Introduction

Ethical values are the foundations on which people base their actions. They are guides to behavior, usually socially acceptable, and help distinguish between what is right and wrong. Every person has certain ethical principles and acts in a certain way based on them.

A value is the standard or quality of what is worthwhile, and what is desirable. Values can be easily recognized by each of us in our everyday human experiences. They can be spoken about, expressed by behavior, and by the way a person conducts themselves. Values are organized into a certain system and encompass those truths that humans accept and believe in. Each of these values, which have found their place in a person’s value system, has a motivating force and influences their choices. It often happens that people do not know which values influence their choices and decisions. Understanding moral and non-moral, personal, professional, and cultural values helps the nurse to identify the importance of values in daily practice. Moral and non-moral values can easily come into conflict with each other, as well as with the rights of the patient and the professional duties of nurses [1, 2]. All members of the healthcare multidisciplinary team, such as physicians, nurses, and midwives, encounter ethical challenges in their work activities. Having ethical sensitivities is one of the essential requirements for their performance [3]. In this way, high-quality and non-judgmental care without discrimination should be provided to all patients, and respecting human rights and treating individuals, regardless of their position, should be considered as an integral part of the healthcare system [4].

Nursing is a profession rooted in professional ethics and ethical values, and nursing performance is based on such values. Professional ethics includes four main general principles: autonomy, beneficence, non-maleficence, and justice [5]. Teaching these principles to the members of the healthcare multidisciplinary team is one of the requirements of professional ethics [3], and it is expected that nurses are aware of these principles and consider them in their practice [6]. Continuing developments in medical science and modern technology are increasing the complexity of nursing practice, increasingly confronting nursing staff with moral issues [7] and ethical questions that make ethical decision-making in patient care increasingly difficult. The challenges facing modern nursing, and the variety of decisions that nurses have to make, make it important to pay attention to students’ attitudes towards ethical values in the education of future nursing staff. Because of nurses’ role in patient care, they are always faced with circumstances that require them to make ethical decisions. As such, they should be sufficiently prepared to identify and respond to such issues [8].

In clinical decision-making, nurses rely on what they have learned and what they believe to be true. These values, therefore, underpin nursing practice and guide nurses in their interactions with patients, colleagues, members of other professions, and the public [9]. These values act as a guide for the implementation of ethical behaviors in the provision of safe care [10] and are predictors of quality of care, job satisfaction, motivation, organizational attachment, and work engagement [11]. Ethical dilemmas and professional values in nursing influence the quality of nurses’ working lives and play an important role in the emergence or prevention of professional burnout in nurses and in decisions to stay or leave the job or even the profession. Conduct by nursing students and nurses that goes against the ethical values of the profession can threaten the image and identity of the profession [12] and thus reduce the prestige of the profession and public trust.

The aim of this study is to compare the ethical values of nursing students from different countries. This is an important issue because even if knowledge of nursing issues and technical skills are similar in both countries, ethical attitudes may differ. Poland and Turkiye differ in terms of geography, religion, economy, and society, among others.

Poland, situated in Central Europe, has a largely homogeneous population with minimal minorities, shaping its cultural and historical landscape [13]. Conversely, Turkiye spans Europe and Asia, hosting a diverse population that includes Turks, Kurds, and others, establishing it as a cultural crossroads [14]. In Poland, about 87% of the population is Roman Catholic, deeply influencing social norms and values [15]. Turkiye, predominantly Muslim with 99% adhering to Sunni Islam, sees religious practices and values profoundly affecting daily life and ethical perspectives [14]. Poland, classified as a high-income economy by the World Bank, has thrived economically since its 2004 EU accession, boasting a mixed economy with a robust industrial base [16]. Turkiye, an emerging market economy, is an upper-middle-income country with diverse agricultural, industrial, and service sectors, though it faces regional disparities and economic challenges [17]. Polish society highly values family, education, and national identity, emphasizing individual rights and democratic values [18]. Turkish society, valuing family, hospitality, and tradition, blends secular and Islamic norms, fostering strong community and collective responsibility [19]. Poland’s healthcare system is predominantly public, funded by the National Health Fund, offering universal coverage but facing issues like long waiting times and regional access disparities [20]. Turkiye’s mixed healthcare system, improved by the 2003 Health Transformation Program, includes public and private providers, yet struggles with urban-rural access disparities [21].

This short comparative analysis highlights the distinct geographical, religious, economic, societal, cultural, and healthcare characteristics of Poland and Turkiye, crucial for understanding their ethical values.

