Effect of Self-Regulated Learning by Nursing Students on Ethical Problems in Clinical Teaching

Effect of Self-Regulated Learning by Nursing Students on Ethical Problems in Clinical Teaching | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Self-Regulated Learning by Nursing Students on Ethical Problems in Clinical Teaching Ramazan Bozkurt, Ozlem Dogu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5898417/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The clinical education process, which is essential for nursing education, must be carried out by contributing to students' ethical values and self-regulated learning situations. Aim The study was conducted to evaluate the relationship between self-regulated learning situations and the ethical problems experienced by nursing students in clinical teaching and to determine their views. Methods This study used a mixed-method design with 371 nursing students. Data were collected using the Socio-Demographic Data Form, the Self-Regulated Learning Scale in Clinical Nursing Practice, and The Scale of Ethical Problems in Clinical Teaching in Nursing. The qualitative part was completed with 67 students who reported ethical issues. Results There was a weak, positive, and significant relationship between self-regulated learning in clinical practice and ethical problems in clinical teaching. Qualitative data were analyzed in two themes: "Team members with ethical problems" and "Ethical violation principles". Conclusions It was determined that nursing students experienced fewer ethical problems in clinical teaching as their self-regulated learning level increased. They also reported ethical problems within the team and that the most common violations were patient autonomy and respect for the individual. ethics self-regulate principle nursing student clinical teaching mixed methods Figures Figure 1 Figure 2 Figure 3 1. INTRODUCTION Self-regulated learning (SRL) is a mental information process in which learners are supported to control their behavior, understand all aspects of learning, and maintain their learning processes (Dogu et al., 2022 ). SRL refers to students' ability to identify learning needs, set goals, manage resources, and self-assess (Ding & Zhu, 2018 ). In this direction, self-regulated learners can be defined as active individuals who effectively manage their learning by observing themselves and generally as those who can use learning strategies (Kurt & Eskimez, 2022 ). SRL develops students' ability to control or manage their learning environment and processes responsibly and with the belief that tasks will be accomplished (Hwang & Oh, 2021 ). Clinical learning enables students to use their knowledge in the natural environment and develop their psychomotor skills and professional socialization (Ünsal et al., 2013 ). Clinical learning has been defined as the place where nursing students move from theory to practice. However, although it is complementary and one of the most critical components of nursing education (Ünsal et al., 2013 ), it can be affected by many factors, as it occurs in a complex and social environment (Akın Korhan et al., 2018 ). One of these factors is ethical problems that can be experienced through unprofessional attitudes and behaviours. The clinical learning processes of nursing students who experience this situation may be adversely affected (Ünsal et al., 2013 ; Akın Korhan et al., 2018 ). Addressing ethical issues is essential for nursing education (Bremer & Holmberg, 2020 ). One major goal of nursing education is to develop nursing students' professional values, develop critical thinking and decision-making abilities, and help them perform ethical behaviours (Ding & Zhu, 2018 ). SRL is used more when necessary, and support is provided for students' critical thinking and decision-making abilities in the clinic (Şenol, 2018 ). Furthermore, students who demonstrate self-regulated learning (SRL) abilities tend to invest greater effort in attaining knowledge and competencies, as well as in managing their learning processes and exercising initiative (Dogu et al., 2022 ). Similarly, SRL has revealed that students increase their professional competence and skills (Şenol, 2018 ). It is essential to test the relationship between nursing students' use of SRL in clinical practice and their state of ethical problems. Based on this importance, the research findings and results are expected to raise awareness and contribute to the ability to understand the effects of nursing education programs on the development level of these skills. However, there are limited studies in this field in China. This research is also considered necessary in terms of contributing to eliminating this deficiency. 1.1. Aim and research questions The study was conducted to evaluate the relationship between self-regulated learning situations and the ethical problems experienced by nursing students in clinical teaching and to determine their views. The conceptual framework of the research is given in Fig. 1 . Research questions: Q1: What are the Self-Regulated Learning Scale in Clinical Nursing Practice (SRLS-CNP) and the Scale of Ethical Problems in Clinical Teaching in Nursing (SEPCTN) levels of nursing students? Q2: What is the level of relationship between SRLS-CNP and SEPCTN? Q3: What ethical problems are experienced by nursing students? Q4: Do nursing students' self-regulated learning and experience of ethical problems in clinical teaching affect their experience with ethical problems? 2. METHODS 2.1. Design The design was a mixed method. 2.2. Settings and participants The study population comprised 371 students enrolled in the first, second, third, and fourth grades of the Nursing Department of a university in the northwestern region of Turkey during the spring semester of the 2022–2023 academic year. A power analysis was conducted via the G*Power 3.1.9.7 program with a margin of error of 0.5, an α value of 0.05, and an 80% effect size, resulting in a minimum required sample size of 289. Considering the potential for data loss, a larger number of students were initially contacted, and the study was ultimately completed with 371 participants. Systematic random sampling was employed as the sampling method. The inclusion rate for the study was 85.2%. The qualitative phase was completed by analysing the detailed responses of 67 students who reported experiencing ethical problems. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. 2.3. Instruments The sociodemographic data form consists of a total of 13 items based on previous studies (Akın Korhan et al., 2018 ; Kurt & Eskimez, 2022 ; Dogu et al., 2022 ). The general features include questions about ethical experience, gender, age, nationality, and educational characteristics. One open-ended question, “If you have experienced ethical problems, please explain,” asked the students to explain the ethical problems they had experienced. The Self-Regulated Learning Scale in Clinical Nursing Practice (SRLS-CNP) was developed by Iyama and Maeda (2017) for the purpose of evaluating the self-regulated learning levels of nursing students engaged in clinical practice. The scale, which was adapted to Turkish by Şenol ( 2018 ), consists of 16 items and two dimensions. The motivation subdimension is composed of two factors. The subdimensions of Internal Motivation and Success Motivation comprise the first dimension of the scale. The Learning Strategies subdimension comprises three elements: synthesized knowledge, international mindfulness, and effort control (Şenol, 2018 ). The score obtained from the five-point Likert scale ranges from 16 to 80 points. As the score from the scale increases, the student's use of the self-regulated learning approach also increases (Iyama & Maeda, 2018 ). In this study, the Cronbach's alpha values were α = 0.89 for SRLS-CNP, α = 0.77 for SRLS-M, and α = 0.92 for SRLS-LS. The Scale of Ethical Problems in Clinical Teaching in Nursing (SEPCTN) was developed by Kırşan ( 2019 ) to determine the ethical problems experienced by nursing students in clinical teaching. The scale uses a five-point Likert-type scale and consists of 52 items and two subdimensions. It has two subdimensions: Clinical Educator (SEPCTN-CE) and Healthcare Professional (SEPCTN-HP) (Kırşan, 2019 ). A score between 52 and 260 can be obtained from the scale. There is no cut-off point in the scale, and the higher the score obtained from the scale is, the lower the level of ethical problems experienced by nursing students in clinical teaching (Kırşan, 2019 ). This study yielded Cronbach's alpha values of α = 0.96 for SEPCTN, α = 0.82 for a clinical educator, and α = 0.94 for a healthcare professional. 2.4. Data collection The students were informed about the study, and the researchers collected the data outside of class hours. The questionnaires were left in the classroom in closed envelopes, and the students who completed them and left them in closed boxes left the classroom. The researcher checked these boxes daily and collected the envelopes. In the event that a student did not wish to participate in the study, the next student on the list was included. The quantitative data collection phase occurred at the end of the sociodemographic questionnaire and the quantitative data. This was carried out with the concurrent data collection method of mixed-method studies (Teddlie & Yu, 2007 ). 2.5. Data analysis 2.5.1. Quantitative data analysis The Statistical Package for the Social Sciences (SPSS) Statistics® version 29 (IBM Corp, Armonk, NY, USA) was used with a 95% confidence level and a significance level of p < 0.05. Kruskal‒Wallis and Mann‒Whitney U tests, as well as post hoc comparisons (Mann‒Whitney U with Bonferroni correction), were performed for variables that exhibited significant differences (number, percentage, minimum‒maximum, frequency, mean, and standard deviation) between the groups in the distribution of scale levels according to the general and ethical characteristics of the participants. The data were confirmed to have a normal distribution via the Shapiro‒Wilk test. To evaluate internal consistency, the Cronbach's alpha coefficient was used. To determine the relationship between the participants' scales, Spearman's rho correlation analysis was used. 2.5.2. Qualitative data analysis The participants were asked open-ended questions to explain the ethical problems they experienced. The answers to the questions were obtained via the inductive content analysis method (Graneheim & Lundman, 2004 ). The aim of obtaining qualitative data in this study was to capture multidimensional feelings and thoughts about the subject. Data were analysed with the MAXQDA® (VERBI, Berlin, Germany) programme in three stages: preparation, editing, and reporting. The researchers evaluated the data and inferred their meaning. Similarities and differences are grouped and underlined. The meanings reached during the editing phase were classified by coding. Each meaning in the obtained data was given a code, and similar meanings were gathered under the same code. Themes were created to solve the codes. The themes have been verified and checked. As a result, two different main themes emerged from the data. 2.6. Ethical considerations This study was approved by the university's faculty management and ethics committee (E-61923333-050.99-137131). The study was conducted in accordance with the principles of the Declaration of Helsinki. The purpose of the study was explained to all participants before they responded, and they were assured that their responses would be kept confidential. Written informed consent was also obtained from the participants. 