Multimedia-supported e-learning versus face-to-face practical ethics education and nursing students’ moral awareness and moral sensitivity: a non-randomized quasi-experimental study
Year: 2026
Type: article
Abstract: Background Nursing students need adequate moral awareness and moral sensitivity to recognize and address ethical challenges in clinical practice. This study compared multimedia-supported e-learning with conventional face-to-face instruction for delivering practical ethics education, in terms of nursing students’ moral awareness and moral sensitivity. Methods This non-randomized quasi-experimental study with a pretest–posttest design and a control group was conducted at the Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Iran, from October to December 2021. Eighty second-semester nursing students were allocated 1:1 to an intervention group ( n = 40) or a control group ( n = 40) according to odd or even student identification numbers. Both groups received identical theoretical ethics instruction. The practical component, of equal duration in both groups, was delivered through multimedia-supported e-learning in the intervention group and face-to-face workshops in the control group. Moral awareness and moral sensitivity were measured at baseline and two weeks after the intervention using the Questionnaire on Nurses’ Awareness about the Iranian Nursing Code of Ethics and the Moral Sensitivity Questionnaire. Post-test scores were compared using analysis of covariance (ANCOVA) adjusted for baseline scores (SPSS version 26). Results Baseline scores were comparable between groups. Post-test moral awareness did not differ significantly between the intervention and control groups (unadjusted means 30.17 ± 2.96 vs. 29.72 ± 2.89; adjusted mean difference 0.45, 95% CI − 1.06 to 1.96; p = 0.556; partial η² = 0.005). Moral sensitivity was significantly higher in the intervention group (145.55 ± 14.38 vs. 133.32 ± 21.64; adjusted mean difference 12.1, 95% CI 6.65 to 17.55; p < 0.001; partial η² = 0.20). Conclusion When practical ethics content was identical, multimedia-supported e-learning was associated with higher moral sensitivity than face-to-face instruction, but not with higher moral awareness. It may serve as a useful complement to conventional nursing ethics education, particularly for strengthening moral sensitivity. Because allocation was non-random and only short-term self-reported outcomes were assessed, causal inference is limited, and further randomized studies are needed to determine whether these differences persist and translate into ethical competence and clinical ethical decision-making. Clinical trial number Not applicable.
Source: BMC Nursing
Language: English
Topic: Ethics in medical practice
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7222817258
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