The core ethical values are generally shared within the global community, and they are a reflection of the human and spiritual approach to the nursing profession. However, the values in the care of patients are affected by cultural, social, economic, and religious conditions dominating the community, making it essential to identify such values in each country [22, 23]. In the era of open borders, ease of movement, and frequent migrations of people from many parts of the world, meetings of different cultures in patient-nurse or nurse-nurse interactions are becoming more and more common. This can cause difficulties in communication, understanding the reasons for making professional decisions, and in teamwork. Therefore, it is important to realize that sometimes decisions and attitudes, while professional, are also culturally conditioned [24, 25].

Methods

A cross-sectional study design was used. The study involved 463 nursing students from the State University of Applied Sciences in Piła, Poland, and Nevşehir Hacı Bektaş Veli University in Nevşehir, Turkiye. After analyzing the collected data for data complementarity, 463 respondents were finally qualified for the study (Table 1). The inclusion criteria were nursing student status and consent to participate in the study. Students’ participation in the survey was voluntary. No incentive was used to encourage participation in the study.

Table 1 Sociodemographic characteristics of the study population
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Procedure of the study

Data collection took place between April and June 2022. Students answered questions at the university. The questionnaires were distributed at the university by a person who did not teach the students in their year. Along with the questions, participants were given information about the procedure and purpose of the survey and the possibility to leave the survey without having to give a reason. The time allowed for answering was 15 min. After data collection, each questionnaire was visually checked for completeness.

Instrument

For the purposes of this study was used The Inclination to Ethical Values Scale (IEVS). The Inclination to Ethical Values Scale (IEVS) was developed by İbrahim Kaya [26]. The IEVS typically comprises several subscales, each focusing on a different dimension of ethical values:

  • Love-Respect: This subscale measures the extent to which individuals demonstrate love and respect for others, regardless of age or status. Items in this subscale assess attitudes towards inclusivity, empathy, and respect for diversity.

  • Justice-Honesty: This subscale evaluates the importance individuals place on justice and honesty in their actions. It includes items that reflect fairness, transparency, and integrity in decision-making and interactions.

  • Cooperation: This subscale assesses the willingness and ability of individuals to work collaboratively with others. Items focus on teamwork, communication, and the ability to engage effectively with colleagues and clients [27].

Scoring and interpretation

The scale includes statements to which respondents indicate their level of agreement or disagreement on a Likert scale, typically ranging from “Strongly Disagree” to “Strongly Agree”. The scale consists of 16 items and is in a 5-point Likert style, with scale items as “1” totally disagree and “5” totally agree. The range of points that can be obtained from the scale is 16–80 points. The scale consists of three sub-dimensions; the first sub-dimension “Love-respect” (1, 2, 3, 4, 5, 6, 7 and 8th items), the second sub-dimension “Justice-honesty” (9, 10, 11, 12 and 13th items) and the third sub-dimension sub-dimension “Collaboration” (items 14, 15 and 16). The Cronbach’s alpha values ​​of the sub-dimensions of the scale were determined as 0.88-0.85-0.73, respectively [26, 27].

  • Mean ± SD (Standard Deviation): Indicates the average score and the variability of responses around the mean. Higher mean scores suggest stronger adherence to ethical values, while higher standard deviations indicate greater variability in responses.

  • Median: Represents the middle value of the dataset, providing an additional measure of central tendency that is less affected by outliers.

  • Min-Max: Shows the range of scores, indicating the spread between the lowest and highest scores.

  • Cronbach’s Alpha: This statistic measures internal consistency reliability. Values above 0.70 are generally considered acceptable, indicating that the items within each subscale reliably measure the same underlying construct.

Statistical analysis

The study data were analysed by SPSS 22.0 software program. In categorical measurements, number (n) and percentage (%) were used, while mean and standard deviation (Mean ± SD) were used in numerical measurements. Independent sample t test were used in the comparison of independent quantitative data. The significance level was taken as p < 0.05.

Ethical considerations

The necessary approval from the Ethics Committee at both universities was obtained before the study was conducted: State University of Applied Sciences in Piła and Nevşehir Hacı Bektaş Veli University. Respondents were informed that they could withdraw from the study without giving any reasons and without any consequences; that their responses would be anonymised by removing any personal information, and would be analysed with other responses to obtain aggregate results; no identifying information would be included in this dataset; and there was no direct personal benefit associated with participation in this study. Consent was also obtained from the heads of departments to conduct the research.