3. RESULTS 3.1. SEPCTN and SRLS-CNP levels of nursing students according to sociodemographic distribution The general characteristics of the students are presented in Table 1 . For women (n = 326) and Turkish citizens (n = 359), the grade point average (GPA) was close to each other, and the second- and third-grade participation rates were high (n = 137-n = 173). All participants’ SEPCTN score was 205.18 ± 31.57, and the SRLS-CNP score was 65.31 ± 9.91. The Clinical Educator (SEPCTN-CE) subdimension score was 93.34 ± 14.97, and the Healthcare Professional (SEPCTN-HP) subdimension score was 111.84 ± 18.89. The motivation (SRLS-M) subdimension score was 27.60 ± 4.74, and the learning strategies (SRLS-LS) subdimension score was 37.70 ± 6.02. Table 1 Comparison of the sociodemographical characteristics of the students and the total scores of SRLS-CNP and SEPCTN (n = 371) Variables SEPCTN SRLS-CNP Total (Mean ± SD Clinical Educator (SEPCTN-CE) (Mean ± SD) Healthcare Professional (SEPCTN-HP) (Mean ± SD) Total (Mean ± SD) Motivation (SRLS-M) (Mean ± SD) Learning Strategies (SRLS-LS) (Mean ± SD) Total (Mean ± SD) 205.18 ± 31.57 93.34 ± 14.97 111.84 ± 18.89 65.31 ± 9.91 27.60 ± 4.74 37.70 ± 6.02 Age ≤ 20 (n = 206) 209.08 ± 27.76 95.16 ± 13.52 113.91 ± 16.76 65.23 ± 9.65 27.71 ± 4.76 37.52 ± 5.77 > 20 (n = 165) 200.28 ± 35.26 91.06 ± 16.36 109.24 ± 21.04 65.41 ± 10.26 27.47 ± 4.71 37.93 ± 6.34 U: 14427,000; p:0.016* U:14416.000; p:0.012* U: 14824,000; p:0.043* U:16632,500; p:0.724 U:16675,000; p:0.754 U: 15996,000; p:0.328 Gender Male (n = 45) 186.51 ± 34.96 87.02 ± 14.63 99.48 ± 23.39 62.91 ± 10.16 27.22 ± 4.45 35.68 ± 6.56 Female (n = 326) 207.76 ± 30.23 94.21 ± 14.83 113.55 ± 17.55 65.64 ± 9.85 27.66 ± 4.78 37.98 ± 5.90 U:4944.000; p:0.000*** U:5432,500; p:0.005** U:47733,000; p:0.000*** U:6043,500; p:0.055 U:6592.500; p:0.269 U:5833,500; p:0.025* Nationality TC (n = 359) 206.14 ± 31.43 93.76 ± 14.91 112.38 ± 18.79 65.36 ± 9.95 27.63 ± 4.72 37.72 ± 6.06 Other (n = 12) 176.41 ± 20.90 80.66 ± 11.06 95.75 ± 14.98 63.75 ± 9.06 26.75 ± 5.36 37 ± 4.84 U:903,500; p:0.001** U:1036,500; p:0.002** U:1019,500; p:0.002** U:1872,500; p:0.441 U:2052,500; p:0.781 U: 1810.000; p:0.344 Grade Point Average (GPA) ≤ 3.00 (n = 183) 199.95 ± 34.10 90.68 ± 15.66 109.27 ± 20.66 63.88 ± 9.75 27.02 ± 4.59 36.85 ± 6.03 > 3.00 (n = 188) 209.90 ± 28.65 95.92 ± 13.85 113.96 ± 16.89 66.89 ± 9.56 28.27 ± 4.72 38.62 ± 5.71 U:13387,000; p:0.012* U:12891.000; p:0.002** U:14009,500; p:0.059 U:12802,500; p:0.001** U:13187,500; p:0.005** U:12988,000; p:0.002** Grade 1st grade (n = 21) 220.47 ± 25.61 101.90 ± 11.54 118.57 ± 16.10 69.52 ± 8.90 29.95 ± 5.00 39.57 ± 5.39 2nd grade (n = 137) 208.83 ± 29.70 94.94 ± 14.50 113.88 ± 18.14 64.75 ± 10.97 27.56 ± 5.09 37.18 ± 6.64 3rd grade (n = 173) 202.77 ± 28.57 92.36 ± 13.81 110.42 ± 16.62 64.37 ± 9.33 27 ± 4.56 37.37 ± 5.64 4th grade (n = 40) 195.02 ± 46.20 87.60 ± 19.90 107.42 ± 28.58 69.07 ± 7.70 29.15 ± 3.28 39.92 ± 5.19 KW: 11,504; p:0.009** KW: 15.140; p:0.002** KW: 6,921; p:0.074 KW:13.389; p:0.004** KW: 15.140 ; p:0.002** KW:9,363; p:0.025* Abbreviations: Kruskal‒Wallis H: KW; Mann‒Whitney U: U; p: p value; SD: Standard deviation; p values of the statistically significant were shown as bold *p < 0.05, **p < 0.01, ***p < 0.001 Considering the general and ethical characteristics of the students according to the scale scores, there was a significant relationship between the mean SEPCTN score and age, sex, nationality, GPA, and grade. There was a significant relationship between the mean SEPCTN-CE score and age, sex, nationality, GPA, and grade. There was a significant relationship between the mean SEPCTN-HP score and age, sex, and nationality (p < 0.05) (Table 1 ). There was a significant relationship between the SRLS-CNP mean score and GPA grade. There was a significant relationship between the SRLS-M mean score and GPA grade. There was a significant relationship between the SRLS-LS mean score, sex, GPA, and grade (p < 0.05) (Table 1 ). Students expressed their ethical problems qualitatively, and the statements were grouped according to the 2019 International Council of Nurses (ICN) ethical principles (Fig. 2 ). 3.2. Relationships between nursing students' SRLS-CNP and SEPCTN scores SEPCTN and SRLS-CNP were positive, weak, and statistically significant correlations obtained between the scores (r = 0.241; p < 0.001). The SRLS-CNP and SEPCTN subscales strongly correlate with the SEPCTN-CE subscale (r = 0.245; p < 0.001). SRLS-LS has the strongest correlation with SEPCTN and its subdimension SEPCTN-CE (r = 0.255; p < 0.001) (Table 2 ). Table 2 Findings Regarding the Relationship between SRL-CNP and SEPCTN (n = 371) one 2 3 4 5 6 1- SEPCTN r α: 0.96 p - 2- SEPCTN-CE r 0.913 α: 0.82 p 0.000*** - 3- SEPCTN-HP r 0.946 0.732 α: 0.94 p 0.000*** 0.000*** 4- SRLS-CNP r 0.241 0.245 0.209 α: 0.89 p 0.000*** 0.000*** 0.000*** - 5- SRLS-M r 0.168 0.189 0.131 0.899 α: 0.77 p 0.001*** 0.000*** 0.012* 0.000*** - 6- SRLS-LS r 0.265 0.255 0.240 0.939 0.692 α: 0.92 p 0.000*** 0.000*** 0.000*** 0.000*** 0.000*** - Abbreviations: r: Spearman's rho correlation coefficient; α: Cronbach's alpha internal consistency coefficient; *p < 0.05, **p < 0.01, ***p < 0.001; p values of the statistically significant correlation coefficients were shown as bold. 3.3. Examining the ethical problems experienced by nursing students As a result of the qualitative analysis of the nursing students' answers to the open-ended questions, two main themes and four subthemes belonging to these main themes were identified (Fig. 3 ). These themes are “team members with ethical problems and ethical principles”. 3.3.1. Main theme: Team members with ethical problems Four subthemes were created under the main theme of team members experiencing ethical problems. It was determined that ethical issues occurred between students, nurses and students, students and patients, and nurses and patients. 3.3.1.1. Subtheme: Students-students It was concluded that there were ethical problems among nursing students studying clinical practice at different grade levels in the same clinic. The attitudes of interns towards lower classes are expressed in the following sentences. “To be treated as absent by intern students in our service” (Participant (P) 183) “There is no respect by the intern students; they have a contemptuous look” (P 164) “Because I am a man, they always excluded me (women's health and disease practice internship), nurses, and our friends when I went to the patient for intervention. (P 82) 3.3.1.2. Subtheme: Between students and patients According to the data obtained from the interviews, the student nurses encountered some difficulties with patients in the clinic. They violate ethical rules by going beyond clinical practices. “Intern nurses from other wards come to see the patient in the psychiatry ward” (P 172). “Female patients did not want us to enter their room” (P 244) “I have come across patients who do not allow the student to practice on himself and try to criticize and hinder the student with a harsh attitude” (P 256). 3.3.1.3. Subtheme: Between nurses and students Ethical problems have arisen because of the need for more effective communication between nurses working in the clinical environment and student nurses. Based on the students' statements, they stated that nurses use harsh communication language and see student nurses, who will be their colleagues in the future, as a workforce. “The nurses showed a bit of a harsh attitude towards us” (P 51). “Students are not respected” (P 31) “I do not think that our future colleagues treat us fairly and respect us” (P 165) “Healthcare personnel see the students who come to the clinic not as individuals but as a workforce and prevent us from resting” (P 115). 3.3.1.4. Subtheme: Between nurses and patients Nursing students also cooperate with health professionals as observers in the clinical environment. One of their negative experiences in their observations is as follows: “The patient who came out of the abortion procedure was scared and crying due to anaesthesia. The patient wanted to hold someone's hand. The patient was asked if much bleeding had occurred. The nurse left shouting that there are many patients here, I cannot stand next to you all the time” (P 182). 3.3.2. Main theme: Ethical principles Themes were created according to the ICN 2019 ethical codes. The ethical problems experienced in the clinic were discussed from the students' perspective. 3.3.2.1. Subtheme: Principle of confidentiality and privacy They stated that the ethical principle of confidentiality and privacy is a principle that can often be violated in the clinical setting by nurse students. “The curtain between the patients is never drawn in the double patient rooms in the service” (P 49) “There is much talk about patients who have just come of age or have a mental illness but are hospitalized in another service” (P 178). 3.3.2.2. Subtheme: Autonomy-respect for the individual principle The most common ethical violation experienced by nursing students was the principles of autonomy and respect for the individual. It was expressed to the students that the patients are informed about all kinds of procedures and that they are carried out in a way that does not hurt human dignity. “Some patients do not respect their self-identity” (P 208) “While I was there, I translated the patient's words to the doctors and nurses. However, vascular access, etc., they chose the way of communicating by nudging the patient” (P 176). 3.3.2.3. Subtheme: Principle of justice-equality It was stated that there are principles in the similar nursing approach to patients by allowing students to observe ethical problems during the clinical education process, and patients are separated according to their diagnoses. “Patients with infectious diseases are excluded and left alone” (P 115) “A patient with a diagnosis of schizophrenia is taking a stand” (P 30) 3.3.2.4. Subtheme: Do no harm-benefit principle Future nurse candidates should carry out initiatives not to harm patients and provide benefits in the theoretical and clinical training they receive during nursing education. The students’ statements revealed that the health professionals did not fully fulfill this principle against the patients. “Some health personnel think that the patient's wounds will not hurt, and they do it very hard while dressing” (P 120). “Installing a urinary catheter in a patient without a sterile method and consent” (P 62) 4. DISCUSSION The findings are discussed under three headings. 