The mediating effect of nursing professional values on the relationship between ethical values and ethical decision-making confidence in nursing students approaching graduation

Purpose: To explore the relationships and pathways among ethical decision-making confidence and its influencing factors in nursing students approaching graduation and preparing to transition into clinical practice.Methods: A descriptive cross-sectional study was conducted. Data were collected through a structured online questionnaire administered from November 3 to December 15, 2025. The data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA with Scheffé post-hoc tests, and Pearson’s correlation coefficients. We performed mediation analysis using the PROCESS Macro program Model 4 with bootstrapping and 95% confidence intervals (CI).Results: Ethical values significantly influenced nursing professional values (β =.46, <i>p</i><.001), and the latter had a significant effect on ethical decision-making confidence (β=.30, <i>p</i><.001). A statistically significant direct and total effect of ethical values on ethical decision-making confidence (β=.26, <i>p</i>=.001 and β=.40, <i>p</i><.001, respectively) was observed. The indirect effect of ethical values on ethical decision-making confidence mediated by nursing professional values was also significant (β=.07, 95% CI=0.03~0.12).Conclusion: To enhance nursing students’ ethical decision-making confidence, individual strategies should focus on fostering ethical values and internalizing nursing professional values. More importantly, an integrated educational approach that combines these elements is essential. Given that both ethical and nursing professional values differed by satisfaction with clinical practice, ethics education that is integrated into the clinical practicum context needs to be designed and implemented.