How cultural humility and ethical sensitivity shape ethical decision-making competence

Abstract

Background

Nursing students encounter ethically complex situations in culturally diverse healthcare settings where ethical decision-making requires more than the application of ethical principles alone. Cultural humility and ethical sensitivity may play a critical role in shaping ethical decision-making competence in nursing education and practice.

Aim

This study aimed to examine the relationship between cultural humility, ethical sensitivity, and ethical decision-making competence among undergraduate nursing students in Egypt and to investigate whether ethical sensitivity mediates this relationship.

Research design

A descriptive cross-sectional survey design was used. Data were analyzed using descriptive statistics, Pearson’s correlation, multiple linear regression, and structural equation modelling.

Participants and research context

A total of 900 undergraduate nursing students were recruited from three public universities representing lower, middle, and upper regions of Egypt. Participants completed Arabic-translated versions of the Cultural Humility Scale for Nursing Students (CHSNS), Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS), and Ethical Decision-Making Competence Scale (EDM-CS).

Ethical considerations

Ethical approval was obtained from the Institutional Review Board of the Faculty of Nursing, Zagazig University (Approval No. 313). Written informed consent was obtained from all participants, and confidentiality and anonymity were maintained throughout the study in accordance with the Declaration of Helsinki.

Findings

Students demonstrated moderate-to-high levels of cultural humility and ethical sensitivity. Cultural humility was positively associated with ethical sensitivity and ethical decision-making competence. Multiple regression analysis revealed that cultural humility and ethical sensitivity significantly predicted ethical decision-making competence. Mediation analysis further showed that ethical sensitivity partially mediated the relationship between cultural humility and ethical decision-making competence.

Conclusions

Cultural humility directly and indirectly enhances ethical decision-making competence through ethical sensitivity among nursing students. Integrating cultural humility and ethical sensitivity into nursing ethics education may strengthen students’ moral awareness, ethical reasoning, and culturally responsive nursing practice.