4.1. Discussion of SEPCTN and SRLS-CNP scale data with sociodemographic findings This study revealed that the mean SEPCTN score was high and students had low ethical problems in the clinic. Similar results have also been obtained in the literature (Kırşan, 2019 ; Dığın & İşcan Ataşen, 2021 ). This makes the concept of ethics important because the nursing center is human, and its education is human-oriented. In theoretical and clinical education, ethical education is needed for students to learn ethical principles and decision-making processes and gain ethical sensitivity (Mehdipour Rabori et al., 2019 ). This was considered a favourable situation for the students in the study after the educational content conveyed in line with ethical values had moderate ethical problems in the practice field. A significant difference was found between the total SEPCTN score and age, sex, nationality, GPA, grade, choice of profession, and its effect on clinical practice. This difference was as follows: the mean score increased with decreasing age, and female students had fewer ethical problems than male students. The findings of this study were handled according to the literature (Akutay & Ceyhan, 2022 ; Kurt & Eskimez, 2022 ; Salar et al., 2016 ). The SRLS-CNP, SRLS-M, and SRLS-LS total scores were high among the nursing students. Although existing studies in the literature support our findings, other studies contrast with our results (Subaş & Karacay, 2023; Dogu et al., 2022 ; Dığın & İşcan Ataşen, 2021 ). In contrast, Chen et al. ( 2019 ) reported that nursing students had a high level of SRL. Denat et al. ( 2017 ), with 524 students, reported that the students had moderate SRL skills, similar to our findings and that the scale scores decreased as their academic achievements decreased. In addition, it was concluded that the SRL skills of fourth-grade students were lower than those of lower-grade students (Denat et al., 2017 ). Significant differences were obtained between the SRLS-CNP total score, GPA, and grade. This difference was that the students used more SRL techniques in the second and third grades, and clinical practice positively impacted the average success rate. The findings of this study were handled according to the literature (Dogu et al., 2022 ; Hwang & Oh, 2021 ; Denat et al., 2017 ). This finding can be considered self-sacrificing, motivated, and effortful individuals to learn in the clinical setting. In addition, students positively contribute to their learning processes as they constantly interact with nurses and instructors in the clinical practice environment. 4.2. Discussing the findings of the relationship between the SEPCTN and SRLS-CNP The theoretical model of SRL in nursing was created by Kuiper et al. The model predicted that the student could develop metacognitive thinking strategies that support clinical decision-making and the development of competence in practice (Kuiper, 2005 ). Studies have shown that nursing students' academic performance and self-confidence in clinical practice are high due to high SRL (Subaş & Karacay, 2023; Dogu et al., 2022 ; Moghadari-Koosha et al., 2020 ). It is predicted that the higher the self-directed learning level of nursing students is, the greater their critical thinking and problem-solving skills will be, and they will be able to cope with the ethical problems that may arise. Recent developments and increasing demands in the health field have resulted in complex health environments and various ethical problems (Muramatsu et al., 2019 ). To cope with clinical ethical issues, it is necessary to develop problem-solving skills and to educate students who take responsibility and have high self-confidence. Considering this point of view, it will be mandatory for students to actively participate in the teaching-learning process to research and question (Dogu et al., 2022 ; Mehdipour Rabori et al., 2019 ; Ding & Zhu, 2018 ) as the level of ethical problems increases during clinical education. In our study, as the SEPCTN and SRLS-CNP (p < 0.001) levels of nursing students increased, the SRLS-CNP levels also increased; in this context, the SRLS-CNP can increase the number of students who take responsibility in education and clinical practice, have high self-confidence, and therefore can cope with ethical problems. It is essential to show that it will contribute. This provided meaningful data that enabled students responsible for learning to recognize ethical problems. 4.3. Discussion of findings related to ethical problems experienced by students Qualitative data were obtained from students who reported ethical issues they experienced and/or were observed in the clinic. Approximately 1 in 5 of the nursing students in the study faced ethical issues and/or observed ethical issues in the clinic. In parallel with our results, it has been reported that undergraduate nursing students experience moderate and frequent ethical distress in clinical settings (Mehdipour Rabori et al., 2019 ; Escolar-Chua, 2018 ). The researchers considered this situation optimistic concerning students' ability to recognize unethical practices. A review of nursing students revealed that many unethical practices of doctors and other nursing students were observed (Albert et al., 2020 ). However, it was surprising to the researchers that they experienced these situations during their student lives. As a result of the qualitative analysis of the students’ responses to the question “If you have experienced ethical problems, please explain,” two main themes emerged. Ethical problems related to healthcare team members were grouped under the "team members with ethical problems" theme. The data of students who observed ethical problems among healthcare team members were also reported in the literature (Chen et al., 2019 ; Eriksson et al., 2014 ; Albert et al., 2020 ). It was emphasized that communication was necessary for the professional work of the healthcare team, so ethical problems were an obstacle to communication (Adams et al., 2017 ). Lemonidou et al. ( 2004 ) reported that students experienced ethical problems with health professionals regarding ethical principles not being followed and violations of patients' rights. In this study, the nursing students stated that autonomy or respect for the individual was the most common ethical principle violation. Similarly, Blondeau et al. ( 2009 ) reported that ethical principle violations are related to restricting autonomy. In another study conducted with nursing students, the authors reported that the ethical principle of doing no harm-benefit was violated the most in the clinic (Akın Korhan et al., 2018 ). Failure to pay attention to patient rights and inadequate information, inappropriate communication, failure to ensure the ethical principle of confidentiality and privacy, and inadequate support of students by nurse educators and nurses are some of the ethical challenges frequently experienced and observed by nursing students (Mehdipour Rabori et al., 2019 ). Although nursing students learn ethical principles during their education, they may need more support and guidance in clinical settings (Albert et al., 2020 ). Sinclair et al. ( 2016 ) reported that more than two-thirds of nursing students violated the ethical principles of privacy and respect for the individual, and 87% encountered unsafe working conditions. The fact that students take an ethics course makes them more sensitive to ethical issues. In this respect, they are in an excellent position to identify ethical problems, and this situation contributes positively to their experience and attitudes. It is crucial for researchers who are educators to be aware of issues of concern to support role models and encourage the development of ethical attitudes (Sinclair et al., 2016 ). Therefore, clinical educators have been role models in solving ethical issues identified by students in the clinic. Nurse researchers need to be sensitive to ethical situations in the clinic. In both clinical and academic settings, nurse educators encourage nurses and students to identify ethical issues and plan action, even in the face of institutional limitations. In clinical settings, educators and clinicians should be involved in developing a culture of collaboration and patient advocacy (Albert et al., 2020 ). The researchers in this study planned sessions about ethical situations observed by students and their solutions. Studies also show that students realize that they apply ethical values in practice but feel restricted due to the culture of the clinical environment, which allows unethical practices (Solum et al., 2012 ; Yeh et al., 2010 ). It was thought that nurse educators should be role models in providing appropriate conditions for students to express ethical situations, preparing the groundwork for this culture, and conveying ways to follow when expressing ethical situations. A study conducted in New Zealand reported that although ethics education was provided in the nursing undergraduate program, it was unsuccessful in raising ethically competent graduates. For this reason, educators with a leadership role in clinical practice should encourage students to raise ethical issues through institutional procedures (Albert et al., 2020 ; Sinclair et al., 2016 ). In the literature, it has been emphasized that nursing students are encouraged to practice moral dilemmas, necessary training is provided, and tools are provided to address ethical issues (Khatiban et al., 2019 ; Sinclair et al., 2016 ; Epstein & Carlin, 2012 ). In this study, the researchers initiated the necessary work to report the ethical situations experienced in the clinic observed by the nursing students and themselves and to transfer them to those responsible. They recommended risk analysis to prevent incident recurrence, transfer and express students' observations, and fulfil their ethical duties. Nursing students can express their opinions and values, participate in ethical discussions, and gain a sense of autonomy and ownership in patient care by using institutional infrastructure and role modelling (Mehdipour Rabori et al., 2019 ; Truglio-Londrigan & Slyer, 2018 ). It also reportedly reduces the danger of improper patient care and needless emotional anguish by prioritizing patients’ desires and preferences. To allow nursing students and staff to voice issues without worrying about how they would affect their work, it was also recommended that anonymous whistleblower platforms be set up where needed (Heng & Shorey, 2023 ). Nursing students may develop disappointment when care is not as centralized as they believe. In the literature, unprofessional behaviors of healthcare staff, expectations of students to complete paperwork and do things in a short time, patients' right to privacy and autonomy, communication, listening, insufficient time to evaluate the preferences and values of the patient individual, and insufficient time for individualized patient care have been reported (Krautscheid et al., 2017 ; Mehdipour Rabori et al., 2019 ; Palese et al., 2019 ). Therefore, inappropriate or inadequate care can cause ethical distress among nursing students. 