A Multidimensional Intervention to Improve Ethical Decision-Making Competence Among Nursing Student Interns

Participants assigned to this group will receive a 5-week multidimensional intervention designed to improve ethical decision-making competence among nursing student interns during clinical learning. The intervention will address factors relevant to ethical decision-making through structured educational activities. Participants will complete outcome assessments at baseline, at the end of the intervention, and at 1-month and 3-month follow-ups after the intervention ends.

A 5-week multidimensional educational intervention to improve ethical decision-making competence among nursing student interns. Sessions will be delivered once weekly, lasting 1.5-2 hours each. The intervention includes five modules: (1) ethical issue recognition; (2) ethical emotion regulation; (3) ethical reasoning and decision-making; (4) ethical expression and action; and (5) clinical teaching rounds. The intervention aims to strengthen participants' ethical awareness, emotional regulation, decision-making, and ability to address ethical challenges during clinical learning.

Participants in the usual clinical internship training group will receive routine clinical learning and teaching according to the hospital's established training program. Regular activities include clinical skills training, observation and participation in nursing care under the supervision of clinical instructors, case discussions. When encountering ethical issues during clinical learning, participants will generally seek advice from their clinical instructors or supervising nurses. No additional study-specific intervention will be provided.

Participants assigned to this group will receive usual clinical internship training according to the hospital's standard training arrangements. They will not receive the study-specific 5-week multidimensional intervention during the intervention period. Participants will complete outcome assessments at baseline, at the end of the 5-week intervention period, and at 1-month and 3-month follow-ups after the intervention period ends.

Participants in the usual clinical internship training group will receive routine clinical learning and teaching according to the hospital's established training program. Regular activities include clinical skills training, observation and participation in nursing care under the supervision of clinical instructors, case discussions. When encountering ethical issues during clinical learning, participants will generally seek advice from their clinical instructors or supervising nurses. No additional study-specific intervention will be provided.

The scale consists of 18 items across four dimensions and assesses nursing students' creativity, confidence, awareness, and neutrality when facing ethical decision-making dilemmas involving patients or their families. It is based on Rest's Four-Component Model of Ethical Decision-Making, comprising ethical judgment, ethical sensitivity, ethical motivation, and ethical action. Each item is rated on a 5-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). The total score ranges from 0 to 72, with higher scores indicating a higher level of ethical decision-making competence.

This scale measures nurses' levels of imposter phenomenon and their attributions. It consists of 18 items across three dimensions: passive concealment (4 items), external attribution (6 items), and self-doubt (8 items). Each item is rated on a 5-point Likert scale ranging from 1 ("completely inconsistent") to 5 ("completely consistent"). The total score ranges from 18 to 90, with higher scores indicating a more severe imposter phenomenon.

The scale consists of 17 items across three dimensions: coping with nursing ethical dilemmas and relational integrity (10 items), personal integrity (2 items), and ethical efficacy in nursing (5 items). Each item is rated on a 4-point Likert scale ranging from 1 ("strongly disagree") to 4 ("strongly agree"). The total score ranges from 17 to 68, with higher scores indicating greater ethical resilience.

This scale measures nursing students' moral sensitivity and consists of 11 items across three dimensions: moral strength (4 items), moral burden (5 items), and moral responsibility (2 items). Each item is rated on a 6-point Likert scale ranging from 1 ("strongly disagree") to 6 ("strongly agree"). The total score ranges from 11 to 66, with higher scores indicating greater moral sensitivity.

The scale consists of three dimensions: compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS). CS represents a positive aspect, whereas BO and STS represent negative aspects. Items are rated on a 5-point Likert scale ranging from 1 ("never") to 5 ("always"). The cutoff scores for CS, BO, and STS are 27, and >17, respectively. Compassion fatigue severity is classified as mild when one dimension exceeds its cutoff, moderate when two dimensions exceed their cutoffs, and severe when all three dimensions exceed their cutoffs.