcare providers. This research provides a foundation for meeting these educational needs and will significantly influence future multicultural education and policy development.

Ethics Approval and Consent to Participate

Gwangju Women’s University institutional review board of the researcher’s University (IRB No. 1041485-2015-03-HR-002-01) approved this research. We conducted the study following the Declaration of Helsinki. We obtained informed consent from all participants involved in this study. We informed all participants that academic journals might publish their anonymized data.

Acknowledgments

The National Research Foundation of Korea Grant funded by the Korean Government (NRF-2022R1A2C10089481240982119420102) supported this work.

Disclosure

The authors report no conflicts of interest in this work.

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