Results

A total of 463 students participated in the survey, including 191 from Poland and 272 from Turkiye. An analysis of respondents’ answers to the IEVS indicates that there are differences between the countries. Both groups generally show high ethical standards, with the majority agreeing or strongly agreeing with the positive ethical statements (Table 2). Core values such as respect (90.08% strongly agree - Polish students, 54.8% strongly agree – Turkish students), fulfilling human requirements (51.54% strongly agree - Polish students, 49.3% strongly agree – Turkish students), trust (63.36% strongly agree - Polish students, 61.0% strongly agree – Turkish students), and honesty (35.16% strongly agree - Polish students, 37.1% strongly agree – Turkish students) are highly rated in both countries. Turkish students show slightly more ambivalence and lower strong agreement on several points compared to Polish students. Areas like impartiality (50.27% strongly agree, 40.84% agree, 6.8% undecided, 2.09% disagree - Polish students, 34.9% strongly agree, 46.3% agree, 15.8% undecided, 1.1% strongly disagree, 1.8% disagree – Turkish students), patience (35.16% strongly agree, 48.16% agree, 12.57% undecided, 1.57% strongly disagree, 2.62% disagree - Polish students, 20.6% strongly agree, 34.2% agree, 32.4% undecided, 3.3% strongly disagree, 1.66% disagree – Turkish students), and enjoying interaction with people (45.56% strongly agree, 45.55% agree, 6.8% undecided, 2.09% disagree - Polish students, 28.3% strongly agree, 48.9% agree, 16.2% undecided, 2.9% strongly disagree, 3.7% disagree – Turkish students) have more varied responses among Turkish students (Table 2).

Table 2 Comparison of Polish and Turkish students’ responses to IEVS questions
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The IEVS total score for all respondents was 68.20, and the median was 68, indicating overall high ethical values among respondents (Table 3). The standard deviation of 8.80 suggests moderate variability in overall ethical values. In the individual subscales:

Table 3 Scores to IEVS
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  • Love-Respect 34.76 (median 35), the standard deviation (4.45) suggests moderate variability in responses; the range shows a wide spread of scores from 8 to 40, indicating diverse attitudes among some respondents;

  • Justice-Honesty 21.29 (median 21), indicating strong justice and honesty values among respondents, a standard deviation of 3.26 indicates less variability compared to Love-Respect, suggesting more uniform responses, the range of 5 to 25 demonstrates some outliers with significantly lower scores, but most respondents scored high;

  • Cooperation 12.14 (median 12), suggesting that respondents generally exhibit high levels of cooperation, the standard deviation (2.11) is relatively low, indicating limited variability and more consistent responses, the range of 3 to 15 shows some lower outliers but a generally high level of cooperation.

Polish students’ total IEVS score average was 70.48 ± 6.81, and Turkish students’ IEVS total score average was 66.61 ± 9.65. Polish students have a higher overall mean score, indicating stronger ethical values across all dimensions: Love-Respect, Justice-Honesty, and Cooperation. The greater standard deviation and range in Turkish students’ total scores suggest more diverse ethical views. It was found that there was a statistically significant difference between the total score average of the IEVS of the students from the two countries (p < 0.001) (Table 4).

Table 4 Comparison of students’ mean scores on IEVS
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Discussion

This study focused on a comparative analysis of the ethical values ​​of students from Poland and Turkiye, two countries with different cultural.

In the available literature, the authors did not find many comparative studies on the ethical values presented by students depending on culture, including place of origin [28,29,30]. So far, in cross-cultural studies, nursing ethics has received little attention, despite the fact that it may have serious implications for health care organizations. The present study may therefore address this gap and show that cultural factors, such as country of origin, can influence nursing students’ views on ethics and thus the delivery of patient care.

The results of the study showed differences in ethical values between nursing students from Poland and Turkiye. Analysis of respondents’ responses indicates that both groups generally demonstrate high ethical standards, with the majority of students agreeing or strongly agreeing with the positive ethical statements. Similar results were obtained by other researchers, showing that well-developed ethical attitudes are present among nursing students [31,32,33,34]. However, when comparing the answers between students from both countries, several differences are noticeable. Polish students show a higher level of agreement with basic ethical values, such as respect (90.08% strongly agree vs. 54.8% among Turkish students), meeting human needs (51.54% vs. 49.3%), trust (63.36% vs. 61.0%), and honesty (35.16% vs. 37.1%). Values such as impartiality, patience, and willingness to interact with people were more diverse among Turkish students, suggesting greater ambivalence and lower levels of strong agreement in these areas. The average IEVS score for all respondents was 68.20, with a median of 68, indicating overall high ethical values. The average scores of Polish students were higher (70.48 ± 6.81) compared to Turkish students (66.61 ± 9.65), which suggests stronger ethical values among Polish students in all analyzed dimensions. The statistically significant difference between the average IEVS scores of students from Poland and Turkey indicates significant differences in the perception and internalization of ethical values in both countries.

