Ethics Program with AI Component Linked to Improved Nursing Moral Reasoning

Participation in a multi-component professional ethics education program incorporating artificial intelligence-assisted case exploration was associated with greater improvements in moral reasoning among nursing students than standard educational instruction, according to findings from a quasi-experimental study published in BMC Research Notes. The investigation evaluated changes in moral reasoning following the integrated educational curriculum compared directly with the routine nursing curriculum. Within the framework of the study, moral reasoning was defined as an essential professional competency in nursing that supports ethical decision-making. By tracking participant performance across structured assessment points, the researchers sought to analyze how structured ethics education incorporating technological case exploration affects students’ ethical decision-making competencies over time.

The investigation was conducted utilizing a quasi-experimental study design and involved an initial sample of 80 nursing students. The research cohort was split into two equal arms of 40 participants each: an experimental group receiving the multi-component professional ethics education program incorporating AI-assisted case exploration, and a comparison group receiving the routine curriculum. Across the progression of the study schedule, one participant from the comparison group was lost to follow-up, leaving 39 participants in the comparison cohort for subsequent evaluations, while the experimental group retained all 40 enrolled nursing students through the completion of the protocol.

To evaluate changes in ethical reasoning, the researchers measured moral reasoning using Crisham’s Nursing Dilemma Test, commonly designated as the NDT. The assessment schedule comprised three discrete measurement intervals designed to record baseline measurements and determine whether educational gains persisted. Testing took place at baseline before the curricular programs commenced, at post-test immediately following the completion of the educational coursework, and at a three-month follow-up assessment. This structured testing timeline allowed researchers to contrast immediate post-intervention performance against baseline levels and observe long-term score maintenance across both participant cohorts.

In the experimental group, students who engaged with the multi-component professional ethics curriculum incorporating artificial intelligence-assisted case exploration demonstrated consistent gains across the testing timeline. At baseline, the experimental cohort recorded a mean Nursing Dilemma Test score of 43.13 with a standard deviation of 5.29. Following the completion of the educational intervention, the experimental group achieved a post-test mean score of 48.83 with a standard deviation of 5.97. At the three-month follow-up assessment, the experimental group sustained these improvements, documenting a mean score of 48.68 with a standard deviation of 5.43.

In contrast, nursing students allocated to the comparison group who participated solely in the routine curriculum exhibited relatively stable scores with minimal change across identical measurement intervals. The comparison cohort began the study with a baseline mean Nursing Dilemma Test score of 43.90 with a standard deviation of 5.69. At the post-test assessment interval, the comparison group recorded a mean score of 44.59 with a standard deviation of 5.21. When assessed again at the three-month follow-up interval, the comparison group registered a mean score of 43.97 with a standard deviation of 5.37.

A repeated-measures analysis of covariance, or repeated-measures ANCOVA, demonstrated statistically significant effects across the assessment timeline and between cohorts. The analysis revealed a significant effect of time with a p-value of 0.001, as well as a significant group-by-time interaction effect with a p-value of 0.001. After adjusting for the students’ academic term as a covariate, the overall effect of group remained statistically significant with a p-value of 0.025. Further pairwise evaluation revealed that post-test scores and follow-up scores were both significantly higher than baseline scores, with each comparison achieving a p-value of 0.001. In contrast, the comparison between post-test scores and three-month follow-up scores did not differ significantly, yielding a p-value of 0.138, which confirmed the stability of moral reasoning scores following the conclusion of the intervention.

Overall, the findings indicated that participation in the multi-component program was associated with greater improvement in moral reasoning compared with the routine curriculum alone. However, the researchers emphasized an important limitation regarding causal attribution within the educational design. Because the intervention comprised multiple distinct educational components alongside artificial intelligence-assisted case exploration, the independent contribution of the AI-assisted learning component could not be determined. The authors thus contextualized the observed gains as the result of the combined multi-component educational package rather than attributing the measured outcomes solely to AI tools.

Subject of Research: Ethics education and moral reasoning in nursing students

Article Title: A multi-component professional ethics education program incorporating AI-assisted learning for nursing students: changes in moral reasoning in a quasi-experimental study

Article References: Abdi, N., Saeedi, P., Malekzadeh, M., Pendar, R., Moghadam, M. B., & Mirzaee, M. (2026). A multi-component professional ethics education program incorporating AI-assisted learning for nursing students: changes in moral reasoning in a quasi-experimental study. BMC Research Notes. https://doi.org/10.1186/s13104-026-08071-3

Image Credits: AI Generated

DOI: 10.1186/s13104-026-08071-3

Keywords: nursing education, moral reasoning, professional ethics, artificial intelligence, Nursing Dilemma Test, quasi-experimental study, repeated-measures ANCOVA, curriculum evaluation, multi-component, professional, ethics, education