We're often asked if any research which has been completed about our cross cultural simulation BaFa' BaFa' in the health care / nursing setting.

Sharon See MSN, RNC-OB, Clinical Assistant Professor at Schar College of Nursing and Health Sciences at Ashland University in Ohio contacted us asking for permission to use BaFa' BaFa' in their research.  We received the following request:

"I teach community health to senior nursing students. We have been using BaFa' BaFa' cultural simulation for a few years now, and are very pleased with the simulation. Much meaningful discussion has taken place during our debriefing sessions. We are interested in doing some research and scholarly nursing presentations (potentially publications) based on our findings. We have approval from the University's Human Subjects Review Board. The next step for us is to have permission to use BaFa' BaFa' for our research and scholarly endeavors."

We gladly gave Professor See permission, and asked that we be able to publish the findings. After the research was complete we received a note from Professor See and a powerpoint with the results of which was presented at the Transcultural Nursing Conference in San Antonio in Oct 2018.

Here is a copy of the powerpoint presentation for your review:

Overview from the Presentation (details and methodologies in powerpoint):


  • Prepare nurses to practice in a multicultural environment (AACN, 2008).
  • Often a mismatch between the culture of the nurse and the patient.
  • Gaming/Simulation can help students;
    • different from traditional teaching methods.
    • new understanding could lead to better patient care (Graham & Richardson, 2008).
    • insights into culturally based nursing (Graham & Richardson, 2008).
    • raise awareness and develop skills of nursing students when encountering a patient from an unfamiliar culture (Fowler &  Push, 2010).


  • Understand the impact of the BaFa' BaFa' cultural simulation game on senior nursing students’ perceptions about culture and intent to act in their future practice.
  • Inform nursing education regarding practices to incorporate cultural simulation games.


  • Quantitative and qualitative results affirm the BaFa' BaFa' cultural simulation is an effective educational strategy.
  • Engaging way to learn about culture for nursing students getting ready to practice.
  • Group differences:
    • Greater impact on intent to change practice in traditional students.
    • Accelerated students demonstrated less discomfort with the cultural experience.

Anectdotal Findings

What is interesting as a teacher is how the game plays out differently with different groups of students.

We ask students at the end which culture they would prefer to live in.

  • It is extremely rare for a male who has been in the Alpha culture to want to change. We talk about the middle east and how hard it would be for a male dominated culture to give up the power they have had for so long.
  • Had a single mom say she wanted to be part of the Alpha culture to have someone to protect her. Most females want to be a Beta to have more life control.
  • Over the years most students prefer Beta culture (most of our students are female).
  • Didn't like Beta because it was too "touchy feely".

When asking what "feeling" words they felt when going into a new culture:

  • all groups consistently list powerful words (dumb, left out, taken advantage of, frustrated etc).
  • English as a second language students confirm all the words are similar to their feelings coming into the US.

Unusual things we have seen students do over the year:

  • grab Beta cards from the visitors hands.
  • pull the  Beta Visitor cards down so they can see what they are.
  • sit down on the floor in the Beta room and refuse to be kicked out.
  • be chased around the room because they didn't want to be kicked out.
  • one Beta group decided  at the end they were going to change the culture and work together. I told them remember cultures are very slow to change.
  • during debriefing one of the oldest males said he didn't like being in charge it was too much pressure and responsibility.

The debriefing is always rich. Students highlight how their "feeling" words might be what a patient experiences. Identify how important it is to allow extra time with patients new to the US. Lots of discussion about the Beta culture forced aggression and the lengths you might be forced to go to ensure your family is taken care of (ie money to support family).