Background: Nurses play a pivotal role in pain observation in people living with dementia. However, currently, there is little understanding of the influence culture may have on the way nurses observe pain experienced by people living with dementia. Aim: This review explores the influence of culture on nurses. pain observations experienced by people living with dementia. Settings: Studies were included regardless of the setting (e.g., acute medical care, long-term care, community). Design: An integrative review. Participants/Subjects: PubMed, Medline, Psychological Information Database, Cochrane Library, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and ProQuest were included in the search. Methods: Electronic databases were searched using synonyms for “dementia,” “nurse,” “culture,” and “pain observation.” The review included ten primary research papers following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Results: Nurses reported that pain observation in people living with dementia is challenging. Four themes were identified by data synthesis: (1) using behaviors for pain observation; (2) information from carers for pain observation; (3) pain assessment tools for pain observation; and (4) role of knowledge, experience, and intuition in pain observation. Conclusions: There is a limited understanding of the role of culture on nurses’ pain observations. However, nurses take a multifaceted approach to observing pain using behaviors, information from carers, pain assessment tools, and their knowledge, experience, and intuition.