5. LIMITATIONS The greatest strength of this study is the size of the sample. Experienced researchers collected the data. One limitation of the study is that the results were based on the self-reports and experiences of the nursing students. Participants' self-reporting is considered a limitation, as it is a subjective evaluation. Another limitation is that the study was conducted with students who enrolled and attended the course in the spring semester of the 2022–2023 academic year. 6. CONCLUSION There is a need to improve the quality of nursing students' learning ability due to the increasingly complex and variable medical environments. In this study, the students' SEPCTN and SRLS-CNP scores were not at the desired level, but a significant correlation was obtained between the scales. This situation can be used in nursing education programs to improve self-learning success, integrate SRL strategies into the clinic, and improve judgment ability and clinical reasoning skills. In addition, the ability to recognize ethical problems in the clinic increased as the students' mean scores on the SEPCTN and SRLS-CNP increased in the clinic. The qualitative interviews revealed that students in the clinic could have ethical problems with nurses, friends, and patients. The students determined that ethical problems occur within the team and that the most common ethical problem violates the principles of autonomy and respect for the individual. Students should be encouraged to identify these problems’ primary sources and prevent violations before they occur. 6.1. Integration into clinical education It has been suggested that creating an SRL environment is necessary for nursing students to recognize ethical situations without instructor guidance and to comply with professional ethical principles. Nursing students must be aware of their values as they adapt to their professional values and new roles during their education, which may be related to SRL. The results of this study revealed that students with high SRL status can recognize ethical issues in clinical teaching. In line with these data, course content and clinical teaching should be organized and improved to enhance students' self-regulation skills in the clinic. The importance of the clinical environment cannot be overlooked, given that students look to their clinical educators as role models, helping them develop coping skills while gaining experience in caring and thus contributing to ethical competence. In addition, students should be allowed to express their ethical concerns and develop an autonomous and professional attitude. Strengthening ethical content in theoretical courses will prepare students for the complex situations they will encounter in clinical practice. Declarations Author Contribution RB: Conceptualization, validation, formal analysis, investigation, resources, data curation, writing - original draft, writing - review & editing, visualization.OD: Methodology, validation, formal analysis, data curation, writing - original draft, writing - review & editing, supervision Acknowledgement The authors thank all nursing students who participated in the study. References Adams, A. M. N., Mannix, T., & Harrington, A. (2017). Nurses' communication with families in the intensive care unit–a literature review. Nursing in Critical Care , 22(2), 70-80. https://doi.org/10.1111/nicc.12141 Akın Korhan, E., Ceylan, B., Üstün, Ç., et al. (2018). Ethical problems in the clinical setting from the perspective of nursing students Ege Journal of Medicine , 57, 75-81. Akutay, S., & Ceyhan, Ö. (2022). Determination of nursing students’ ethical problems in clinical teaching. Gümüşhane University Journal of Health Sciences , 11, 1452-1459. Albert, J. S., Younas, A., & Sana, S. (2020). Nursing students' ethical dilemmas regarding patient care: An integrative review. Nurse Education Today , 88, 104389. https://doi.org/10.1016/j.nedt.2020.104389 Blondeau, D., Dumont, S., Roy, L., et al. (2009). Attitudes of Quebec doctors toward sedation at the end of life: An exploratory study. Palliative & Supportive Care , 7(3), 331–337. https://doi.org/10.1017/S1478951509990265 Bremer, A., & Holmberg, M. (2020). Ethical conflicts in patient relationships: Experiences of ambulance nursing students. Nursing Ethics , 27, 946-959. https://doi.org/10.1177/0969733020911077 Chen, J. H., Björkman, A., Zou, J. H., et al. (2019). Self–regulated learning ability, metacognitive ability, and general self-efficacy in a sample of nursing students: A cross-sectional and correlational study. Nurse Education in Practice , 37, 15–21. https://doi.org/10.1016/j.nepr.2019.04.014 Denat, Y., Dikmen, Y., Arslan, G., et al. (2017). Factors affecting self-regulated learning in nursing students in Turkey. Oxidation Communications , 40, 973-985. Dığın, F., & İşcan Ataşen, G. (2021). Determining the Self-Regulated Learning Status of Nursing Students Regarding Clinical Nursing Practices. Humanistic Perspective , 3, 420-432. https://doi.org/10.47793/hp.888099 Ding, M., & Zhu, H. (2018). Nursing students’ self-regulated learning ability: A descriptive literature review. Lishui University, Lishui, China. Dogu, O., Karadas, A., & Eskin Bacaksiz, F. (2022). The relationships between self-regulated learning in clinical nursing practice and self-efficacy: A cross-sectional study among nursing students. Perspectives in Psychiatric Care , 58, 2107-2115. https://doi.org/10.1111/ppc.13037 Epstein, I., & Carlin, K. (2012). Ethical concerns in the student/preceptor relationship: a need for change. Nurse Education Today , 32, 897–902. https://doi.org/10.1016/j.nedt.2012.03.009 Eriksson, H., Andersson, G., Olsson, L., et al. (2014). Ethical dilemmas around the dying patient with stroke: a qualitative interview study with team members on stroke units in Sweden. Journal of the American Association of Neuroscience Nurses , 46(3), 162–170. https://doi.org/10.1097/JNN.0000000000000049 Escolar-Chua, R. L. (2018). Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students. Nursing Ethics , 25, 458-469. https://doi.org/10.1177/0969733016654317 Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today , 24, 105-112. https://doi.org/10.1016/j.nedt.2003.10.001 Heng, T. J. T., & Shorey, S. (2023). Experiences of moral distress in nursing students–A qualitative systematic review. Nurse Education Today , 129, 105912. https://doi.org/10.1016/j.nedt.2023.105912 Hwang, Y., & Oh, J. (2021). The Relationship between Self-Directed Learning and Problem-Solving Ability: The Mediating Role of Academic Self-Efficacy and Self-Regulated Learning among Nursing Students. International Journal of Environmental Research and Public Healt h, 18, 20210211. https://doi.org/10.3390/ijerph18041738 Iyama, S., & Maeda, H. (2018). Development of the Self-Regulated Learning Scale in Clinical Nursing Practice for Nursing Students: Consideration of its reliability and validity. Japanese Journal of Nursing Science , 15, 226-236. https://doi.org/10.1111/jjns.12191 Khatiban, M., Falahan, S. N., Amini, R., et al. (2019). Lecture-based versus problem-based learning in ethics education among nursing students. Nursing Ethics , 26(6), 1753-1764. https://doi.org/10.1177/0969733018767246 Kırşan, M. (2019). Development of scale of ethical problems in clinical teaching in nursing [Master Thesis]. İzmir Katip Çelebi University, İzmir. Krautscheid, L., DeMeester, D. A., Orton, V., Smith, A., Livingston, C., & McLennon, S. M. (2017). Moral distress and associated factors among baccalaureate nursing students: a multisite descriptive study. Nursing Education Perspectives , 38 (6), 313-319.https://doi.org/10.1097/01.NEP.0000000000000214 Kuiper, R. (2005). Self-regulated learning during a clinical preceptorship: the reflections of senior baccalaureate nursing students. Nursing Education Perspectives , 26, 351-356. Kurt, E., & Eskimez, Z. (2022). Examining self-regulated learning of nursing students in clinical practice: A descriptive and cross-sectional study. Nurse Education Today , 109, 105242. https://doi.org/10.1016/j.nedt.2021.105242 Lemonidou, C., Papathanassoglou, E., Giannakopoulou, M., Patiraki, E., & Papadatou, D. (2004). Moralprofessional personhood: Ethical reflections during initial clinical encounters in nursing education. Nursing Ethics , 11(2), 122-137. Mehdipour Rabori, R., Dehghan, M., & Nematollahi, M. (2019). Nursing students’ ethical challenges in the clinical settings: A mixed-methods study. Nursing Ethics , 26, 1983-1991. https://doi.org/10.1177/0969733018810766 Moghadari-Koosha, M., Moghadasi-Amiri, M., Cheraghi, F., et al. (2020). Self-efficacy, self-regulated learning, and motivation as factors influencing academic achievement among paramedical students: A correlation study. Journal of Allied Health , 49, 145E-152E. Muramatsu, T., Nakamura, M., Okada, E., et al. (2019). The development and validation of the Ethical Sensitivity Questionnaire for Nursing Students. BMC Medical Education , 19, 215. https://doi.org/10.1186/s12909-019-1625-8 Palese, A., Gonella, S., Destrebecq, A., Mansutti, I., Terzoni, S., Morsanutto, M., ... & Dimonte, V. (2019). Opportunity to discuss ethical issues during clinical learning experience. Nursing ethics , 26 (6), 1665-1679. https://doi.org/10.1177/0969733018774617 Salar, A. R., Zare, S., & Sharifzadeh, E. (2016). The Survey of Nursing Students’ Ethical Sensitivity. Biol Med (Aligarh), 8, 1-4. https://doi.org/10.4172/0974-8369.1000311 Sinclair, J., Papps, E., & Marshall, B. (2016). Nursing students' experiences of ethical issues in clinical practice: A New Zealand study. Nursing Education in Practice , 17, 1-7. https://doi.org/10.1016/j.nepr.2016.01.005 Solum, E. M., Maluwa, V. M., & Severinsson, E. (2012). Ethical problems in practice as experienced by Malawian student nurses . Nursing Ethics , 19(1), 128-138. https://doi.org/10.1177/0969733011412106 Subaş, F., & Karaçay, P. (2023). Factors associated with nursing students' self-regulated learning in clinical practicum: A descriptive cross-sectional study. Nursing & health sciences , 25(1), 98–107. https://doi.org/10.1111/nhs.12997 Şenol, A. (2018). The investigation of the validity and reliability of the self-regulated learning scale in clinical nursing practice [Master Thesis]. Ege University, İzmir. Teddlie, C., & Yu, F. (2007). Mixed methods sampling: A typology with examples. Journal of mixed methods research , 1 (1), 77-100. https://doi.org/10.1177/1558689806292430 Truglio-Londrigan, M., & Slyer, J. T. (2018). Shared decision-making for nursing practice: An integrative review. Open Nursing Journal , 12, 1–14. https://doi.org/10.2174/1874434601812010001 Ünsal, C., Öcal, G., Demiral, M., et al. (2013). Ethics policy violations that academic staff applied to the students at a school of health in Trabzon during clinical applications. Gümüşhane University Journal of Health Sciences , 2, 12-24. Yeh, M. Y., Wu, S. M., & Che, H. L. (2010). Cultural and hierarchical influences: Ethical issues faced by Taiwanese nursing students. Medical Education , 5, 475–484. https://doi.org/10.1111/j.1365-2923.2009.03589.x Additional Declarations No competing interests reported. Supplementary Files COREQandSTROBEChecklist.