Ethical and human formation in certified nursing assistant education: A qualitative study

Abstract

Human and ethical values are foundational to nursing education and practice. However, limited empirical evidence exists on how ethical formation is enacted and sustained in Certified Nursing Assistant (CNA) education, particularly in vocational and non-university settings, despite CNAs’ central role in patient care. To explore perceived strengths and challenges in the human and ethical formation of CNA students across different stages of training and early professional practice. Qualitative descriptive study using thematic analysis. The study was conducted within a five-semester CNA education program. Data were generated through 29 semi-structured interviews and two focus groups involving 44 participants, including students, graduates, teachers, teaching managers, clinical preceptors, and employers. Perspectives were explored across four stages: prior to program entry, during the curriculum, the internship period, and early employment. Ethical approval was granted by the institutional Scientific Ethics Committee (ID 211014002). Participation was voluntary, written informed consent was obtained, and confidentiality and anonymity were ensured. Participants identified a distinctive institutional hallmark characterized by humanized care and ethical commitment. Ethical formation was supported by students’ value-based motivations, educator engagement, and reinforcement during clinical learning. However, participants also described tensions, including reliance on hidden curricula, insufficient educator preparation, misalignment between ethical instruction and clinical realities, limited support during internship, and lack of structured opportunities for continuing ethical development after graduation.  Ethical formation in CNA education was shaped not only by formal curriculum, but also by institutional culture, clinical environments, and transition into practice.  Although the program promotes strong humanistic and ethical values, the findings highlight the need for a more explicit and sustained institutional approach to ethics education. Strengthening ethical formation through curriculum, clinical accompaniment, interprofessional collaboration, and continuing support is essential to foster moral agency and person-centered care.