Mansure Madani

Nursing is a moral profession requiring virtues such as compassion and integrity to deliver ethical care amid complex challenges like moral distress. Despite known influences on moral development, nursing students’ own perceptions of factors shaping their moral character remain underexplored. Therefore, this study aimed to explore nursing students’ perceptions of the factors contributing to the development of moral character. A qualitative descriptive study and conventional content analysis was used. Semi-structured interviews were conducted with 16 purposive-sampled nursing students (Bachelor’s and Master’s) at Hormozgan University of Medical Sciences, Iran, between June and August 2025. Data were analysed following Graneheim and Lundman’s approach until data saturation (meaning saturation) was achieved. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability strategies, guided by the COREQ checklist. Four overarching themes emerged, encompassing 14 sub-themes: (1) inner motivations and values (four sub-themes: intrinsic motivation, personal/religious beliefs, psychological capital, self-reflection); (2) relational dynamics and communication (three sub-themes: role modeling, peer support, family/community influences); (3) moral learning in practice (three sub-themes: formal ethics education, staged clinical experiences, simulation training); and (4) systemic and organizational influences (four sub-themes: university culture, clinical ethical climate, professional norms, resource availability). Moral character development is a dynamic, multifaceted process shaped by personal conviction, social relationships, structured learning, and institutional contexts, underscoring the ethical significance of virtues like resilience and integrity in navigating moral distress. In this Iranian cohort, religious values and relational role models were particularly salient. These findings inform bioethics curricula and policy to strengthen moral resilience among nursing students, preparing them for ethical practice amid complex healthcare challenges.

Ethical dilemmas are among the most important ethical problems in medicine. With the advent of COVID-19, the moral problems of physicians have taken on new dimensions as the specific features of this disease pose additional ethical challenges that require particular solutions. One common way to solve ethical dilemmas is to use ethical decision making models. One of the most recent models in ethics of technology is the “ethical cycle” developed by Ibo van de Poel. By describing and comparing several models, this paper examines the application of the ethical cycle to physicians' ethical problems and medical ethics. This model can help solve complex problems in consultations and ethics committee meetings because it is comprehensive and covers various aspects of the discussion.In this model, first the ethical problem is formulated and analyzed and then the potential options for action are proposed.Subsequently, by referring to ethical theories and professional codes of conduct in the medical field, as well as applying the method of "reflective equilibrium," an ethical decision is reached. This decision is specific to each case and may not necessarily be the best solution for other individuals or situations.

Social and professional behaviors are driven by extrinsic as well as intrinsic factors including executive rules and regulations enacted by extrinsic agents through coercion, police force and penalties. Despite their effectiveness, these mechanisms undermine the fact that ethics is an intrinsic human quality. The present study seeks strategies to apply extrinsic coercion as an incentive to direct ethics as an intrinsic value. Ethical behaviors driven by intrinsic motivations are more permanent and less costly. Legal force can either strengthen or weaken intrinsic requirements. Extrinsic conditions such as considering the interests, attitudes and preferences of others, involving people in the regulation and execution of law, justification of law, avoiding excessive punishment or rewards, and indirect support of ethics by establishing the appropriate social context can help boost intrinsic requirements in individuals. Ethics will not be practically established unless we harness individuals’ ‘willingness to act’ as an essential determinant for ethical behavior. This requires adoption of a more psychological approach to ethics. If this aspect of ethical behavior is considered in regulations and executive processes, extrinsic forces can strengthen intrinsic requirements and spread ethics.

Physicians try hard to alleviate mental and physical ailments of their patients. Thus, they are heavily burdened by observing ethics and staying well-informed while improving health of their patients. A major ethical concern or dilemma in medication is that some physicians know their behavior is unethical, yet act against their moral compass. This study develops models of theory–practice gap, offering optimal solutions for the gap. These solutions would enhance self-motivation or remove external obstacles to stimulate ethical practices in medicine. The Constructivist Grounded Theory Methodology is applied here where the participants and the main researcher mutually interacted with each other. Data collection was performed through qualitative methods including observation and semi-structured interviews with 21 physicians and medical students. Initial and focused coding was done, from which principal concepts were later extracted. MAXQDA software was used for analyzing data. Analysis of twelve major concepts in the study resulted in two factors and solution groups, from which four general notions influencing the ethical theory and practice gap in medicine were extracted: (1) providing effective education to change attitude and behavior; (2) considering motivational and emotional factors; (3) reconstructing regulations and processes to facilitate ethical practice; (4) conducting comprehensive and systematic studies. The existing medical educational system needs to be reconsidered to add to individual internal motivation, including optimizing persuasion strategies, maximizing participation of students, adhering to virtuous ethical theories, and fostering emotions. Additionally, regulations and processes can be reconstructed to remove practical obstacles and promote ethical practice with insignificant damages to individual self-motivation.