From theory to practice: a systematic review and meta-analysis of ethical sensitivity in Iranian nursing students
Abstract
Ethical sensitivity is vital for nursing students as it affects decision-making and care quality. This systematic review and meta-analysis assessed ethical sensitivity among Iranian nursing students. For this purpose, databases (MagIran, SID, PubMed, Scopus, EMBASE, and Web of Science) were searched up to December 30, 2024. Observational studies reporting ethical sensitivity scores were selected, and scores were standardized to a 0–100 scale. Heterogeneity was assessed using I², and analyses were performed with STATA. Sixteen studies yielded a pooled ethical sensitivity score of 67% (95% CI: 62–72), with substantial heterogeneity (I² = 87.2%). Subgroup analyses (by publication year and language) and meta-regression (age,sample size) identified no significant moderators, and sensitivity analysis and trim-and-fill confirmed the stability of the estimate. Based on the findings, ethical sensitivity among Iranian nursing students is moderate, which highlights the need for targeted educational interventions and enhanced clinical experiences.
Jasemi M, Rasoulgoli R, Khalkhali H. Effects of teaching nursing codes of ethics through lecture on moral sensitivity and moral performance of nursing students–a single blind, quasi experimental study. Pak J Med Health Sci. 2020;14(2):1276-80.
Spekkink A, Jacobs G. The development of moral sensitivity of nursing students: A scoping review. Nursing ethics. 2021;28(5):791-808.
Borhani F, Abbaszadeh A, Hoseinabadi-Farahani MJ. Moral sensitivity and its dimensions in Iranian nursing students. Journal of medical ethics and history of medicine. 2016;9.
Temiz Z, Öztürk D, Ünver S, Tohumat Ş, Akyolcu N, Kanan N, et al. Determining ethical sensitivity of nurses employed in surgical units. J Anatolia Nurs Health Sci. 2017;20(2):83-9.
Shadi AZ, Zohreh V, Eesa M, Anoshirvan K. Moral sensitivity of nursing students: a systematic review. BMC nursing. 2024;23(1):99.
Rest J. Moral development: Advances in research and theory. New York: Praeger. 1986.
Gülnar E, Özveren H, Özden D. The relationship between moral sensitivity and medical errors attitude in nursing students. Journal of Forensic and Legal Medicine. 2020;73:101981.
Lützén K, Cronqvist A, Magnusson A, Andersson L. Moral stress: synthesis of a concept. Nursing Ethics. 2003;10(3):312-22.
Ersoy N, Göz F. The ethical sensitivity of nurses in Turkey. Nursing ethics. 2001;8(4):299-312.
Kraaijeveld MI, Schilderman J, van Leeuwen E. Moral sensitivity revisited. Nursing ethics. 2021;28(2):179-89.
Rahnavard M, Zarea K, Fakhri A, Ghanbari S. Investigating the relationship between ethics and job motivation and aggression in nurses working in Ahvaz teaching hospitals (2020). Education and Ethics in Nursing. 2021;10(3-4):31-41.
Soltani Y, Moosazadeh Z, Alipour A, Esmaeili S. Effective interventions for improvement of moral sensitivity among nurses: A systematic review. Journal of nursing reports in clinical practice. 2023;1(1):30-7.
Wolf ZR, Hicks R, Serembus JF. Characteristics of medication errors made by students during the administration phase: a descriptive study. Journal of Professional Nursing. 2006;22(1):39-51.
Lützen K DV, Eriksson S, Norberg A. . Developing the concept of moral sensitivity in health care practice. Nursing ethics. 2006;13(2):187-96.
Devine CA, Chin ED. Integrity in nursing students: A concept analysis. Nurse education today. 2018;60:133-8.
Borhani F, Alhani F, Mohammadi E, Abbaszadeh A. Nursing students perception of barriers of acquiring professional ethics: A qualitative research. Strides in Development of Medical Education. 2011;8(1):67-80.
Sinclair J, Papps E, Marshall B. Nursing students' experiences of ethical issues in clinical practice: A New Zealand study. Nurse education in practice. 2016;17:1-7.
Yeom H-A, Ahn S-H, Kim S-J. Effects of ethics education on moral sensitivity of nursing students. Nursing ethics. 2017;24(6):644-52.
Ramos FRS, Brehmer LCdF, Vargas MA, Trombetta AP, Silveira LR, Drago L. Ethical conflicts and the process of reflection in undergraduate nursing students in Brazil. Nursing ethics. 2015;22(4):428-39.