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5898417","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":406901906,"identity":"81484456-10ca-446e-bb61-467fff1b4777","order_by":0,"name":"Ramazan Bozkurt","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYDADAwYGZhAtByIOPCBBi4ExWEsCKVoSG0A8fFrM208nfvxRcyfPnL39sTHvnj/p88MOPwTaYien24Bdi8yZ3M0SEseeFVv2HEhO5nlmkLvxdpoBUEuysdkB7FokGHI3SBiwHU7ccCPh8GGeA0AtsxNAWg4kbsOlhf/t5h8J/0BaEptBWtINZ6d/wK9FInebxME2kJZk5mSglgR56RwCtki83WbZ2Hc4cWfPMWbDOQeMDTdI5xQcSDDA4xf+3M03f3w7nLgdGGISbw7IycvPTt/84UOFnRwuLZjAAKzSgFjlICDfQIrqUTAKRsEoGAkAAILRZtQE01gpAAAAAElFTkSuQmCC","orcid":"","institution":"Sakarya University, Faculty of Health Sciences, Nursing Department","correspondingAuthor":true,"prefix":"","firstName":"Ramazan","middleName":"","lastName":"Bozkurt","suffix":""},{"id":406901907,"identity":"f5131e6c-3b8c-4dd1-ba35-fc1ac2a91162","order_by":1,"name":"Ozlem Dogu","email":"","orcid":"","institution":"Sakarya University, Faculty of Health Sciences, Nursing Department","correspondingAuthor":false,"prefix":"","firstName":"Ozlem","middleName":"","lastName":"Dogu","suffix":""}],"badges":[],"createdAt":"2025-01-24 22:23:11","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5898417/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5898417/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74948179,"identity":"a31896bf-caa7-4787-8f79-95b9ade645aa","added_by":"auto","created_at":"2025-01-28 15:52:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":94922,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe conceptual framework of the study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5898417/v1/ef3afd4caff9cbf064cb5c7c.png"},{"id":74949357,"identity":"fca4e490-6d09-4287-9821-dca8ef5e2a14","added_by":"auto","created_at":"2025-01-28 16:00:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13352,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of those experiencing ethical problems (n=67)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5898417/v1/b0851fb8e0c7246ae0abfad8.png"},{"id":74949358,"identity":"ab398ac6-15fa-473c-9c93-396396b6e7d1","added_by":"auto","created_at":"2025-01-28 16:00:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":253581,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMain and Sub-Themes\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5898417/v1/4fdc16b1f32f9c6703158200.png"},{"id":75275633,"identity":"79ed488b-99fc-4a20-8482-e2dc706647a9","added_by":"auto","created_at":"2025-02-03 00:01:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1898385,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5898417/v1/949395fb-60af-4810-9b50-adeca481d6b0.pdf"},{"id":74948184,"identity":"49a94f3d-c638-4dbf-8e5d-695dcb8f6528","added_by":"auto","created_at":"2025-01-28 15:52:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":472908,"visible":true,"origin":"","legend":"","description":"","filename":"COREQandSTROBEChecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5898417/v1/f57074c29dec34c8f126900f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Self-Regulated Learning by Nursing Students on Ethical Problems in Clinical Teaching","fulltext":[{"header":"1. INTRODUCTION","content":" \u003cp\u003eSelf-regulated learning (SRL) is a mental information process in which learners are supported to control their behavior, understand all aspects of learning, and maintain their learning processes (Dogu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). SRL refers to students' ability to identify learning needs, set goals, manage resources, and self-assess (Ding \u0026amp; Zhu, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In this direction, self-regulated learners can be defined as active individuals who effectively manage their learning by observing themselves and generally as those who can use learning strategies (Kurt \u0026amp; Eskimez, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). SRL develops students' ability to control or manage their learning environment and processes responsibly and with the belief that tasks will be accomplished (Hwang \u0026amp; Oh, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClinical learning enables students to use their knowledge in the natural environment and develop their psychomotor skills and professional socialization (\u0026Uuml;nsal et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Clinical learning has been defined as the place where nursing students move from theory to practice. However, although it is complementary and one of the most critical components of nursing education (\u0026Uuml;nsal et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), it can be affected by many factors, as it occurs in a complex and social environment (Akın Korhan et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). One of these factors is ethical problems that can be experienced through unprofessional attitudes and behaviours. The clinical learning processes of nursing students who experience this situation may be adversely affected (\u0026Uuml;nsal et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Akın Korhan et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAddressing ethical issues is essential for nursing education (Bremer \u0026amp; Holmberg, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). One major goal of nursing education is to develop nursing students' professional values, develop critical thinking and decision-making abilities, and help them perform ethical behaviours (Ding \u0026amp; Zhu, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). SRL is used more when necessary, and support is provided for students' critical thinking and decision-making abilities in the clinic (Şenol, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Furthermore, students who demonstrate self-regulated learning (SRL) abilities tend to invest greater effort in attaining knowledge and competencies, as well as in managing their learning processes and exercising initiative (Dogu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Similarly, SRL has revealed that students increase their professional competence and skills (Şenol, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is essential to test the relationship between nursing students' use of SRL in clinical practice and their state of ethical problems. Based on this importance, the research findings and results are expected to raise awareness and contribute to the ability to understand the effects of nursing education programs on the development level of these skills. However, there are limited studies in this field in China. This research is also considered necessary in terms of contributing to eliminating this deficiency.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1. Aim and research questions\u003c/h2\u003e \u003cp\u003eThe study was conducted to evaluate the relationship between self-regulated learning situations and the ethical problems experienced by nursing students in clinical teaching and to determine their views. The conceptual framework of the research is given in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eResearch questions:\u003c/p\u003e \u003cp\u003eQ1: What are the Self-Regulated Learning Scale in Clinical Nursing Practice (SRLS-CNP) and the Scale of Ethical Problems in Clinical Teaching in Nursing (SEPCTN) levels of nursing students?\u003c/p\u003e \u003cp\u003eQ2: What is the level of relationship between SRLS-CNP and SEPCTN?\u003c/p\u003e \u003cp\u003eQ3: What ethical problems are experienced by nursing students?\u003c/p\u003e \u003cp\u003eQ4: Do nursing students' self-regulated learning and experience of ethical problems in clinical teaching affect their experience with ethical problems?\u003c/p\u003e \u003c/div\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Design\u003c/h2\u003e \u003cp\u003eThe design was a mixed method.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Settings and participants\u003c/h2\u003e \u003cp\u003eThe study population comprised 371 students enrolled in the first, second, third, and fourth grades of the Nursing Department of a university in the northwestern region of Turkey during the spring semester of the 2022\u0026ndash;2023 academic year. A power analysis was conducted via the G*Power 3.1.9.7 program with a margin of error of 0.5, an α value of 0.05, and an 80% effect size, resulting in a minimum required sample size of 289. Considering the potential for data loss, a larger number of students were initially contacted, and the study was ultimately completed with 371 participants. Systematic random sampling was employed as the sampling method. The inclusion rate for the study was 85.2%. The qualitative phase was completed by analysing the detailed responses of 67 students who reported experiencing ethical problems. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Instruments\u003c/h2\u003e \u003cp\u003eThe sociodemographic data form consists of a total of 13 items based on previous studies (Akın Korhan et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Kurt \u0026amp; Eskimez, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Dogu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The general features include questions about ethical experience, gender, age, nationality, and educational characteristics. One open-ended question, \u0026ldquo;If you have experienced ethical problems, please explain,\u0026rdquo; asked the students to explain the ethical problems they had experienced.\u003c/p\u003e \u003cp\u003eThe Self-Regulated Learning Scale in Clinical Nursing Practice (SRLS-CNP) was developed by Iyama and Maeda (2017) for the purpose of evaluating the self-regulated learning levels of nursing students engaged in clinical practice. The scale, which was adapted to Turkish by Şenol (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), consists of 16 items and two dimensions. The motivation subdimension is composed of two factors. The subdimensions of Internal Motivation and Success Motivation comprise the first dimension of the scale. The Learning Strategies subdimension comprises three elements: synthesized knowledge, international mindfulness, and effort control (Şenol, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The score obtained from the five-point Likert scale ranges from 16 to 80 points. As the score from the scale increases, the student's use of the self-regulated learning approach also increases (Iyama \u0026amp; Maeda, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In this study, the Cronbach's alpha values were α\u0026thinsp;=\u0026thinsp;0.89 for SRLS-CNP, α\u0026thinsp;=\u0026thinsp;0.77 for SRLS-M, and α\u0026thinsp;=\u0026thinsp;0.92 for SRLS-LS.\u003c/p\u003e \u003cp\u003eThe Scale of Ethical Problems in Clinical Teaching in Nursing (SEPCTN) was developed by Kırşan (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) to determine the ethical problems experienced by nursing students in clinical teaching. The scale uses a five-point Likert-type scale and consists of 52 items and two subdimensions. It has two subdimensions: Clinical Educator (SEPCTN-CE) and Healthcare Professional (SEPCTN-HP) (Kırşan, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). A score between 52 and 260 can be obtained from the scale. There is no cut-off point in the scale, and the higher the score obtained from the scale is, the lower the level of ethical problems experienced by nursing students in clinical teaching (Kırşan, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This study yielded Cronbach's alpha values of α\u0026thinsp;=\u0026thinsp;0.96 for SEPCTN, α\u0026thinsp;=\u0026thinsp;0.82 for a clinical educator, and α\u0026thinsp;=\u0026thinsp;0.94 for a healthcare professional.