Introduction

Enhancing the professional competence of students is one of the key objectives of nursing education. Professional competence empowers nurses to carry out their duties efficiently [1]. Evidence shows that ethical competence is one of the dimensions of professional competence in nursing, and ethical codes as a crucial aspect can contribute to the development of ethical competence [2]. Teaching codes of ethics trains nurses to possess professional competence, commitment and responsibility for providing high-quality care. Clear-sighted moral theorists emphasize the role of education in enhancing nurses’ ability to address ethical issues [3].Nursing schools play a vital role in explaining and defining professional competencies. In recent years, a key concern among those involved in nursing education has been reaching a consensus on determining the different competencies of nurses, including the code of ethics. This enables them to train capable students to deliver accurate and safe nursing services to their clients [4]. Therefore, teachers play a crucial role in increasing the capabilities of students in various fields, including the development of professional and ethical competencies [5].

Ethics and moral values play a crucial role in guiding the behavior of nurses in their work and activities. This is particularly evident in the realm of nursing education and educational activities [6]. Ethics can be seen as a systematic body of knowledge that governs the communication and behavior patterns of individuals and organizations, emphasizing the respect for the rights of all parties involved. It contributes significantly to nursing science, knowledge, and education [7].

We tried to produce a guide for development of codes of ethics for nursing students in our society. The code of ethics includes practical-interpretative statements that can be extracted from available documents and guides in each country based on their cultural context. They can provide more specific guidance for nursing students’ practice in the clinical and educational environments in different societies. They represent the commitment of individuals to maintain values and standards in their profession and act ethically. In the nursing profession, codes of ethics reflect a framework of rules and principles that nurses are expected to adhere to [2, 8].

One of the primary concerns in nursing education revolves around enhancing nurses’ ability to apply ethical principles effectively. A guide for professional codes of ethics can serve as a shared framework of goals and values, guiding nurses’ decision-making and ethical performance. The compilation of nursing principles and codes of ethics aims to establish expected standards for nurses’ activities, inform society about these standards, and foster a cohesive professional structure [9]. Therefore, it is essential to equip nurses with the necessary professional competence to navigate ethical challenges and make ethical decisions effectively. Ethical responsibility should be an integral part of the preparation for a professional role in nursing students [10]. Nurse educators play a vital role in educating graduates who are equipped with decision-making skills and can effectively deal with daily ethical challenges [11]. Nursing instructors play a vital role in nurses’ education, enhancing students’ capabilities in various areas such as self-esteem and the use of learning opportunities. The greater the involvement of instructors as meta-cognitive guides in teaching ethics, the stronger the ethical reasoning and decision-making abilities of nursing students. Nursing instructors have a significant impact on shaping the ethical values of their students [12]. Raising awareness of professional code of ethics among nursing educators and their nursing students is important for preparing them to deliver patient care in an ethical and professional manner [13].

A review of the literature demonstrates that education programs have proven effective in facilitating the development of ethical judgment in nursing students [14]. Furthermore, emphasis should be placed on teaching and developing codes of ethics to reflect the realities of modern healthcare. Integrating these codes into nursing education will ensure that they become an integral part of the nursing profession and practice [15].

Evidence shows that specific ethical codes and guidelines for nursing students have been developed in other countries based on their cultural backgrounds [16, 17]. Most of the available studies in Iran indicate the importance of paying attention to the ethical competence and the professional ethics of nurses, and their results have been the compilation of nursing ethical guidelines, patient rights charters, and the compilation of Iranian nursing ethics [2, 5]. In addition, while there are clear guidelines about the codes of ethics for Iranian nurses and the ethical charter of patients in the country [8], there are only a number of qualitative studies in the field of nursing students’ ethics [18]. Thus, there is still a need to formulate a specific guideline as code of ethics for nursing students in order to practice in the clinical and educational environments in our country.

Authors in this study have recognized the importance of conducting a comprehensive meta-synthesis study to explore the experiences of Iranian nursing students and faculty members regarding the various aspects of code of ethics for nursing students in educational and clinical settings. Given the potential impact of cultural factors as well as educational and clinical settings on ethical competencies, we decided to conduct a systematic review and meta-synthesis in this area. Such a study brings together the results of previous qualitative studies to form a new interpretation of the codes of ethics for Iranian nursing students within the context of nursing education. Thus, this study aimed to explore a guide for development of the code of ethics in nursing students that contribute to improve their professional ethical competence in the clinical and educational environments in our society.

