Immersive ethical role-play in undergraduate nursing ethics education: a qualitative descriptive study

Nursing ethics teaching often relies on lectures and paper-based cases, which may not adequately prepare students for ethically ambiguous clinical practice. Evidence on low-resource, narrative, immersive approaches for nursing ethics education remains limited.

To explore how undergraduate nursing students described their ethical reasoning, ethical positioning, and perceived learning after participating in an immersive ethical role-play simulation (IERS).

Qualitative descriptive study.

A total of 102 second-year undergraduate nursing students at Hubei Polytechnic University in central China participated in November 2025.

Students took part in a 2.5-hour, peer-enacted IERS built around an end-of-life decision-making scenario. Anonymous post-session survey data were collected using one two-part mapping item and two open-ended questions. Q1-2 responses were summarized using descriptive content analysis; Q3 responses were examined using typological analysis; and Q4 responses were analyzed using reflexive thematic analysis.

Autonomy was the most frequently identified primary bioethical principle (50/102 responses), although students also referred to beneficence, justice, non-maleficence, and relational obligations such as filial duty. Three post-simulation positioning modes were identified: principle-based distancing, contextualized ambivalence, and value-aligned identification. Four themes described students' perceived learning gains: embodied understanding of bioethical principles, movement beyond binary moral judgment, perspective-taking and empathy, and emerging professional identity.

This study suggests that a low-resource, immersive role-play format may help nursing students engage with bioethical principles in context, consider multiple stakeholder perspectives, and reflect on their future professional responsibilities. The findings support IERS as a feasible complement to didactic ethics teaching, while also indicating the need for longitudinal and comparative research to assess sustained educational impact.