Correlation between ethical sensitivity and humanistic care ability among undergraduate nursing students: a cross-sectional study

This study shows that the ethical sensitivity of undergraduate nursing students is at a moderate level, slightly lower than Hujuan’s study, but the scores of sophomore, junior, and senior students in this study are slightly higher [12]. This is due to a combination of factors related to the research population and clinical practice experience. Firstly, the participants in this study included first-year nursing students who were new to the field of nursing and had not yet been trained in a professional nursing program. Knowledge and awareness of ethical issues were still in the preliminary stages, resulting in a lower level of ethical sensitivity than that of the higher grades. Secondly, during the COVID-19 pandemic, to avoid the risk of infection among students, all universities in China suspended traditional face-to-face classroom instruction, including undergraduate nursing students who transitioned to online learning modes. Due to the implementation of strict epidemic prevention and isolation measures, first to third-year undergraduate nursing students were unable to obtain clinical placements, limiting their learning primarily to theoretical aspects. For fourth-year students, their planned clinical internships and rotations, which typically last at least eight months, were also disrupted due to the pandemic [23]. Although virtual simulation teaching technologies were introduced to compensate for the lack of hands-on experience, studies have shown that remote learning cannot fully replace direct interaction with patients, which to some extent restricts the development of practical skills and ultimately affects students’ comprehensive learning experience and the formation and development of ethical sensitivity [24]. Lee et al. point out that when using virtual simulation equipment to mimic clinical scenarios, students often feel that the process is time-consuming and confusing [25]. With the effective control of the COVID-19 outbreak in China in 2022, the teaching activities of undergraduate nursing programs gradually returned to traditional face-to-face modes, allowing students across all years to re-enter hospital environments and engage directly with patients to continue their clinical placements and internships. This shift not only helps students gain necessary clinical experiences but also deepens their understanding of nursing ethics through firsthand encounters with patient needs and suffering, thereby promoting the enhancement of their ethical sensitivity.

According to our research findings, the scores for the dimensions of ethical sensitivity among nursing students are similar to those reported by Xia [26]. Nowadays, with the continuous application and development of big data, the internet of things, cloud computing, and other artificial intelligence technologies, these advancements have brought convenience to people’s lives while also posing risks to the protection of personal privacy information. It is a simple matter for healthcare professionals to have direct access to patient-related data, which contains a lot of sensitive content. Once healthcare professionals fail to comply with relevant laws and regulations, resulting in the leakage of patients’ private information, it will directly violate patients’ privacy rights and may also cause additional psychological burdens for the patients, leading to a decrease in trust within the nurse-patient relationship. Protecting patient privacy is both a legal requirement and a professional ethical requirement for healthcare personnel, and it is also the foundation for building a good nurse-patient relationship [27]. For the reasons listed above, nursing colleges and hospitals have been enhancing privacy education for nursing students in recent years, which has raised the students’ awareness of protecting patients’ privacy.

Respect for individuals dimension scored the lowest. This may be due to the differences between Eastern and Western cultures. Eastern culture is based on collectivism and family-centered values, while Western culture is rooted in individualism, placing greater emphasis on personal choice and individual rights [28]. Secondly, under the background of traditional Chinese culture, nursing students tend to passively accept knowledge transmitted by teachers rather than actively ask questions or express personal insights, lacking initiative and critical thinking [29]. Due to biases resulting from students’ personal experiences, their perceptions of patients and the nurse-patient interaction may be limited. Some students could behave disrespectfully and treat patients unfairly by remaining silent or by passively supporting their rights. This indicates that nursing ethics education needs to strengthen the curriculum on the principle of respect. Additionally, there needs to be a shift from traditional teaching methods, focusing on a student-centered approach and combining flipped classroom techniques and debate-style ethics teaching to enhance students’ initiative and engagement [30, 31].

Senior nursing students show higher ethical sensitivity than juniors, as found by Park [9] and Muramatsu [18]. However, Baykara et al. [35] reported that students’ ethical sensitivity decreases with increasing educational years. The discrepancies in these results might be attributed to various factors impacting training, including the classroom environment, educational features, the level of preparedness, and the research tools utilized in the studies [36]. Therefore, it is essential to focus on the significant role of education and the implementation of effective ethical teaching strategies to enhance students’ ethical sensitivity. In future nursing education, nursing ethics courses should be introduced as early as possible, and it is suggested to divide them into two stages to optimize teaching effectiveness [37, 38]. The initial phase of the course should focus on the foundational knowledge of ethics to ensure that students establish a solid theoretical foundation. As students progress into clinical practice, the course content should shift towards practical applications. Additionally, integrating virtual patient scenarios generated by ChatGPT can help students develop their ability to address ethical challenges in real-world situations [39].