Methods

Design

This study is a systematic review and meta-synthesis of qualitative studies focusing on a guide for development of codes of ethics in Iranian nursing students. The review included studies published in both the national and international databases from January 1, 2000 to the end of March 2024. This study followed a six-steps meta-synthesis strategy developed by Sandelowski and Barroso [19], which is widely recognized as a highly effective approach for synthesizing qualitative research. The six steps of the meta-synthesis strategy include: conceiving the qualitative synthesis study, searching and retrieving literature, classifying the findings from qualitative reports, synthesizing qualitative findings into meta-summaries, and synthesizing qualitative research findings into meta-synthesis [19].

Step 1: conceiving the qualitative synthesis study

In the first step, the research team was formed, and a clear research question was formulated to guide the study and ensure alignment with the research aim [20]. The research question was: “What are the key components of the code of ethics for nursing students in educational and clinical settings to achieve professional ethical competence, based on the experiences of nursing students and their teachers in nursing schools?”

Step 2: Searching and retrieving literature

In the second step, a comprehensive search was conducted to retrieve relevant literature for the systematic review of qualitative studies on the topic of code of ethics in nursing students. Various databases were searched using a combination of essential keywords, including nursing students, faculty members, professional ethics, codes of ethics, professional competence, and ethical competence. The search strategy was organized using the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) [20], (Table 1).

Table 1 Application of the SPIDER tool to define the review questions and organize the search strategy
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The search was conducted in both international and national scientific databases, including Web of Science, PubMed, Embase, PsycINFO, Cochrane Library, CINAHL and Scopus. Additionally, national databases such as Barakatns, MagIran and SID (Scientific Information Database of Academic Center for Education, Culture and Research) were searched. Furthermore, grey literature was searched using Google Scholar. The search strategy employed the following keywords and phrases:

  1. 1.

    ((“students, nursing“AND (“ethics, professional“OR”Codes of Ethics“)) OR ”competency-based education/ethics“OR”education, nursing/ethics“) AND (“qualitati ve research“ AND (“value“) AND (“Iran”)).

  2. 2.

    (“Students, nursing“AND”Codes of Ethics“)) OR”Competency-Based Education/ethics“)) OR”Education, Nursing/ethics“) AND”Qualitative Research”) AND (“Iran”))

  3. 3.

    (“Students, nursing “) AND”Codes of Ethics“) AND”Teacher Training“) AND”Competency-Based Education/ethics“) AND ”Qualitative Research“) AND ”Iran.”

Step 3: study inclusion and exclusion criteria

The inclusion criteria of the study were as follows: original qualitative studies with accessible full text articles in English or Persian language, studies conducted between January 2000 and March 2024 that focused on the experiences, opinions, views, and impressions of nursing students and/or their teachers regarding the code of ethics for nursing students, studies that provided a comprehensive report of their finding, excluding conference abstracts or letters to the editor. Considering that the initiatives related to nursing students’ ethics began in the early 2000s in our society [3, 21], the database search was conducted starting from January 2000. Furthermore, due to the limited number of studies available, we decided to use mixed sample groups with nursing students too.

The process of study selection followed the PRISMA-2009 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-2009) guideline [22] (Fig. 1). Additionally, the search results were exported into the Endnote™ version 21, where duplicates were removed and the findings from databases and grey literature were merged.

Step 4: classifying the findings in qualitative reports

In step 4, a data extraction form was prepared by the research team based on the objectives of the study, and the necessary information were extracted. Two authors (ISH, ZKH) independently extracted and recorded the information in the data collection form, including the name of the first author, year of publication, study location, aim of the study, study type, sample size and main results.

Step 5: Study Quality Assessment

In step 5, the reports of the included studies were appraised for quality and validity. Two authors independently assessed the studies using the Critical Appraisal Skills Program (CASP) checklist, which consists of 10 questions specifically designed to evaluate the quality of qualitative research [23]. We used the modified version (modified LOW critical appraisal criteria, The Critical Appraisal Skills Program - CASP) [24]. The CASP is a non-scoring tool that is not recommended by the CASP organizing committee. However, the checklist covers various aspects of the study, including study objectives, participant selection process, data collection, data analysis, the researchers’ roles in the results, and ethical considerations. Each question was answered with “yes”, “no”, or “cannot be said” (Supplementary Table 1).

