Immersive ethical role-play in undergraduate nursing ethics education: a qualitative descriptive study.

BACKGROUND

Nursing ethics teaching often relies on lectures and paper-based cases, which may not adequately prepare students for ethically ambiguous clinical practice. Evidence on low-resource, narrative, immersive approaches for nursing ethics education remains limited.

OBJECTIVE

To explore how undergraduate nursing students described their ethical reasoning, ethical positioning, and perceived learning after participating in an immersive ethical role-play simulation (IERS).

DESIGN

Qualitative descriptive study.

SETTING AND

PARTICIPANTS

A total of 102 second-year undergraduate nursing students at Hubei Polytechnic University in central China participated in November 2025.

METHODS

Students took part in a 2.5-hour, peer-enacted IERS built around an end-of-life decision-making scenario. Anonymous post-session survey data were collected using one two-part mapping item and two open-ended questions. Q1-2 responses were summarized using descriptive content analysis; Q3 responses were examined using typological analysis; and Q4 responses were analyzed using reflexive thematic analysis.

RESULTS

Autonomy was the most frequently identified primary bioethical principle (50/102 responses), although students also referred to beneficence, justice, non-maleficence, and relational obligations such as filial duty. Three post-simulation positioning modes were identified: principle-based distancing, contextualized ambivalence, and value-aligned identification. Four themes described students' perceived learning gains: embodied understanding of bioethical principles, movement beyond binary moral judgment, perspective-taking and empathy, and emerging professional identity.

CONCLUSIONS

This study suggests that a low-resource, immersive role-play format may help nursing students engage with bioethical principles in context, consider multiple stakeholder perspectives, and reflect on their future professional responsibilities. The findings support IERS as a feasible complement to didactic ethics teaching, while also indicating the need for longitudinal and comparative research to assess sustained educational impact.