The moral distress, protective factors, and resilience

In previous studies, nursing students have reported experiencing moral distress during practice. However, it is unclear whether student nurses who experience ethical decision-making competence in their clinical internships have a protective effect against moral distress, resilience-protective factors, and resilience. Therefore, this study aimed to examine the effects of ethical decision-making competence on moral distress, resilience, and protective factors among nursing students. The participants were recruited from five nursing schools. The study employed measurement tools, including the Ethical Decision-Making Competence Scale, Scale of Protective Factor-24, Resilience Scale, and Moral Distress Scale–Revised. We applied the partial least squares approach to structural equation modeling and multi-group analysis to analyze the data using SmartPLS software. A group of 134 student nurses participated in this study (72 women and 62 men). Findings revealed that student nurses with higher ethical decision-making competence experienced lower moral distress and greater resilience and protective factors. Students with higher protective factors demonstrated greater resilience. However, resilience was not significantly associated with moral distress. Ethical decision-making competence partially and indirectly affected resilience via protective factors. This study recommends that the cultivation of clinical nursing practice focus on student nurses’ ethical decision-making competencies. Narratives (e.g., moving stories that illustrate human suffering) can prompt students to reflect on the role of the ethical subject in a situation and further enhance their ability to identify ethical issues and apply ethical principles appropriately.