Step 6: data synthesis and presentation

In step 6, two authors (I.S and J.F) independently extracted all the codes from the included studies. Subsequently, these codes were analyzed according to Thomas and Harden’s method in 2008 [25]. This approach is widely used for analyzing qualitative studies and includes three phases. In the first phase, all the codes from the studies were examined and categorized based on their meaning and content. The codes were created without establishing a hierarchical structure, using a line-by-line procedure [26]. In the second phase, the authors identified similarities and differences between the codes and generated new codes based on these similarities to form final themes. This phase involved grouping similar codes together to facilitate the extraction of themes that closely aligned with the findings of the studies. In the third phase, thematic analysis was performed based on the authors’ insight and judgment [27]. The final themes were extracted by reviewing the content of the studies. In cases where there was disagreement between the two authors, a third author facilitated a discussion to reach a consensus.

In the sixth step, the trustworthiness of the findings was evaluated using the peer evaluation method to keep the internal homogeneity and external heterogeneity of data analysis [28]. The coding, classification, and determination of data categories were discussed within the research team. To ensure accuracy and reliability, they were also reviewed by two external referees [26], both with experience in qualitative studies and meta-synthesis, and holding doctoral degrees in nursing. Additionally, the research team reviewed the entire research, including the process of meta-synthesis, to ensure that the research steps were carried out in accordance with the scientific process. This review process aimed to minimize potential biases and ensure the integrity of the research. Furthermore, collaborative working and group reflexivity were employed to enhance the quality and rigor of the study.

Results

A total of 86 qualitative studies were initially included in the study based on the search results. After screening and removing duplicates, 39 studies remained for evaluation. Out of these, 29 studies that did not meet the specified criteria were excluded. Finally, the full texts of 10 studies were selected and thoroughly analyzed. Figure 1 depicts the process of study selection based on the PRISMA 2009 guideline.

Fig. 1
figure 1

The process of study selection according to the PRISMA (2009)

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Table 2 presents the characteristics of the 10 selected studies. These studies involved 261 participants, with ranging from 8 to 50. participants include 254 students and 7 teachers (nursing students = 247 and midwifery students = 7).

The data collection methods varied, with eight studies utilizing semi-structured interviews and two studies [3,4,5, 12, 29,30,31,32] applying focus groups. All of the studies used content analysis method as their qualitative method for study design [18, 31].

Table 2 Characteristics of the 10 selected qualitative studies on codes of ethics in Iranian nursing students
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According to the analysis of the selected qualitative studies, 74 codes were identified. These codes were then carefully compared, classified, and integrated to determine the most important elements of the codes of ethics for the ethical competence of nursing students. Overall, four main themes and 10 categories, along with summarized codes and examples of interview quotations, were extracted (Table 3). Additionally, Fig. 2 illustrates the main themes and categories.

Fig. 2
figure 2

Diagram of the Meta-Synthesis findings, containing four main themes in the middle and 10 categories around

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Main themes

The analyses revealed a guide for codes of ethics for development of the ethical competence of Iranian nursing students in clinical and educational settings. It includes four main themes that indicate components of Knowledge, Standards, Experiences, and Attitudes.

Theme 1: knowledge

Knowledge consisted of six categories. Among these categories, the relationship between nurses and education emerged as one of the most challenging themes. The majority of participants acknowledged the crucial role of nursing education in forming codes of ethics. There were no differences between nursing student and nurse educator participants [12, 31, 33]. This theme encompassed six categories of education, including the use of appropriate or inappropriate teaching methods for ethics instruction [30], the facilitation of ethics learning [12], the failure to provide patients with sufficient and accurate information and knowledge [30], the impact of professional role models [12, 18], and the curriculum [29, 33].

Regarding the curriculum [29], nursing students expressed agreement on its inadequacy and lack of comprehensive content [29, 33]. Additionally, the influence of effective professional role models [12, 18] was highlighted as another important category in the field of nursing education, which significantly affected the practical education of professional ethics.

Theme 2: standards

Standards consisted of five categories. Participants’ experiences highlighted the role of nurses and their professional commitments in the codes of ethics and the professional competence of nursing students. These categories include:

  1. 1.

    Educational justice [4, 29]: emphasizing the importance of fairness in education.

  2. 2.

    Promotion of competence [4]: encompassing the ethical, cultural, spiritual, technical, and religious competencies of nursing.

  3. 3.