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data collection\u003c/h2\u003e \u003cp\u003eThe students were informed about the study, and the researchers collected the data outside of class hours. The questionnaires were left in the classroom in closed envelopes, and the students who completed them and left them in closed boxes left the classroom. The researcher checked these boxes daily and collected the envelopes. In the event that a student did not wish to participate in the study, the next student on the list was included. The quantitative data collection phase occurred at the end of the sociodemographic questionnaire and the quantitative data. This was carried out with the concurrent data collection method of mixed-method studies (Teddlie \u0026amp; Yu, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Data analysis\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.5.1. Quantitative data analysis\u003c/h2\u003e \u003cp\u003eThe Statistical Package for the Social Sciences (SPSS) Statistics\u0026reg; version 29 (IBM Corp, Armonk, NY, USA) was used with a 95% confidence level and a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Kruskal‒Wallis and Mann‒Whitney U tests, as well as post hoc comparisons (Mann‒Whitney U with Bonferroni correction), were performed for variables that exhibited significant differences (number, percentage, minimum‒maximum, frequency, mean, and standard deviation) between the groups in the distribution of scale levels according to the general and ethical characteristics of the participants. The data were confirmed to have a normal distribution via the Shapiro‒Wilk test. To evaluate internal consistency, the Cronbach's alpha coefficient was used. To determine the relationship between the participants' scales, Spearman's rho correlation analysis was used.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.5.2. Qualitative data analysis\u003c/h2\u003e \u003cp\u003eThe participants were asked open-ended questions to explain the ethical problems they experienced. The answers to the questions were obtained via the inductive content analysis method (Graneheim \u0026amp; Lundman, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). The aim of obtaining qualitative data in this study was to capture multidimensional feelings and thoughts about the subject. Data were analysed with the MAXQDA\u0026reg; (VERBI, Berlin, Germany) programme in three stages: preparation, editing, and reporting. The researchers evaluated the data and inferred their meaning. Similarities and differences are grouped and underlined. The meanings reached during the editing phase were classified by coding. Each meaning in the obtained data was given a code, and similar meanings were gathered under the same code. Themes were created to solve the codes. The themes have been verified and checked. As a result, two different main themes emerged from the data.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Ethical considerations\u003c/h2\u003e \u003cp\u003e This study was approved by the university's faculty management and ethics committee (E-61923333-050.99-137131). The study was conducted in accordance with the principles of the Declaration of Helsinki. The purpose of the study was explained to all participants before they responded, and they were assured that their responses would be kept confidential. Written informed consent was also obtained from the participants.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1. SEPCTN and SRLS-CNP levels of nursing students according to sociodemographic distribution\u003c/h2\u003e\n \u003cp\u003eThe general characteristics of the students are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. For women (n\u0026thinsp;=\u0026thinsp;326) and Turkish citizens (n\u0026thinsp;=\u0026thinsp;359), the grade point average (GPA) was close to each other, and the second- and third-grade participation rates were high (n\u0026thinsp;=\u0026thinsp;137-n\u0026thinsp;=\u0026thinsp;173). All participants\u0026rsquo; SEPCTN score was 205.18\u0026thinsp;\u0026plusmn;\u0026thinsp;31.57, and the SRLS-CNP score was 65.31\u0026thinsp;\u0026plusmn;\u0026thinsp;9.91. The Clinical Educator (SEPCTN-CE) subdimension score was 93.34\u0026thinsp;\u0026plusmn;\u0026thinsp;14.97, and the Healthcare Professional (SEPCTN-HP) subdimension score was 111.84\u0026thinsp;\u0026plusmn;\u0026thinsp;18.89. The motivation (SRLS-M) subdimension score was 27.60\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74, and the learning strategies (SRLS-LS) subdimension score was 37.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.02.\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of the sociodemographical characteristics of the students and the total scores of SRLS-CNP and SEPCTN (n\u0026thinsp;=\u0026thinsp;371)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" rowspan=\"2\" style=\"width: 7.6393%;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eSEPCTN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\" style=\"width: 28.5202%;\"\u003e\n \u003cp\u003eSRLS-CNP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 9.4728%;\"\u003e\u003cstrong\u003eTotal (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/strong\u003e\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Educator (SEPCTN-CE)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare Professional\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(SEPCTN-HP) (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMotivation (SRLS-M)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLearning Strategies\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(SRLS-LS) (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 12.8341%;\"\u003e\n \u003cp\u003eTotal (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e205.18\u0026thinsp;\u0026plusmn;\u0026thinsp;31.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e93.34\u0026thinsp;\u0026plusmn;\u0026thinsp;14.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e111.84\u0026thinsp;\u0026plusmn;\u0026thinsp;18.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e65.31\u0026thinsp;\u0026plusmn;\u0026thinsp;9.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27.60\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e37.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\" style=\"width: 7.6393%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;20 (n\u0026thinsp;=\u0026thinsp;206)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e209.08\u0026thinsp;\u0026plusmn;\u0026thinsp;27.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e95.16\u0026thinsp;\u0026plusmn;\u0026thinsp;13.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e113.91\u0026thinsp;\u0026plusmn;\u0026thinsp;16.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e65.23\u0026thinsp;\u0026plusmn;\u0026thinsp;9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e37.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;20 (n\u0026thinsp;=\u0026thinsp;165)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e200.28\u0026thinsp;\u0026plusmn;\u0026thinsp;35.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e91.06\u0026thinsp;\u0026plusmn;\u0026thinsp;16.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e109.24\u0026thinsp;\u0026plusmn;\u0026thinsp;21.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e65.41\u0026thinsp;\u0026plusmn;\u0026thinsp;10.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e37.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU: 14427,000; p:0.016*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:14416.000; p:0.012*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU: 14824,000; p:0.043*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU:16632,500; p:0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU:16675,000; p:0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU: 15996,000; p:0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\" style=\"width: 7.6393%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e186.51\u0026thinsp;\u0026plusmn;\u0026thinsp;34.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e87.02\u0026thinsp;\u0026plusmn;\u0026thinsp;14.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e99.48\u0026thinsp;\u0026plusmn;\u0026thinsp;23.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e62.91\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27.22\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e35.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;326)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e207.76\u0026thinsp;\u0026plusmn;\u0026thinsp;30.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e94.21\u0026thinsp;\u0026plusmn;\u0026thinsp;14.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e113.55\u0026thinsp;\u0026plusmn;\u0026thinsp;17.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e65.64\u0026thinsp;\u0026plusmn;\u0026thinsp;9.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27.66\u0026thinsp;\u0026plusmn;\u0026thinsp;4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e37.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:4944.000; p:0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:5432,500; p:0.005**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:47733,000; p:0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU:6043,500; p:0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU:6592.500; p:0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:5833,500; p:0.025*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\" style=\"width: 7.6393%;\"\u003e\n \u003cp\u003eNationality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003eTC (n\u0026thinsp;=\u0026thinsp;359)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e206.14\u0026thinsp;\u0026plusmn;\u0026thinsp;31.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e93.76\u0026thinsp;\u0026plusmn;\u0026thinsp;14.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e112.38\u0026thinsp;\u0026plusmn;\u0026thinsp;18.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e65.36\u0026thinsp;\u0026plusmn;\u0026thinsp;9.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e37.72\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003eOther (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e176.41\u0026thinsp;\u0026plusmn;\u0026thinsp;20.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e80.66\u0026thinsp;\u0026plusmn;\u0026thinsp;11.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e95.75\u0026thinsp;\u0026plusmn;\u0026thinsp;14.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e63.75\u0026thinsp;\u0026plusmn;\u0026thinsp;9.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e26.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:903,500; p:0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:1036,500; p:0.002**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:1019,500; p:0.002**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU:1872,500; p:0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU:2052,500; p:0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU: 1810.000; p:0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\" style=\"width: 7.6393%;\"\u003e\n \u003cp\u003eGrade Point Average\u003c/p\u003e\n \u003cp\u003e(GPA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;3.00 (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e199.95\u0026thinsp;\u0026plusmn;\u0026thinsp;34.