Comparing the effects of role-playing and mobile-based ethics education on nurses’ moral sensitivity and clinical decision-making: a quasi-experimental study

Abstract

Ensuring the quality and safety of healthcare services requires not only clinical competence but also strong ethical capabilities among nurses. In clinical practice, nurses frequently encounter complex ethical dilemmas that demand high levels of moral sensitivity and effective decision-making. However, despite the recognized importance of ethics education, there is limited evidence regarding the most effective educational approaches for enhancing these competencies, particularly in real clinical settings. As a key component of ethical competence, moral sensitivity enables nurses to recognize ethical issues and provides the foundation for appropriate clinical decision-making. Therefore, identifying and evaluating effective educational strategies is essential to strengthen these critical competencies. This study aimed to compare the effects of two educational approaches—role-playing and mobile phone–based training—on nurses’ moral sensitivity and clinical decision-making. This quasi-experimental study with a pre-test–post-test design was conducted among nurses working at Imam Khomeini Hospital in Urmia, Iran, in 2022. A total of 114 nurses were recruited using convenience sampling and randomly assigned to three groups: role-playing intervention, mobile phone–based training, and control. Data were collected using a demographic questionnaire, the Moral Sensitivity Questionnaire developed by Lützén, and the Clinical Decision-Making Questionnaire by Lauri et al. The role-playing group participated in five interactive training sessions involving ethical scenarios, each lasting approximately 90–120 minutes (total duration ≈ 480–600 minutes). The mobile phone group received two educational messages per day for 14 days (estimated engagement time ≈ 10 minutes per day; total duration ≈ 140 minutes), supplemented by scheduled weekly telephone-based interactions (approximately 30 minutes per session) for clarification and reflective discussion; participants could also contact the research team by telephone for additional clarification when needed. The control group received no additional training. Data were analyzed using descriptive statistics, paired and independent t-tests, chi-square tests, and one-way ANOVA with a significance level of p < 0.05. The findings indicated that both the role-playing and mobile-based training groups showed significant improvements in moral sensitivity and clinical decision-making after the intervention (p < 0.001). In contrast, no significant changes were observed in the control group. Between-group comparisons revealed significant differences between the intervention groups and the control group after the intervention (p < 0.001). However, no statistically significant difference was found between the role-playing and mobile-based training groups in post-intervention scores. Both role-playing and mobile phone–based training were effective in improving nurses’ moral sensitivity and clinical decision-making. These findings highlight the importance of innovative and learner-centered educational strategies in nursing education and suggest that integrating such approaches into professional training programs may enhance ethical competence and improve the quality of patient care.