    Scientific competence of professors and students [18, 29]: highlighting the necessary knowledge and skills that nursing students and professors must possess in order to be recognized as competent individuals.

  4. 4.

    Commitment and accountability [4, 12]: identifying the nursing profession and taking responsibility for one’s actions. Participants highlighted the importance of commitment to implementing the curriculum and educational goals as a key aspect of nursing professionalism.

Furthermore, the implementation of control measures emerged as an important category within the theme of nurses and professional competence. This category contributed to standardizing nursing practice [31]. Participants highlighted that while laws and regulations alone may not be sufficient, the enforcement of these measures can help foster individuals with a strong sense of adherence to the law and professional competence.

Theme 3: experiences

Experiences consisted of five categories. Nurses’ diverse and complex professional roles, their interactions with clients, and other healthcare professionals often give rise to ethical challenges. Participants in the study identified the importance of skills, experience, and effective communication as key elements of codes of ethics [33].

Among the various categories discussed, mutual understanding emerged as a significant theme [31]. Nursing students recognized mutual understanding as a crucial ethical value that necessitated effective communication with at least one other person. Another category highlighted was interpersonal interactions [18], which encompassed the establishment of constructive relationships with patients, their families, and other members of the healthcare team. Some articles referred to this category as “constructive human relations” [4]. Furthermore, unethical behaviors or practices [31] were identified as another important category in the context of nurses and society.

Theme 4: attitudes

Attitudes consisted of five categories. Nursing, unlike other healthcare professions, holds a unique position due to its inherent ethical nature. Neglecting this aspect can significantly affect the effectiveness of nurses in providing patient care, leading to a significant gap [34]. This theme encompassed the following categories:

  1. 1.

    Personal characteristics and beliefs [33] or personal motivations and tendencies [18, 33]: This category focuses on defining the personal characteristics of nursing students. It highlights the participants’ recognition of spiritual foundations and religious beliefs as essential elements of codes of ethics and professional attitudes.

  2. 2.

    Ability to think critically and make decision [12, 32]: This category holds immense importance in fostering students’ creativity, decision-making skills, and ethical competence. It can be considered a central aspect of professional attitude and ethical competence.

  3. 3.

    Interest: According to nursing students and professors in the selected research [29, 33], the two main areas of focus within this category were patient-centeredness and dedication to the nursing profession.

  4. 4.

    Human dignity [4, 32]: This category emphasized the significance of adopting a holistic approach to patient care.

  5. 5.

    Wisdom [4, 12]: This category encompassed subcategories of theology, self-knowledge, and cognition [32]. It represents the culmination of ethical values and codes in nursing professional competence.

Table 3 The results of qualitative synthesis, including main themes, categories, summarized codes and examples of interview quotations
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Discussion

This study aimed to explore the code of ethics that contribute to the professional competence of Iranian nursing students in clinical and educational settings. The findings of this study revealed that the codes of ethics were categorized in the four major areas: Knowledge, Standards, Experiences and Attitudes.

Knowledge

A close examination of the themes and their categories indicates six categories in the area of knowledge, including: “training,” “different teaching methods,” “facilitation of creative learning,” “failure to provide sufficient information to patients,” “effective professional role model,” and “curriculum weakness and lack of alignment with social needs.” The absence of a specific framework and educational process leads to a lack of transparent and structured content related to professional ethics education. This issue has been highlighted in previous studies as well. Enhancing students’ knowledge and awareness of professional ethics and its theoretical foundations is a fundamental step towards improving professionalism [35]. Zanjani et al. (2014) emphasized the importance of a targeted training program in practice to ensure the effectiveness of professional ethics education [36].

One significant consequence of employing different teaching methods for students is the enhancement of their capacity to make autonomous ethical decisions. Instructors, through the use of diverse teaching methods, help creation of this capability [12]. Considering that the nature of nursing work is patient care, it is crucial to employ teaching methods that promote both theoretical knowledge and technical skills in students. Relying solely on experiential learning implies learning from mistakes.

In this study, nursing students identified a lack of sufficient and correct information provided to patients [30]. Previous research emphasizes that doctors and nurses often believe they can make decisions on behalf of patients in the best way, without feeling the need to explain or seek their opinions [37]. The qualitative research conducted by Mohamadkhani et.al. also highlighted the importance of the ”Charter of patient’s rights” in addressing patient’s informational needs [38]. Furthermore, the presence of effective professional role models can significantly influence students’ adherence to professional ethics [35]. Many students, who are future healthcare professionals, expressed dissatisfaction with the curriculum’s inadequate coverage of ethics and the challenges associated with professional ethics. They emphasized the need for greater attention to both theoretical and practical aspects of professional ethics [39, 40].

