Abstract:

Objective To investigate the current status of ethical decision-making ability among undergraduate nursing students in Macao and explore its influencing factors. Methods A cross-sectional study design was adopted. From December 2025 to February 2026，113 fulltime undergraduate nursing students（years 2 to 4） at two higher education institutions in Macao were selected as the participants using quota sampling. An anonymous questionnaire survey was conducted using a self-made general information questionnaire and the locally adapted Ethical Decision-making Ability Scale. Results A total of 103 valid questionnaires were recovered. The total score of ethical decision-making competency among 103 nursing undergraduates was（117.96±8.08），with a Percentage of Maximum Possible（POMP） score of 80.3%. Each dimension was ranked in descending order of POMP value：ethical behavior（84.4%），ethical intention（83.3%），ethical judgment（79.2%），ethical sensitivity（75.0%）. Multiple linear regression analysis showed that language ability，frequency of cross-cultural experience，and cultural-background diversity were positively associated with ethical decision-making ability（all P<0.05），jointly explaining 31.0% of the variance. Conclusion The ethical decision-making ability among undergraduate nursing students in Macao is at a relatively high level；however，ethical judgment and sensitivity are comparatively weaker. Cross-cultural factors are important correlates of ethical decision-making ability. It is recommended that schools and clinical teaching bases construct a differentiated ethical education system that integrates multicultural contexts and language communication training，with a focus on strengthening the cultivation of ethical sensitivity and judgment dimensions.

Key words: Students, Nursing, Ethics, Nursing, Decision Making, Transcultural Nursing, Macao