Kleemola E, Leino-Kilpi H, Numminen O. Care situations demanding moral courage: content analysis of nurses’ experiences. Nursing ethics. 2020;27(3):714-25.
Katelin Hoskins M. Ethics education in nursing: Instruction for future generations of nurses. Online Journal of Issues in Nursing. 2018;23(1):1-11.
Kohansal Z, Avaznejad N, Bagherian B, Jahanpour F. Evaluation of moral sensitivity in nursing students of Bushehr University of Medical Sciences in 2016. Iranian Journal of Medical Ethics and History of Medicine. 2018;11:242-52.
Rahmani P, Behshid M, Seif‐Farshad M, Mousavi S, Molaei Tavani F. Moral awareness and its relationship with moral sensitivity among Iranian nursing students: A basis for nursing ethics education. Nursing Open. 2023;10(2):773-80.
Hakbilen HG, Ince S, Ozgonul ML. Ethical sensitivity of nursing students during a 4-year nursing curriculum in Turkey. Journal of Academic Ethics. 2023;21(1):41-51.
Alnajjar P, Hend Abdu, Abou Hashish P, Ebtsam Aly. Academic ethical awareness and moral sensitivity of undergraduate nursing students: assessment and influencing factors. SAGE open nursing. 2021;7:23779608211026715.
Choe K, Kim S, Lee C, Kim S. Effect of ethics seminar on moral sensitivity and ethical behavior of clinical nurses. International journal of environmental research and public health. 2020;18(1):241.
Shayestehfard M, Torabizadeh C, Gholamzadeh S, Ebadi A. Ethical sensitivity in nursing students: Developing a context–based education. Electronic Journal of General Medicine. 2020;17(2).
Institute JB. The Joanna Briggs Institute critical appraisal tools for use in JBI systematic reviews: checklist for qualitative research. Adelaide: The Joanna Briggs Institute. 2017.
Wang W YJ, Bai D, Lu X, Gong X, Cai M, et al. . Nurses' perceptions and competencies about spirituality and spiritual care: A systematic review and meta-analysis. . Nurse Education Today. 2024;132:106006.
Zhao T CS, Dong X, Lu X, Chen X, Li H, et al. The level of moral sensitivity among nurses: a systematic review and meta-analysis. BMC nursing. 2025;24(1):1-22.
Rezaei H NS, Ghanei Gheshlagh R. . Burden of Care in Caregivers of Iranian patients with chronic disorders: a systematic review and meta-analysis. Health and Quality of Life Outcomes. 2020;18:1-11.
Rahmani P, Behshid M, Seif-Farshad M, Mousavi S, Molaei Tavani F. Moral awareness and its relationship with moral sensitivity among Iranian nursing students: A basis for nursing ethics education. Nursing open. 2023;10(2):773-80.
Nasiriani K, Bahri A, Zamani N, Fazljoo SE. Comparison of Nurses' Professional Moral Sensitivity with Nursing Students in Shahid Sadoughi University of Medical Sciences in Yazd in 2020. 2023.
Bagheri M, Shahriari M, Hassanvand P, Mohammadi Pelarti A, Ghanavatpour A. The Relationship between Moral Sensitivity and Professional Behaviour and Its Comparison in First- and Last-Year Undergraduate Nursing Students. Nurs Res Pract. 2023;2023:5368045.
Yazdanparast E, Davoudi M, Ghorbani SH, Akbarian A, Chenari HA. Investigating the relationship between moral sensitivity and attitude towards euthanasia in nursing students of Birjand University of Medical Sciences. Clinical Ethics. 2022;17(2):205-10.
Ghasemipor Hombari A, Erfani Z, Hajinasab N, Karimian R, Kashaninia Z. The Relationship Between Moral Sensitivity and Anxiety Sensitivity in Nursing Students of Tehran Universities of Medical Sciences. Health, Spirituality and Medical Ethics. 2022;9(4):225-32.
Mohammadi F, Habibzadeh H, Aghakhani N. Factors affecting the formation of nurses' moral sensitivity in cardiopulmonary resuscitation settings: A qualitative study. Nursing ethics. 2022;29(7-8):1670-82.