Standards

Five categories were identified in the area of standards: “educational justice”, “competency promotion in cultural, spiritual, and technical aspects,” “academic competencies of faculty members and students,” “commitment and accountability,” and “internal and external controls.” To contribute to a global future nursing workforce equipped with professional competence in providing safe and high-quality care, it is important to measure and evaluate nursing students’ progress and achievements towards professional competence goals and requirements [41]. Recognizing its significance, nurse managers face the primary challenge of enhancing the level of professional competence among both nurses and nursing students [42].

Based on the participants’ experiences in these studies, educational justice emerged as a key aspect that underscored ethical values in nursing education. Justice serves as the fundamental principle for ethics education in nursing and it can consider one of the core values of nursing because the nurses and the nursing students identified it as one of the most important values. Moreover, this value is associated with patient care and the nurse-patient relationships in clinical settings, which are the focus of the ethical codes for nurses [43].

Another significant category that emerged from this study was the promotion of competence. Competence is a multifaceted and ambiguous concept within the healthcare field [4]. One aspect of this category that participants emphasized greatly was the cultural-religious aspect [44]. Many students expressed their concern about being understood by their instructors and professors. They highlighted the significance of role models who exhibit positive personality traits and demonstrate effective methods of interacting with patients, particularly in light of culturally diverse backgrounds of students in universities [34]. The presence of foreign and minority students in Iran’s higher education system highlights the need for an intercultural perspective to address such cultural diversity, emphasizing the importance of religious competence alongside cultural competence [44]. Several studies [45] have highlighted the values of active listening, commitment to problem-solving, and effective curriculum implementation, which demonstrate a sense of commitment and accountability. It is crucial to note that professional commitment directly affects the manner and quality of nursing profession [46].

One interesting finding of this study is that the nursing students generally consider the instructors’ competence as interrelated. Therefore, promotion of professional ethical competence requires that nurse instructors possess necessary nursing knowledge [47]. Monroe et al. argue that while the model-centered role of instructors is important for creating ethical attitudes among nursing students, it is equally important for instructors to prepare students from a philosophical viewpoint and enhance their knowledge of ethics [48]. Also, it is important to be aware that a person cannot be ethically competent without practical expertise [49]. Furthermore, nursing instructors play a vital role in shaping the ethical values of their students through their responsibilities. They have the ability to enhance students’ skills in different areas, such as ethical competence and the use of learning opportunities [13].

In this study, nursing students believed that both internal and external controls played a significant role in enhancing ethical sensitivity. External controls are referred to as laws, while internal controls are associated with one’s conscience [33]. As nursing involves the collaboration of numerous individuals, external controls hold great importance. However, an individual’s conscience, or internal control, can compensate for any shortcomings in external controls [50].

Experiences

The area of experiences included four categories: “establishment of humanistic and effective communications,” “interpersonal interaction,” “mutual understanding,” “experience of unethical behaviors or practices.” The effectiveness of clinical experiences in the healthcare settings significantly influences the success of ethical actions and decisions in nursing. In this research, participants identified the importance of proper human communication as one of the most crucial ethical values in nursing. They also stressed the need to establish a close relationship with patients and dedicate time to ethical care [51].

Mutual understanding emerged as another key finding in this study, leading to the development of various codes. According to the participants, establishing an ethical and efficient relationship between nurses and clients or patients requires understanding from both sides. Weaver and Morse (2006) emphasized the significance of mutual respect in fostering and sustaining ethical competence [52].

Interactions with peers, healthcare personnel, nurses, and patients are additional factors that influence the development of professional ethics in students. Studies have highlighted the crucial role of interpersonal relationships in ethical competence and development [53]. Weakness in interpersonal communication has been identified as an obstacle to the development of professional ethics in students [54].

The role and performance of teachers have been recognized as influential factors in fostering professional competence. Teachers should serve as role models and possess theoretical knowledge in the field of ethics and professionalism, which can aid in the development of professional ethics in students. Yeom et al. (2017) also suggested that modeling training was more effective in ethical education than theoretical methods and lectures [55].