The observed differences in results between students from Poland and Turkiye may result from cultural, social, and educational factors. These differences significantly impact the development of young people’s ethical values [35]. In Poland, where there is a strong emphasis on individual rights and democratic values, students may be more inclined to prefer autonomy and personal responsibility in their ethical decisions [36]. However, in Turkiye, traditions and collective norms play an important role, which may make students more likely to consider the good of the community and social responsibility in their actions [37]. Furthermore, social and economic differences may also play an important role. The healthcare systems in Poland and Turkiye may place nursing students in different professional contexts, which may influence their approach to ethical values. Additionally, greater availability of resources and support may promote higher ethical standards among students [38]. Nursing education systems in the two countries may differ in their emphasis on professional ethics and values. Curricula that integrate ethical values into practical scenarios and real clinical situations can more effectively shape students’ ethical attitudes. The results obtained in the study may also reflect differences in teaching methods and approaches to nursing education in both countries. Equipping Polish universities with medical simulation centers and using the simulation method in teaching nursing contributes to a significant improvement in the preparation of graduates for their future professional work [39, 40].

University students, especially nursing students, should possess scientific, human, and ethical values [41]. It is crucial that ethical values underpin their professional behavior, making their effective teaching in nursing education essential. In a study conducted in a clinical setting, it was shown that nurses failed to recognize serious ethical issues in psychiatric treatment and care services [42], while nursing students demonstrated their professional values, ethics, and moral values during their internships in hospitals [43]. Well-structured nursing education is positively related to the assessment of professional values [44]. Therefore, it is important for nursing students to receive effective training in professional ethics during their undergraduate education and to reflect this training in their professional lives. Additionally, training in cultural competence, which includes cultural awareness, sensitivity, respect for human rights, and ethical attitudes toward cultural differences, is also an important aspect of nursing education.

Limitations

Despite the high value of the research presented, it has its limitations. In the study, the primary variable differentiating students was their country of origin. Other factors, such as age, gender, religion, or family status, were not taken into account. These variables can also influence the ethical values presented. However, the authors of this study aimed to start with general formulations. Future research can provide more detailed results to more precisely identify which socio-cultural factors more strongly influence nursing students’ ethical values.

Implications for nursing and health policy

The obtained results should not be used to evaluate students from either country; rather, they should highlight the need to intensify educational efforts in fostering ethical attitudes among nursing students. These findings should be considered when preparing students for interactions with culturally diverse individuals, and should increase awareness that attitudes can change under the influence of one’s cultural background. Additionally, identifying and understanding these cultural differences in ethical attitudes can enhance the quality of patient care. Nurses who are aware of and sensitive to cultural differences can provide more empathetic and effective care, reducing the risk of misunderstandings and conflicts. Moreover, this awareness can improve teamwork and collaboration among nurses from diverse backgrounds, leading to a more harmonious and efficient working environment. Finally, these studies contribute to the broader field of nursing ethics by providing comparative data that can inform global nursing practices. They can highlight the universal aspects of nursing ethics while also acknowledging and respecting the diversity of ethical perspectives shaped by different cultural contexts. This dual understanding can promote a more inclusive and holistic approach to nursing education and practice, ultimately benefiting patients and healthcare systems worldwide.

Conclusions

Students in both countries generally demonstrate high ethical standards. There are noticeable differences between the responses of students from Poland and Turkiye. These differences may be influenced by cultural, social, and educational environments. Poland’s more homogeneous and European Union-influenced context contrasts with Turkiye’s diverse and geopolitically complex environment.

As part of their academic training, students should have the opportunity to practice ethical attitudes and discuss ethical values during all nursing, clinical, or specialty subjects. In this way, the ethical principles instilled, trained, and established will translate into greater understanding and respect for them in professional practice. It is important to continue cross-cultural comparative research on professional ethics to better understand its origins and implications for the ethical values presented among students. Further research can help better understand these differences and support ethics education in both countries.