Barkhordari-Sharifabad M, Kaka-Tafti SZ, Bastani P, Mahmoudi-Hashemi F. Investigating the Role of Spiritual Intelligence in Moral Sensitivity of Nursing Students. Iranian Journal of Medical Ethics and History of Medicine. 2022;15:239-52.
Shamsizadeh M, Oshvandi K, Alipour K, Moamer S, Maghsoudi Z. The Relationship Between Spiritual Health and Moral Sensitivity in Nursing Students of Hamadan University of Medical Sciences, 2017. Avicenna Journal of Nursing and Midwifery Care. 2020;28(2):75-82.
Hoseini BL, Shomoossi N, Rakhshani MH, Norouzi ZB. Moral Sensitivity among Nursing and Midwifery Students and Practitioners: A Comparative Report from Iran. Journal of Biostatistics and Epidemiology. 2020;6(1):12-8.
mostafavian z, gholampour j, faraj pour a, akbari farmad s, rahchamani ma. Comparison of Moral Sensitivity among last year Nursing Students and Nurses Working at teaching Hospitals of Islamic Azad University of Mashhad. Education and Ethics In Nursing ISSN: 2322-5300. 2019;8(3-4):30-6.
Amiri E, Ebrahimi H, Vahidi M, Asghari Jafarabadi M, Namdar Areshtanab H. Moral sensitivity and its relationship with demographic and professional characteristics of nurses working in medical wards of hospitals affiliated to Tabriz university of medical sciences. HAYAT. 2018;23(4):295-306.
Salar AR, Zare S. The survey of Zahedan medical sciences university training hospitals’ nurses' ethical sensitivity in decision making in 2016. International journal of medical research & health sciences Suamthi publications suamthi publications, ahmednagar, 00000, india. 2016;5(5):1-8.
Karimi Noghondar M, Tavakoli N, Borhani F, Mohsenpour M. Ethical sensitivity: A comparison between the nursing students and nurses of Azad University. Iranian Journal of Medical Ethics and History of Medicine. 2016;8(5):69-76.
Borhani F, Abbaszadeh A, Hoseinabadi-Farahani MJ. Moral sensitivity and its dimensions in Iranian nursing students. J Med Ethics Hist Med. 2016;9:19.
Mousavi S, Mohsenpour M, Borhani F, Ebadi M. Ethical Sensitivity of nurses and nursing students working in Aja University of Medical Sciences. 2015.
sadrollahi a, khalili z. A survey of professional moral sensitivity and associated factors among the nurses in west Golestan province of Iran. Iranian Journal of Medical Ethics and History of Medicine. 2015;8(3):50-61.
Lee JM, Min HY, Kim Y. Factors Affecting Ethical Sensitivity Among Nursing Students: Secondary Data Analysis. International Journal of Advanced Culture Technology. 2021;9(4):204-12.
Tuvesson H, Lützén K. Demographic factors associated with moral sensitivity among nursing students. Nursing ethics. 2017;24(7):847-55.
Numminen O, van der Arend A, Leino-Kilpi H. Nurse educators' and nursing students' perspectives on teaching codes of ethics. Nursing Ethics. 2009;1(6):69-82.
Park M, Kjervik D, Crandell J, Oermann MH. The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. Nursing ethics. 2012;19(4):568-80.
Namadi F, Hemmati MM, Moradi Y, Ghasemzadeh N. The effect of professional ethics education through case-based method on moral sensitivity in nursing students: a clinical trial study. 2018.
Purabdollah M, Zamanzadeh V, Valizadeh L, Ghahramanian A, Mousavi S, Ghasempour M. Comparison of the Iranian and Scandinavian bachelor of nursing curriculum (Sweden): A scoping review. Journal of Education and Health Promotion. 2023;12(1):389.
Jackson JL, Kuriyama A. How often do systematic reviews exclude articles not published in English? Journal of general internal medicine. 2019;34:1388-9.
Ahn SH, Yeom HA. Moral sensitivity and critical thinking disposition of nursing students in K orea. International journal of nursing practice. 2014;20(5):482-9.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327(7414):557-60.
Nora CRD, Zoboli ELCP, Vieira MM. Moral sensitivity in primary health care nurses. Revista brasileira de enfermagem. 2017;70:308-16.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. bmj. 1997;315(7109):629-34.
| Files | ||
| Issue | Vol 19 (2026) | |
| Section | Review Article(s) | |
| Keywords | ||
| Ethical sensitivity; Nursing students; Systematic review; Meta-analysis; Medical ethics. | ||
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