Beyond Ethical Awareness: Knowledge–Application Gaps Among Nigerian Nursing and Midwifery Students in a Faith-Based Institution
Aloysius Ochasi, Nene Okunna, Henry Ogu, Simon A. Isueseni, Godswill Agbagwa, John Chidi ObasiIntroduction
Recent studies document growing but uneven healthcare ethics education across Nigerian health professions programs. Relatively little is known about how nursing and midwifery students in faith-based institutions respond to clinical ethics vignettes spanning professional risk, contested moral norms, and care for stigmatized populations. This study examined ethical knowledge–application patterns among students at a faith-based nursing institution in Southeast Nigeria.
Objectives
This study aimed to assess nursing and midwifery students’ self-reported awareness of core ethical principles and professional obligations, examine their responses to vignette-based ethical dilemmas, and identify domain-specific patterns of divergence between self-reported ethical awareness and vignette-based ethical recognition and evaluation.
Methods
A cross-sectional survey was administered to 614 nursing and midwifery students who attended a one-day Healthcare Ethics Workshop at a private, Catholic-affiliated College of Nursing Sciences in Southeast Nigeria. A self-administered questionnaire assessed sociodemographic characteristics, prior ethics exposure, ethical awareness, and responses to ten clinical ethics vignettes involving whistleblowing, medical error disclosure, patient–provider boundaries, reporting of unethical practices, abortion, physician-assisted suicide, euthanasia, transgender care, conscientious objection, and end-of-life decision-making. Descriptive statistics summarized responses across domains.
Results
Most participants reported prior formal ethics training, and the overall mean self-reported awareness score was 4.06 ± 0.39 on a five-point scale. Students responded most consistently to scenarios involving patient–provider relationships (85.4% correct assessment; 87.8% correct evaluation) and reporting of unethical practices (71.5%; 95.4%). Domain-specific variation was evident in whistleblowing (62.7%; 39.6%), end-of-life requests (46.3%; 64.2%), disclosure of medical errors (49.9%; 80.3%), and abortion (75.7%; 49.0%).
Conclusion
Students demonstrated high self-reported awareness of foundational ethical principles, but vignette-based performance varied across domains, with distinct recognition–evaluation patterns in professionally risky and socioculturally contested dilemmas. These findings support longitudinal, case-based, and dialogical ethics education that addresses professional risk, institutional hierarchy, and contested moral issues within the sociocultural context of nursing practice.