A systematic review of educational interventions to enhance ethical sensitivity in nursing students in Asia and the Middle East

BACKGROUND: As future providers of medical services, nursing students require strong ethical sensitivity to effectively manage clinical ethical dilemmas. However, studies have shown that they often exhibit lower ethical sensitivity than practicing nurses, which may hinder their ability to address ethical challenges competently. OBJECTIVE: This systematic review aimed to comprehensively evaluate the effectiveness of educational interventions in enhancing the ethical sensitivity of nursing students. The findings will offer practical guidelines and a theoretical foundation for advancing nursing ethics education. METHODS: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted comprehensive searches across nine databases (PubMed, Embase, Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Cochrane Library, Cumulated Index in Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), VIP (Chinese Science and Technology Journal Database), and Wanfang Data) to identify relevant studies published through December 2024. Two researchers independently performed the screening, data extraction, and quality assessment, with any disagreements resolved through discussion to reach a consensus. RESULTS: Twenty-one studies were included. The results indicated that current educational interventions primarily focus on two dimensions: teaching methods and curricular content. Among teaching methods, situational participatory learning was found to be more effective than traditional didactic instruction in enhancing nursing students’ ethical sensitivity. The curricular content was organized into a three-dimensional framework encompassing fundamental theories, clinical practice, and interdisciplinary integration, establishing a comprehensive knowledge system ranging from ethical principles to emerging technological ethics. CONCLUSIONS: This review confirmed that interactive teaching methods effectively enhance nursing students’ ethical sensitivity, although they require significant resources. Future nursing education should integrate cross-cultural competencies, spiritual care training, and emerging ethical issues while establishing comprehensive ethics curricula within clinical training. Such approaches will better prepare nurses for ethical challenges in practice.