Mapping factors associated with nursing students’ ethical sensitivity: a scoping review

Ethical sensitivity is a core competence for nursing students facing clinical ethical dilemmas. However, evidence on its associated factors remains fragmented and lacks multi-level integration, and a comprehensive overview is needed. This scoping review aimed to map and synthesize factors associated with nursing students’ ethical sensitivity. This review followed the JBI methodology and the PRISMA-ScR checklist. The research question was framed using the PCC framework. Original Chinese- or English-language studies on nursing students were included. Nine databases, including PubMed, were searched up to 18 June 2026. Two reviewers independently screened and extracted data; disagreements were resolved by discussion or arbitration. Factors were categorized using the Social Ecological Model. Fifty-one studies were included: 37 cross-sectional, 7 quasi-experimental, 4 randomized controlled trials, 2 mixed-methods, and 1 qualitative study. Studies were conducted in seven countries, mostly China ( n = 21), Iran ( n = 13), and Türkiye ( n = 12), involving 14,481 participants. Factors were mapped at the individual, interpersonal, and organizational levels; no community- or policy-level evidence was identified. Individual factors included demographic and socioeconomic characteristics, personal traits, abilities and behaviors, psychological factors, ethical cognition and attitudes, education and training, and professional attitudes and identity. Interpersonal evidence was limited, mainly concerning teachers’ and classmates’ attitudes towards nursing. Organizational factors included academic year, ethics education and training, clinical practice experience, internship characteristics, and organizational care climate. Heterogeneity was considerable across study design, instruments, scoring direction, and cut-off points, and many associations were supported only by isolated evidence. Because instruments were not directly comparable, ethical sensitivity levels were reported as raw continuous scores. Factors associated with nursing students’ ethical sensitivity span multiple levels, with evidence concentrated at the individual and interpersonal levels. No community- or policy-level evidence was identified, and many associations were supported only by single studies. Given the predominance of cross-sectional designs, findings should be interpreted as associative rather than causal. Future research should measure genuine community- and policy-level exposures, use more comparable instruments, and replicate isolated findings. Not applicable.