Culture is learned behavior, including ways of seeing and thinking, shared by members of a group and from generation to generation within that group. This basic definition is widely reflected in medicine, nursing and other health professions [NCI Dictionary of Cancer Terms, Accessed November 24, 2022]. Cognitive neuroscience research suggests that humans are programmed to create culture because our brains have evolved to foster social understanding and group cooperation [Kolbert, 2017]. Culture connects people to each other in ways that include shared values, beliefs and practices about disease and health [Berlinger & Berlinger, 2017]. It has a profound impact on how ethical decisions are made in critical medical situations. What is considered right or wrong in a healthcare setting can depend on the socio-cultural context [Khattopadhyay & Sımon, 2008].
The rapidly evolving multicultural world requires medical personnel, including nurses, to understand the diversity of cultures in order to make appropriate ethical decisions and work effectively with people who hold different values, beliefs and ideas about health, care, illness, death and disability [Berestova et al., 2019].
Global ethics calls upon the discipline of nursing to critically evaluate personal and culture-based beliefs to nurture professionalism in relationships and improve health disparities [Milton, 2015]. Ethical decision-making principles in health care are aimed at preserving and protecting human life and health in the perinatal and postnatal periods, preventing disease, restoring health and reducing suffering from incurable illness and death [Goloff & Moore, 2019]. There is a direct correlation between the level of competence of medical professionals and their ability to provide culturally sensitive medical services [Mınkoff, 2014]. Nursing staff must have the skills to resolve ethical dilemmas. Above all, they must be able to communicate effectively and understand the unique cultural values and beliefs of each client/patient, respecting cultural differences and making decisions that thoughtfully and effectively meet the needs of each client/patient. The literature emphasizes the importance of assessing the ethical value propensity of health care professionals, who have an important responsibility for human health [Shafakhah et al., 2018].
The results obtained in the course of the present study may suggest that cultural factors influence students' ethical attitudes. Despite the fairly high total scores on the IEVS, differences are seen between the responses of students from Turkiye and Poland. Students from Poland scored 4 points higher overall and their responses were more homogeneous than those of students from Turkiye.
In the available literature, the authors did not find comparative studies on students' ethical attitudes depending on culture or religion. So far, in cross-cultural studies, medical ethics has received little attention, despite the fact that it may have serious implications for health care organizations. The present study may therefore inscribe this gap and show that cultural factors, such as country of origin, can influence nursing students' views toward ethics and thus the delivery of patient care.
In the study presented, it was found that nursing students scored quite high on the IEVS and its sub-dimensions: love, justice and cooperation. This indicates that nursing students attach importance to ethical values. Similar results were reached by other researchers who assessed the attitudes of medical staff and medical students in Turkey [Menekli et al, 2021; Yidirim et al, 2020; Kırca et al, 2020]. Studies on the general ethical attitudes of Polish nursing students do not exist. To date, they have been based, for example, on assessing knowledge of the Code of Ethics for Nursing and Midwifery [Nawalana et al, 2014] and attitudes toward specific social groups [Dobrowolska et al, 2019; Lesińska-Sawicka, 2022].
University students should have scientific, human and ethical values [Erdem, 2003] and especially nursing students. It is important that ethical values be the source of their professional behavior. In this context, it is important that they are effectively taught in nursing education. 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 [Aydin & Ersoy, 2017] while nursing students demonstrated their professional values, ethics and moral values in actions during their internships in hospitals [Rose et al., 2017]. Well-run nursing education is positively related to the assessment of professional values [Kantek et al., 2017]. In this context, it was important for nursing students to receive effective training in professional ethics during their undergraduate education and to reflect this training in their professional lives.
In addition, training in cultural competence, related to cultural awareness, sensitivity, respect for human rights and ethical attitudes toward cultural differences, among others, is also an important aspect of teaching.
Limitations
Despite the high value of the research presented, it has its limitations.
In the study, the variable that differentiated students was their country of origin. Other factors such as, for example, age, gender, religion or family status were not taken into account. These variables can also affect ethical attitudes but the authors of this study wanted to start with general formulations. Certainly, the research can be continued to provide more detailed results to more likely indicate which socio-cultural factors are more important in shaping nursing students' ethical attitudes.
Implications For Nursing And Health Policy
The results obtained should not value students from both countries; rather, they should be an indication of the need to intensify educational efforts in the formation of ethical attitudes among nursing students. The results should be taken into account when preparing students for encounters with culturally different people, and should raise awareness that attitudes can change under the influence of the culture from which a person comes.