Latent profile analysis of moral decision-making in clinical practice nursing students

Abstract

Background

Ethical decision-making in nursing is crucial for care quality and patient safety. Nursing interns, being in a critical transition from students to professional nurses, have ethical decision-making abilities that are susceptible to environmental and individual factors. It is necessary to explore the latent profiles of ethical decision-making among interns and their influencing factors to provide targeted educational interventions.

Aim

To identify latent profiles of ethical decision-making in clinical nursing interns and analyze their influencing factors.

Study Design

A cross-sectional study design was adopted.

Participants and Setting

In August 2025, 640 nursing interns were recruited from four medical universities in China using convenience sampling. Data were collected via the Questionnaire Star platform, including a general information questionnaire, the Ethical Decision-Making Competence Scale (EDM-CS), the Perceived Social Support Scale (PSSS), and the Interpersonal Reactivity Index-C (IRI-C). Latent profile analysis was conducted based on the four dimensions of the EDM-CS, and multivariate logistic regression was used to analyze influencing factors.

Ethical Considerations

We obtained ethical approval from the First Affiliated Hospital of China Medical University (Approval number: [2024]710).

Results

Three latent profiles of ethical decision-making were identified: Ethical Decision-making Basic Type (35.47%, n = 227), Ethical Decision-making Intermediate Type (52.81%, n = 338), and Ethical Decision-making Integration Type (11.72%, n = 75). Multivariate logistic regression showed that male interns were less likely to belong to the Ethical Decision-making Intermediate Type (OR = 0.46, p = .008) and the Ethical Decision-making Integration Type (OR = 0.26, p = .017). A positive hospital teaching environment significantly promoted membership in both the Ethical Decision-making Intermediate Type (OR = 1.84, p = .009) and the Ethical Decision-making Integration Type (OR = 9.12, p < .001). Clinical work pressure (OR = 2.22, p = .008) and an internship duration of 3–6 months (OR = 1.96, p = .017) increased the likelihood of belonging to the Ethical Decision-making Intermediate Type.

Conclusion

Ethical decision-making among nursing interns can be categorized into three distinct profiles. Optimizing the teaching environment and reducing work pressure are key to promoting moral integration. Tailored educational strategies based on profile characteristics, internship stage, and gender differences are recommended to enhance ethical decision-making competence.