Moral character development in nursing students: a qualitative content analysis in Iran

Abstract

BACKGROUND: Nursing is a moral profession requiring virtues such as compassion and integrity to deliver ethical care amid complex challenges like moral distress. Despite known influences on moral development, nursing students' own perceptions of factors shaping their moral character remain underexplored. Therefore, this study aimed to explore nursing students' perceptions of the factors contributing to the development of moral character. METHODS: A qualitative descriptive study and conventional content analysis was used. Semi-structured interviews were conducted with 16 purposive-sampled nursing students (Bachelor's and Master's) at Hormozgan University of Medical Sciences, Iran, between June and August 2025. Data were analysed following Graneheim and Lundman's approach until data saturation (meaning saturation) was achieved. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability strategies, guided by the COREQ checklist. RESULTS: Four overarching themes emerged, encompassing 14 sub-themes: (1) inner motivations and values (four sub-themes: intrinsic motivation, personal/religious beliefs, psychological capital, self-reflection); (2) relational dynamics and communication (three sub-themes: role modeling, peer support, family/community influences); (3) moral learning in practice (three sub-themes: formal ethics education, staged clinical experiences, simulation training); and (4) systemic and organizational influences (four sub-themes: university culture, clinical ethical climate, professional norms, resource availability). CONCLUSION: Moral character development is a dynamic, multifaceted process shaped by personal conviction, social relationships, structured learning, and institutional contexts, underscoring the ethical significance of virtues like resilience and integrity in navigating moral distress. In this Iranian cohort, religious values and relational role models were particularly salient. These findings inform bioethics curricula and policy to strengthen moral resilience among nursing students, preparing them for ethical practice amid complex healthcare challenges.