According to our results, the level of ethical sensitivity is influenced by the relationship between nursing students and their parents. The creation of moral judgments, behavioral patterns, and moral development is significantly influenced by an individual’s home environment [40]. In a healthy and harmonious family, family members tend to maintain mutual support, respect, understanding, and stable emotional connections. The moral consciousness of the individual strengthens, and their level of morality and responsibility is raised in this familial setting. People are conditioned to care more for others, be more willing to collaborate, adopt socially responsible behavior, and apply their internalized values to real-world decisions and actions. Moreover, an individual’s understanding of moral ethics requires certain emotional experiences. In a harmonious family atmosphere, emotions develop more healthily, leading to sharper intuitive responses to moral issues [41]. College counselors should proactively understand students’ living conditions and family environments, and encourage open and honest communication between parents and students. Additionally, nursing ethics education can be enhanced through case-based teaching methods combined with role-playing and reflective journals to strengthen students’ sense of responsibility and empathy skills [42].

Students who selected a liking to the nursing major showed higher ethical sensitivity scores than those who selected a disliking the nursing major, which is similar to the findings of Akca [43]. Interest, as a form of intrinsic motivation, plays a crucial role in driving individual behavior [44]. Students who are passionate about nursing usually choose the profession out of a desire to care for and help others. During their studies, they typically possess a strong intrinsic motivation, which not only drives them to choose nursing as a career path but also makes them more proactive and focused in their daily learning and practice [45]. In the process of interacting with patients, one can always pay attention to their needs. When faced with ethical issues, they are better equipped to identify potential ethical conflicts and seek appropriate solutions. Therefore, nursing educators should pay attention to the psychological state of students during the learning process and provide them with the necessary support and counseling to help them cope with the stress and challenges of learning. Research has found that mindfulness practices, guided imagery, and meditation can help alleviate anxiety among nursing students during their studies [46]. At the same time, nursing educators should also stimulate students’ enthusiasm for the profession through diverse teaching methods, such as education based on learning styles and metaverse-based learning methods [47, 48].

Students who are willing to work in nursing have higher ethical sensitivity scores, likely due to their higher level of professional identity and positive professional values. A strong sense of professional identity is crucial for nursing students to develop into confident, successful, and resilient healthcare professionals. Research shows that nursing students with a strong professional identity exhibit more positive attitudes toward their future careers [49]. According to Eckard et al. [50], nursing students with positive professional values have better clinical performance, a clearer perception of the ethical challenges of nursing, and a clearer understanding of applying positive strategies to resolve ethical conflicts. There is a positive correlation between professional values and ethical sensitivity among undergraduate nursing students [51]. This suggests that the process of nursing education involves not only imparting subject knowledge but also guiding students in enhancing their professional identity and professional values. The study found that the ethics laboratory program has a positive impact on the professional values of nursing students, providing valuable references for the design of nursing curricula [52].

According to this study, 43.0% of undergraduate nursing students had attended a nursing ethics course, and those who had showed a higher level of ethical sensitivity than those who had not. The courses provide systematic ethical theoretical knowledge, enhance students’ critical thinking abilities and practical experience through case analysis and simulated practices. In addition, the courses promote self-reflection and the formation of professional identity, enabling students to better identify and resolve ethical issues. The study found that nursing students possess a certain level of ethical sensitivity from the outset, and this sensitivity can be further developed through comprehensive nursing education [53]. Thankfully, nursing ethics education has become a required specialty course for undergraduate nursing students in China, which will help to raise the ethical sensitivity of the students. In terms of curriculum design, existing studies have shown the value of teaching methods such as inquiry-oriented teaching [54], debate-based teaching [30], simulation-based teaching [55], problem-based learning, and reflective practice [56] in nursing ethics education. Research indicates that using instructional strategies that cater to three distinct learning styles can significantly increase students’ capacity for making ethical decisions and enhance their sensitivity to ethical issues [57],. Educators can create a digital, personalized, interactive educational approach, closely integrating ethics education with practical teaching, and encourage students’ interest and initiative in learning by combining contemporary technological tools like virtual reality technology and online courses.

The experience of caring for patients is also an important factor influencing the ethical sensitivity of undergraduate nursing students. In the process of caring for sick family members, individuals need to continuously monitor the patient’s physical condition and psychological fluctuations, while integrating their personal emotions, care, warmth, and empathy into daily caregiving [58]. Therefore, when faced with ethical dilemmas, these individuals tend to be better at considering issues from others’ perspectives and engaging in effective communication and understanding. Empathy is a crucial element in providing high-quality nursing care and is considered one of the most closely related core factors to humanistic concern [15]. Research indicates that there is a significant positive correlation between the level of empathy and ethical sensitivity among Chinese nursing students [59]. This suggests that students with higher levels of empathy tend to exhibit greater ethical sensitivity, allowing them to pay closer attention to the physical and emotional needs of patients in clinical practice. Similarly, research has found that medical students with higher ethical sensitivity usually possess stronger empathy [60]. These students can more acutely identify patients’ issues and deeply understand their suffering, enabling them to take timely and appropriate actions from the patients’ perspective to resolve problems and reduce the occurrence of conflicts between healthcare providers and patients [61]. This suggests that nursing education should focus on cultivating students’ empathy to enhance their capacity for humanistic care and improve their ethical sensitivity. Existing research shows that narrative medicine [62] and Balint groups [63] have positive effects on cultivating empathy in nursing students.