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Cited by 5Ethics in medical practiceEthics in Business and EducationHealthcare Education and Workforce Issues

Investigating the Impact of Scenario‐Based Moral Concepts Training on the Professional Moral Courage of Nursing Students: A Protocol for a Randomized Controlled Trial

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Akbari, Ali, Mirshahi, Arvin, Mehravar, Fatemeh, Rozveh, Ali Karimi, Nasrabadi, Alireza Nikbakht·2025·Health Science Reports
DOI 10.1002/hsr2.71021PMC PMC12256659
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Abstract

Background and Aims: Moral courage is vital in nursing, enabling professionals to make ethical decisions and uphold values, even in challenging situations. Nursing students often struggle with moral decision‐making due to limited experience and insufficient ethical training. This study proposes a randomized controlled trial (RCT) to evaluate the effectiveness of scenario‐based ethics training compared to traditional methods in improving professional moral courage among nursing students. Methods and Analysis: This RCT involved a 3‐month scenario‐based ethics training program delivered under faculty supervision, targeting sixth‐semester undergraduate nursing students. Participants ( n = 48) were randomly assigned to either the intervention group or the control group. Both groups received traditional ethics education, however, the intervention group also participated in two workshops focused on core and derived ethical concepts (e.g., autonomy, confidentiality) utilizing a scenario‐based approach. This was followed by weekly online follow‐ups and discussions conducted via WhatsApp Messenger. The outcomes will be assessed using the Sekerka Professional Moral Courage Questionnaire at four time points: immediately before, immediately after, and at 1 and 3 months postintervention. The questionnaire has demonstrated acceptable validity and reliability in previous studies, with Cronbach's α exceeding 0.8, and a value of 0.977 reported in an Iranian validation study. In this study, face validity was confirmed by ten nursing faculty members. The data will be analyzed using t ‐tests, χ 2 tests, and ANCOVA to evaluate changes in professional moral courage (SPSS v22, p < 0.05). Conclusion: This protocol outlines a trial to evaluate the impact of scenario‐based training on enhancing nursing students' professional moral courage and improving ethics education in clinical settings. Trial Registration: Iranian Clinical Trials Registry: IRCT20240319061338N1.

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  • The long-term stability of teaching outcomes and the efficiency of translating knowledge comprehension into clinical decision-making capabilities remain critical challenges to be addressed in nursing ethics education.

    “These studies indicate that the long-term stability of teaching outcomes and the efficiency of translating knowledge comprehension into clinical decision-making capabilities remain critical challenges to be addressed [11–21].”

    From Exploring the integration of AI and national quality courses in China: a study on teaching practices in nursing smart education (2025) · cites this paper as [16]

    The Introduction (page not available) says traditional ethics teaching emphasizes theoretical content and may not adequately prepare nursing students for ethical decision-making in clinical settings. The Methods/Design section plans assessments at one and three months, but the paper is a protocol and does not establish that the long-term stability of teaching outcomes is a critical challenge. (LLM, conf=0.85)

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Research works printed but not linked: 4

  1. [1]A. Heydari and A. Meshkinyazd, “Ethical Challenges in Nursing Profession,” Journal of Multidisciplinary Care 7, no. 1(2018).
  2. [18]M. Bagheri, A. Mohammadi Pelarti, and S. Karimi, “ Investigating the Effect of Reflective Learning Based on Clinical Scenarios on the Moral Sensitivity of Nursing Students,” Education and Ethics in Nursing 11, no. 1–2 (2022): 39– 46.
  3. [30]E. Hatami and M. Naderi Beni, “ The Effect of Internal Marketing on Professional Moral Courage and Organizational Silence: A Case Study of Employees at Yazd University,” in 2nd International Conference on Management, Accounting and Economics (2016), https://civilica.com/doc/610989.
  4. [31]M. Hosseini Yazdan Abad Soflavi, M. Ebadi, and Z. Farsi, “ The Effect of an Ethical Motivational Program on the Moral Courage of Nurses in Military Hospitals in Mashhad,” Military Medicine 21, no. 4 (2022): 410–7, https://militarymedj.bmsu.ac.ir/article_1000841.html.

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Authors
Akbari, A., Mirshahi, A., Mehravar, F., Rozveh, A. K., & Nasrabadi, A. N.
Affiliations
  • Tehran University of Medical Sciences (IR)
  • University of Alabama at Birmingham (US)
  • Golestan University of Medical Sciences (IR)
Corresponding author
Nasrabadi, Alireza Nikbakht
ORCID
Venue
Health Science Reports
Publisher
Wiley
Published
2025-07
Volume
8
Issue
7
Pages
e71021-e71021
ISSN
2398-8835 (ISSN-L)
DOI
10.1002/hsr2.71021
PMC
PMC12256659
OpenAlex
W4412381964
Cited by
5
References
35
Citations by year
2026: 4 · 2025: 1
FWCI
6.31
Type
journal article
Language
en
Open access
Licence
Locations
  • Health Science Reports (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Tehran University of Medical Sciences and Health Services
Topics
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
  • Social Sciences › Decision Sciences › Information Systems and Management › Ethics in Business and Education
  • Health Sciences › Nursing › Leadership and Management › Healthcare Education and Workforce Issues
Keywords
nursing ethics education, scenario-based training, nursing students, ethical decision-making, moral concepts, autonomy, confidentiality

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