Kant-informed ethical orientation, recognition of Kantian duty ethics, and perceived moral pressure among nursing students: a cross-sectional study

Background Ethics education aims to prepare healthcare students to recognise and respond to ethical challenges in clinical practice, yet the ability to recognise an ethical theory may not correspond directly to the principles students endorse or to their experiences in clinical settings. The aim of this study was to examine the relationship between self-reported Kant-informed ethical orientation, recognition of a basic duty-based description of Kantian ethics, and perceived pressure to act against one’s moral principles during clinical practice among nursing students, and to identify educational and demographic factors associated with students’ ethical orientation. Methods A cross-sectional survey was conducted among 205 undergraduate and postgraduate nursing students in Slovenia. Ethical orientation was assessed using the newly developed Kantian Ethical Orientation Scale for Nursing Students (KEOS-NS). Recognition of a basic duty-based description of Kantian ethics and perceived moral pressure during clinical practice were assessed using single items. Associations with KEOS-NS scores were examined using non-parametric tests and multiple linear regression; the relationship between employment in nursing and perceived moral pressure was examined using a chi-square test. Results Only 75 students (36.6%) correctly identified Kantian ethics as duty-based, while 126 (61.5%) reported perceived pressure during clinical practice to act contrary to their moral principles. Neither recognition of a basic duty-based description of Kantian ethics nor perceived moral pressure was associated with KEOS-NS scores. Second-cycle students had lower KEOS-NS scores than first-cycle students, and level of study remained the only significant individual predictor in the multivariable model (B = − 5.57, 95% CI − 9.94 to − 1.19; p = .013), although the overall regression model was not statistically significant ( p = .265) and the bootstrap confidence interval included zero. Students employed in nursing were more likely to report perceived moral pressure than those not employed (72.7% vs. 56.1%; OR = 2.09, 95% CI 1.10 to 3.94). Conclusions Recognition of a basic duty-based description of Kantian ethics and endorsement of Kant-informed ethical principles appear to represent distinct aspects of ethical learning. Perceived moral pressure was common but was not associated with ethical orientation, indicating that endorsement of ethical principles may coexist with pressure to act contrary to them. The lower ethical orientation scores among second-cycle students require further investigation. Ethics education should connect theoretical frameworks with critical reflection on ethically challenging clinical experiences. Trial registration Not applicable.