Ethical sensitivity is a foundational competency that enables nursing interns to recognize and respond to ethical issues in clinical practice. Understanding its heterogeneity is essential for designing tailored educational interventions.
Aim
This study aimed to identify distinct latent profiles of ethical sensitivity among nursing interns and to examine their associations with critical thinking and readiness for artificial intelligence (AI) in healthcare.
Research design
A cross-sectional study design was employed.
Participants and research context
A total of 458 nursing interns from 32 medical colleges across seven provinces in China completed a general information questionnaire, the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS), the Simplified Critical Thinking Scale (S-CTS), and the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS).
Ethical considerations
Approved by the Institutional Review Board (No. 2025-1380). Informed consent was obtained. Data were anonymous and confidential.
Results
Latent profile analysis identified four distinct profiles of ethical sensitivity: Rights-Privacy Focused (14.2%), Justice-Beneficence Focused (57.9%), Balanced-Intermediate (10.9%), and High Overall Sensitivity (17.0%). Significant differences were observed across profiles in critical thinking (S-CTS) and AI readiness (MAIRS-MS) scores. Multinomial logistic regression revealed that lower critical thinking scores were significantly associated with higher odds of belonging to the Balanced-Intermediate and Rights-Privacy Focused profiles, compared to the High Overall Sensitivity profile.
Conclusions
Ethical sensitivity among nursing interns is heterogeneous, manifesting in four distinct profiles. Critical thinking differed significantly across these profiles. The findings underscore the need for tailored educational strategies that address specific profile characteristics to better prepare future nurses for ethically complex and increasingly technology-driven healthcare environments.
RainerJSchneiderJKLorenzRA. Ethical dilemmas in nursing: an integrative review. J Clin Nurs2018; 27: 3446–3461. https://doi.org/10.1111/jocn.14542
2.
LützénKDahlqvistVErikssonS, et al.Developing the concept of moral sensitivity in health care practice. Nurs Ethics2006; 13: 187–196. https://doi.org/10.1191/0969733006ne837oa
3.
ZhengZLiSWangJet al. Latent profile analysis of nurses’ moral resilience and its influencing factors. Nurs Ethics. 2026; 33: 205–224. https://doi.org/10.1177/09697330251366609
4.
ChenXZhangYZhengR, et al.Latent profiles of nurses' moral resilience and compassion fatigue. Nurs Ethics2024; 31: 635–651. https://doi.org/10.1177/09697330231222594
5.
MuramatsuTNakamuraMOkadaE, et al.The development and validation of the Ethical Sensitivity Questionnaire for Nursing students. BMC Med Educ2019; 19: 215. https://doi.org/10.1186/s12909-019-1625-8
6.
HuJChenXKhoshnoodK, et al.A survey of ethical sensitivity among nursing students and its influencing factors. Nurs Ethics2024; 31: 1467–1480. https://doi.org/10.1177/09697330231225399
7.
ZhangYLiSHuangY, et al.Correlation between ethical sensitivity and humanistic care ability among undergraduate nursing students: a cross-sectional study. BMC Nurs2024; 23: 863. https://doi.org/10.1186/s12912-024-02532-5
8.
MathewADoorenbosAZ. Latent profile analysis – an emerging advanced statistical approach to subgroup identification. Indian Journal of Continuing Nursing Education2022; 23: 127–133. https://doi.org/10.4103/ijcn.ijcn_24_22
9.
HickendorffMEdelsbrunnerPAMcMullenJ, et al.Informative tools for characterizing individual differences in learning: latent class, latent profile, and latent transition analysis. Learn Indiv Differ2018; 66: 4–15. https://doi.org/10.1016/j.lindif.2017.11.001
10.
FacioneNCFacionePASanchezCA. Critical thinking disposition as a measure of competent clinical judgment: the development of the California critical thinking disposition inventory. J Nurs Educ. 1994; 33: 345–350. https://doi.org/10.3928/0148-4834-19941001-05
PeirceAGElieSGeorgeA, et al.Knowledge development, technology and questions of nursing ethics. Nurs Ethics2020; 27: 77–87. https://doi.org/10.1177/0969733019840752
13.
BallDPAMichalowskiM. Advancing AI data ethics in nursing: future directions for nursing practice, research, and education. JMIR Nurs2024; 7: e62678. https://doi.org/10.2196/62678
LyuYLiangXLiJ, et al.Assessment of ethical sensitivity in nursing students: tools, trends, and implications. Nurs Ethics2025; 32: 1240–1252. https://doi.org/10.1177/09697330241295375
17.
HuKZhouQZhangY, et al.Latent profile analysis of nurses' moral courage: a professional values perspective. Nurs Ethics2025; 32: 678–689. https://doi.org/10.1177/09697330241270734
18.
QuZSunJLiL, et al.The effect of simulated problem learning in nursing ethics on moral sensitivity, empathy and critical thinking of nursing students: a quasi-experimental study. Nurse Educ Pract2024; 80: 104119. https://doi.org/10.1016/j.nepr.2024.104119
19.