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e90.68\u0026thinsp;\u0026plusmn;\u0026thinsp;15.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e109.27\u0026thinsp;\u0026plusmn;\u0026thinsp;20.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e63.88\u0026thinsp;\u0026plusmn;\u0026thinsp;9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e36.85\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;3.00 (n\u0026thinsp;=\u0026thinsp;188)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e209.90\u0026thinsp;\u0026plusmn;\u0026thinsp;28.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e95.92\u0026thinsp;\u0026plusmn;\u0026thinsp;13.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e113.96\u0026thinsp;\u0026plusmn;\u0026thinsp;16.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e66.89\u0026thinsp;\u0026plusmn;\u0026thinsp;9.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e28.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e38.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:13387,000; p:0.012*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:12891.000; p:0.002**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eU:14009,500; p:0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:12802,500; p:0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:13187,500; p:0.005**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU:12988,000; p:0.002**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\" style=\"width: 7.6393%;\"\u003e\n \u003cp\u003eGrade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003e1st grade (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e220.47\u0026thinsp;\u0026plusmn;\u0026thinsp;25.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e101.90\u0026thinsp;\u0026plusmn;\u0026thinsp;11.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e118.57\u0026thinsp;\u0026plusmn;\u0026thinsp;16.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e69.52\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e29.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e39.57\u0026thinsp;\u0026plusmn;\u0026thinsp;5.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003e2nd grade (n\u0026thinsp;=\u0026thinsp;137)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e208.83\u0026thinsp;\u0026plusmn;\u0026thinsp;29.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e94.94\u0026thinsp;\u0026plusmn;\u0026thinsp;14.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e113.88\u0026thinsp;\u0026plusmn;\u0026thinsp;18.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e64.75\u0026thinsp;\u0026plusmn;\u0026thinsp;10.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e37.18\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003e3rd grade (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e202.77\u0026thinsp;\u0026plusmn;\u0026thinsp;28.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e92.36\u0026thinsp;\u0026plusmn;\u0026thinsp;13.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e110.42\u0026thinsp;\u0026plusmn;\u0026thinsp;16.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e64.37\u0026thinsp;\u0026plusmn;\u0026thinsp;9.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e37.37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\n \u003cp\u003e4th grade (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e195.02\u0026thinsp;\u0026plusmn;\u0026thinsp;46.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e87.60\u0026thinsp;\u0026plusmn;\u0026thinsp;19.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e107.42\u0026thinsp;\u0026plusmn;\u0026thinsp;28.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e69.07\u0026thinsp;\u0026plusmn;\u0026thinsp;7.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e29.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e39.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 5.1947%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKW: 11,504; p:0.009**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKW: 15.140; p:0.002**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003eKW: 6,921; p:0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKW:13.389; p:0.004**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKW: 15.140 ; p:0.002**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.4728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKW:9,363; p:0.025*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"8\" style=\"width: 69.8744%;\"\u003e\n \u003cp\u003e\u003cem\u003eAbbreviations: Kruskal‒Wallis H: KW; Mann‒Whitney U: U; p: p value; SD: Standard deviation; p values of the statistically significant were shown as bold *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eConsidering the general and ethical characteristics of the students according to the scale scores, there was a significant relationship between the mean SEPCTN score and age, sex, nationality, GPA, and grade. There was a significant relationship between the mean SEPCTN-CE score and age, sex, nationality, GPA, and grade. There was a significant relationship between the mean SEPCTN-HP score and age, sex, and nationality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThere was a significant relationship between the SRLS-CNP mean score and GPA grade. There was a significant relationship between the SRLS-M mean score and GPA grade. There was a significant relationship between the SRLS-LS mean score, sex, GPA, and grade (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eStudents expressed their ethical problems qualitatively, and the statements were grouped according to the 2019 International Council of Nurses (ICN) ethical principles (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2. Relationships between nursing students\u0026apos; SRLS-CNP and SEPCTN scores\u003c/h2\u003e\n \u003cp\u003eSEPCTN and SRLS-CNP were positive, weak, and statistically significant correlations obtained between the scores (r\u0026thinsp;=\u0026thinsp;0.241; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The SRLS-CNP and SEPCTN subscales strongly correlate with the SEPCTN-CE subscale (r\u0026thinsp;=\u0026thinsp;0.245; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). SRLS-LS has the strongest correlation with SEPCTN and its subdimension SEPCTN-CE (r\u0026thinsp;=\u0026thinsp;0.255; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFindings Regarding the Relationship between SRL-CNP and SEPCTN (n\u0026thinsp;=\u0026thinsp;371)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eone\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e1- SEPCTN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026alpha;: 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e2- SEPCTN-CE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.913\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026alpha;: 0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e3- SEPCTN-HP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.946\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.732\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026alpha;: 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e4- SRLS-CNP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.241\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.245\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.209\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026alpha;: 0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e5- SRLS-M\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.189\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.131\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.899\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026alpha;: 0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e6- SRLS-LS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.265\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.255\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.240\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.939\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.692\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026alpha;: 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"8\"\u003e\n \u003cp\u003e\u003cem\u003eAbbreviations: r: Spearman\u0026apos;s rho correlation coefficient; \u0026alpha;: Cronbach\u0026apos;s alpha internal consistency coefficient; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; p values of the statistically significant correlation coefficients were shown as bold.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3. Examining the ethical problems experienced by nursing students\u003c/h2\u003e\n \u003cp\u003eAs a result of the qualitative analysis of the nursing students\u0026apos; answers to the open-ended questions, two main themes and four subthemes belonging to these main themes were identified (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). These themes are \u0026ldquo;team members with ethical problems and ethical principles\u0026rdquo;.\u003c/p\u003e\n \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n \u003ch2\u003e3.3.1. Main theme: Team members with ethical problems\u003c/h2\u003e\n \u003cp\u003eFour subthemes were created under the main theme of team members experiencing ethical problems. It was determined that ethical issues occurred between students, nurses and students, students and patients, and nurses and patients.\u003c/p\u003e\n \u003cdiv id=\"Sec17\" class=\"Section4\"\u003e\n \u003ch2\u003e3.3.1.1. Subtheme: Students-students\u003c/h2\u003e\n \u003cp\u003eIt was concluded that there were ethical problems among nursing students studying clinical practice at different grade levels in the same clinic. The attitudes of interns towards lower classes are expressed in the following sentences.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;To be treated as absent by intern students in our service\u0026rdquo; (Participant (P) 183)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;There is no respect by the intern students; they have a contemptuous look\u0026rdquo; (P 164)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Because I am a man, they always excluded me (women\u0026apos;s health and disease practice internship), nurses, and our friends when I went to the patient for intervention. (P 82)\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec18\" class=\"Section4\"\u003e\n \u003ch2\u003e3.3.1.2. Subtheme: Between students and patients\u003c/h2\u003e\n \u003cp\u003eAccording to the data obtained from the interviews, the student nurses encountered some difficulties with patients in the clinic. They violate ethical rules by going beyond clinical practices.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Intern nurses from other wards come to see the patient in the psychiatry ward\u0026rdquo; (P 172).\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Female patients did not want us to enter their room\u0026rdquo; (P 244)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I have come across patients who do not allow the student to practice on himself and try to criticize and hinder the student with a harsh attitude\u0026rdquo; (P 256).