Another important category in our results was the experience of unethical behaviors or practices. Nursing aims to help vulnerable people, and caring is seen as an entirely moral action [56]. Engaging in immoral acts would impose additional harm on vulnerable individuals. Since immoral acts cause distress for nurses, they try to avoid such actions [57].

Goli et al. (2020) observed that in the absence of sufficient education and information, experience played a significant role in cultivating ethical and professional competence [58]. It is important to recognize that experiences come at a high cost to patients, nurses, and healthcare systems. Therefore, they should undoubtedly be considered as key factors in the development of ethical competence and sensitivity. All aspects of experience should be thoroughly examined and understood [59].

Attitudes

The area of attitudes included five categories: “personal characteristics and beliefs,” “ability to think critically and make decisions,” “interest,” “human dignity,” and “wisdom.” The impact of professional attitudes on job satisfaction and the improvement of professional performance is highly noticeable among nursing students and nurses. These values give meaning to life, and possessing such characteristics aligns well with Iranian culture [12]. Nursing experts also assert that ethical performance is closely linked to individuals’ personality traits [33]. Considering the significant role of belief and religion in Iranian society, this research also took into account students’ adherence to religious principles. Many of the chosen articles suggested that students who had a stronger inclination towards spirituality tended to demonstrate more spiritual aspects in their work [4, 18, 33].

The ability to think critically and make decisions is crucial in fostering creativity and ethical competence. In essence, it can be considered a central aspect of ethics and professional competence [33]. The appropriate performance of nurses, tailored to specific contexts and circumstances, primarily relies on their ethical reasoning abilities. Ethical reasoning is a significant criterion for professional competence [58]. White et al. (2021) argued that students frequently encountered patients with complex problems and challenges, necessitating the ability to analyze situations and make well-reasoned judgments [60]. Studies have shown that students recognize the importance of reasoning and decision-making not only in ethical issues but also across various aspects of nursing profession. Every decision made by a student in different situations carries a unique ethical nature [61, 62].

The students in this research expressed interest in two main areas: the patient and the nursing profession. They believed that these factors shaped the sensitivity and professional competence of nurses. Showing interest in the patient prevents nurses from easily overlooking their problems and encourages them to address all concerns and problems holistically to find solutions [33]. This finding aligns with a study (2018) that explored the correlation between nurses’ internal beliefs and their corresponding actions [63].

The participants highlighted the significance of human dignity as a crucial ethical value. According to Combrinck et al. (2020), human dignity is a complex and multifaceted concept. The first aspect pertains to the dignity of patients, which is considered an inherent value in healthcare and is particularly relevant to the work of nurses. The second aspect, known as professional dignity of nursing, is less defined and remains uncertain [64].

Based on the participants’ experiences, wisdom emerged as one of the categories associated with ethical competence in nursing. Wisdom is considered a goal of intellectual development, achievable through knowledge, critical thinking skills, creative problem-solving, and philanthropy [60]. Promoting wisdom and incorporating it as a core value in nursing education can offer a unique perspective in curriculum development and address the challenges faced by nurses in the 21st century [65].

One limitation of this study was the scarcity and the scattered nature of studies on ethical codes of nursing students in our healthcare system. It is important to note that becoming a nurse involves more than just acquiring knowledge and practical skills; it also entails specific professional and ethical values that bring about fundamental changes in the attitudes and professional position of nurses [29].

Conclusions

A guide for development of codes of ethics in Iranian nursing students was found. It can assist to improve ethical competency of nursing students in the clinical and educational settings. Our results showed this is a multidimensional concept with four major areas: Knowledge, Experiences, Standards, and Attitudes. Further exploration involving diverse groups can yield practical applications for educational departments, management, and clinical environments, ultimately enhancing the moral competence of nurses. This systematic review and meta-synthesis were conducted to provide an updated and objective guide for nursing policy- and decision-makers in clinical settings, nursing schools and the Ministry of Health and Medical Education.The results can play a significant role in enhancing the professional ethics of nursing students and provide valuable insights for those responsible for the nursing education system. The application of this guide in collaborative programs between nursing schools can be beneficial, and it is the responsibility of the nursing schools together with the Ministry of Health and Medical Education to approve, develop, and implement this guide for codes of ethics. Additionally, these guide for codes can serve as the basis for creating an effective evaluation tool to assess the ethical competencies of nursing students in Iran and/or other countries with similar education and healthcare systems.