AhnSHYeomHA. Moral sensitivity and critical thinking disposition of nursing students in Korea. Int J Nurs Pract2014; 20: 482–489. https://doi.org/10.1111/ijn.12185
Nylund-GibsonKGarberACCarterDB, et al.Ten frequently asked questions about latent transition analysis. Psychol Methods2023; 28: 284–300. https://doi.org/10.1037/met0000486
22.
YuBYuL. An instrument for measuring critical thinking for LIS research and practice: Feasibility test of CTDI-CV simplification. Library and Information2020; 4: 21–27.
23.
YangGWeiHWanL, et al.Reliability and validity of a simplified Critical Thinking Scale applied to medical students. Journal of Zhengzhou University(Medical Sciences)2022; 57: 330–335.
24.
KaracaOCaliskanSADemirK. Medical artificial intelligence readiness scale for medical students (MAIRS-MS) - development, validity and reliability study. BMC Med Educ2021; 21: 112. https://doi.org/10.1186/s12909-021-02546-6
25.
BurucuRTürkben PolatH. Nursing students' readiness and anxiety regarding medical artificial intelligence: a mixed-methods study. Nurse Educ Pract2025; 88: 104538. https://doi.org/10.1016/j.nepr.2025.104538
26.
KayaGBüyükyılmazFÇulhaY, et al.Investigation of the relationship between medical artificial intelligence readiness and individual innovativeness levels in nursing students. Nurse Educ Today2025; 151: 106721. https://doi.org/10.1016/j.nedt.2025.106721
27.
Demir-KaymakZTuranZUnlu-BidikN, et al.Effects of midwifery and nursing students' readiness about medical Artificial intelligence on Artificial intelligence anxiety. Nurse Educ Pract2024; 78: 103994. https://doi.org/10.1016/j.nepr.2024.103994
NumminenOLeino-KilpiHIsoahoH, et al.Ethical climate and nurse competence - newly graduated nurses' perceptions. Nurs Ethics2015; 22: 845–859. https://doi.org/10.1177/0969733014557137
30.
KimYSParkJWYouMA, et al.Sensitivity to ethical issues confronted by Korean hospital staff nurses. Nurs Ethics2005; 12: 595–605. https://doi.org/10.1191/0969733005ne829oa
31.
Feijoo-CidMArreciado MarañónAFernández-CanoMI, et al.Expert patients leading activities on social justice: towards patient-centered education. Nurs Ethics2024; 31: 1233–1246. https://doi.org/10.1177/09697330231217038
32.
DunnM. Ethical practice as a shared professional endeavour: is healthcare ethics education fit for purpose?Nurs Ethics2025; 32: 1707–1709. https://doi.org/10.1177/09697330251371437
33.
GroothuizenJE. Axiological reflection for nursing ethics education: the missing link in understanding value conflicts. Nurs Ethics2025; 32: 1230–1239. https://doi.org/10.1177/09697330241295369
34.
OforiR. Age and 'type' of domain specific entry qualifications as predictors of student nurses' performance in biological, social and behavioural sciences in nursing assessments. Nurse Educ Today2000; 20: 298–310. https://doi.org/10.1054/nedt.1999.0396
35.
MurrayJW. Critical thinking activities and the Enhancement of Ethical Awareness: an application of a ‘Rhetoric of Disruption’ to the undergraduate general education classroom. Open Review of Educational Research2015; 2: 240–258. https://doi.org/10.1080/23265507.2015.1084478
36.
DreierJ. Why ethical satisficing makes sense and rational satisficing doesn't. In: ByronM (ed). Satisficing and Maximizing: Moral Theorists on Practical Reason. : Cambridge University Press, 2004, pp. 131–154.
37.
AbuadasMAlbikawiZRayaniA. The impact of an AI-focused ethics education program on nursing students' ethical awareness, moral sensitivity, attitudes, and generative AI adoption intention: a quasi-experimental study. BMC Nurs2025; 24: 720. https://doi.org/10.1186/s12912-025-03458-2
38.
CaoYDengLLiuX, et al.Ethical challenges in the algorithmic era: a systematic rapid review of risk insights and governance pathways for nursing predictive analytics and early warning systems. BMC Med Ethics2025; 26: 151. https://doi.org/10.1186/s12910-025-01308-z
39.
AkhtarK. Ethical challenges in nursing: balancing care, confidentiality, and consent. Kashf Journal of Multidisciplinary Research2025; 2: 1–7. https://doi.org/10.71146/kjmr689
40.
ShiXWangRLiY, et al.A systematic review of educational interventions to enhance ethical sensitivity in nursing students in Asia and the Middle East. BMC Med Ethics2025; 26: 185. https://doi.org/10.1186/s12910-025-01334-x
41.
PesutDJ. Preparing future-focused nurse leaders: innovation, ethics, and foresight in education–practice partnerships. Nurse Lead. 2025; 24: 102634. https://doi.org/10.1016/j.mnl.2025.102634