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec19\" class=\"Section4\"\u003e\n \u003ch2\u003e3.3.1.3. Subtheme: Between nurses and students\u003c/h2\u003e\n \u003cp\u003eEthical problems have arisen because of the need for more effective communication between nurses working in the clinical environment and student nurses. Based on the students\u0026apos; statements, they stated that nurses use harsh communication language and see student nurses, who will be their colleagues in the future, as a workforce.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The nurses showed a bit of a harsh attitude towards us\u0026rdquo; (P 51).\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Students are not respected\u0026rdquo; (P 31)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I do not think that our future colleagues treat us fairly and respect us\u0026rdquo; (P 165)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Healthcare personnel see the students who come to the clinic not as individuals but as a workforce and prevent us from resting\u0026rdquo; (P 115).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec20\" class=\"Section4\"\u003e\n \u003ch2\u003e3.3.1.4. Subtheme: Between nurses and patients\u003c/h2\u003e\n \u003cp\u003eNursing students also cooperate with health professionals as observers in the clinical environment. One of their negative experiences in their observations is as follows:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The patient who came out of the abortion procedure was scared and crying due to anaesthesia. The patient wanted to hold someone\u0026apos;s hand. The patient was asked if much bleeding had occurred. The nurse left shouting that there are many patients here, I cannot stand next to you all the time\u0026rdquo; (P 182).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\n \u003ch2\u003e3.3.2. Main theme: Ethical principles\u003c/h2\u003e\n \u003cp\u003eThemes were created according to the ICN 2019 ethical codes. The ethical problems experienced in the clinic were discussed from the students\u0026apos; perspective.\u003c/p\u003e\n \u003cdiv id=\"Sec22\" class=\"Section4\"\u003e\n \u003ch2\u003e3.3.2.1. Subtheme: Principle of confidentiality and privacy\u003c/h2\u003e\n \u003cp\u003eThey stated that the ethical principle of confidentiality and privacy is a principle that can often be violated in the clinical setting by nurse students.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The curtain between the patients is never drawn in the double patient rooms in the service\u0026rdquo; (P 49)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;There is much talk about patients who have just come of age or have a mental illness but are hospitalized in another service\u0026rdquo; (P 178).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec23\" class=\"Section4\"\u003e\n \u003ch2\u003e3.3.2.2. Subtheme: Autonomy-respect for the individual principle\u003c/h2\u003e\n \u003cp\u003eThe most common ethical violation experienced by nursing students was the principles of autonomy and respect for the individual. It was expressed to the students that the patients are informed about all kinds of procedures and that they are carried out in a way that does not hurt human dignity.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Some patients do not respect their self-identity\u0026rdquo; (P 208)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;While I was there, I translated the patient\u0026apos;s words to the doctors and nurses. However, vascular access, etc., they chose the way of communicating by nudging the patient\u0026rdquo; (P 176).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e\n \u003ch2\u003e3.3.2.3. Subtheme: Principle of justice-equality\u003c/h2\u003e\n \u003cp\u003eIt was stated that there are principles in the similar nursing approach to patients by allowing students to observe ethical problems during the clinical education process, and patients are separated according to their diagnoses.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Patients with infectious diseases are excluded and left alone\u0026rdquo; (P 115)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;A patient with a diagnosis of schizophrenia is taking a stand\u0026rdquo; (P 30)\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec25\" class=\"Section4\"\u003e\n \u003ch2\u003e3.3.2.4. Subtheme: Do no harm-benefit principle\u003c/h2\u003e\n \u003cp\u003eFuture nurse candidates should carry out initiatives not to harm patients and provide benefits in the theoretical and clinical training they receive during nursing education. The students\u0026rsquo; statements revealed that the health professionals did not fully fulfill this principle against the patients.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Some health personnel think that the patient\u0026apos;s wounds will not hurt, and they do it very hard while dressing\u0026rdquo; (P 120).\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Installing a urinary catheter in a patient without a sterile method and consent\u0026rdquo; (P 62)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThe findings are discussed under three headings.\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Discussion of SEPCTN and SRLS-CNP scale data with sociodemographic findings\u003c/h2\u003e \u003cp\u003e This study revealed that the mean SEPCTN score was high and students had low ethical problems in the clinic. Similar results have also been obtained in the literature (Kırşan, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Dığın \u0026amp; İşcan Ataşen, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This makes the concept of ethics important because the nursing center is human, and its education is human-oriented. In theoretical and clinical education, ethical education is needed for students to learn ethical principles and decision-making processes and gain ethical sensitivity (Mehdipour Rabori et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This was considered a favourable situation for the students in the study after the educational content conveyed in line with ethical values had moderate ethical problems in the practice field.\u003c/p\u003e \u003cp\u003eA significant difference was found between the total SEPCTN score and age, sex, nationality, GPA, grade, choice of profession, and its effect on clinical practice. This difference was as follows: the mean score increased with decreasing age, and female students had fewer ethical problems than male students. The findings of this study were handled according to the literature (Akutay \u0026amp; Ceyhan, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Kurt \u0026amp; Eskimez, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Salar et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe SRLS-CNP, SRLS-M, and SRLS-LS total scores were high among the nursing students. Although existing studies in the literature support our findings, other studies contrast with our results (Subaş \u0026amp; Karacay, 2023; Dogu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Dığın \u0026amp; İşcan Ataşen, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In contrast, Chen et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) reported that nursing students had a high level of SRL. Denat et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), with 524 students, reported that the students had moderate SRL skills, similar to our findings and that the scale scores decreased as their academic achievements decreased. In addition, it was concluded that the SRL skills of fourth-grade students were lower than those of lower-grade students (Denat et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSignificant differences were obtained between the SRLS-CNP total score, GPA, and grade. This difference was that the students used more SRL techniques in the second and third grades, and clinical practice positively impacted the average success rate. The findings of this study were handled according to the literature (Dogu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Hwang \u0026amp; Oh, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Denat et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This finding can be considered self-sacrificing, motivated, and effortful individuals to learn in the clinical setting. In addition, students positively contribute to their learning processes as they constantly interact with nurses and instructors in the clinical practice environment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Discussing the findings of the relationship between the SEPCTN and SRLS-CNP\u003c/h2\u003e \u003cp\u003eThe theoretical model of SRL in nursing was created by Kuiper et al. The model predicted that the student could develop metacognitive thinking strategies that support clinical decision-making and the development of competence in practice (Kuiper, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Studies have shown that nursing students' academic performance and self-confidence in clinical practice are high due to high SRL (Subaş \u0026amp; Karacay, 2023; Dogu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Moghadari-Koosha et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It is predicted that the higher the self-directed learning level of nursing students is, the greater their critical thinking and problem-solving skills will be, and they will be able to cope with the ethical problems that may arise.\u003c/p\u003e \u003cp\u003eRecent developments and increasing demands in the health field have resulted in complex health environments and various ethical problems (Muramatsu et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). To cope with clinical ethical issues, it is necessary to develop problem-solving skills and to educate students who take responsibility and have high self-confidence. Considering this point of view, it will be mandatory for students to actively participate in the teaching-learning process to research and question (Dogu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mehdipour Rabori et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Ding \u0026amp; Zhu, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) as the level of ethical problems increases during clinical education.\u003c/p\u003e \u003cp\u003eIn our study, as the SEPCTN and SRLS-CNP (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) levels of nursing students increased, the SRLS-CNP levels also increased; in this context, the SRLS-CNP can increase the number of students who take responsibility in education and clinical practice, have high self-confidence, and therefore can cope with ethical problems. It is essential to show that it will contribute. This provided meaningful data that enabled students responsible for learning to recognize ethical problems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Discussion of findings related to ethical problems experienced by students\u003c/h2\u003e \u003cp\u003eQualitative data were obtained from students who reported ethical issues they experienced and/or were observed in the clinic. Approximately 1 in 5 of the nursing students in the study faced ethical issues and/or observed ethical issues in the clinic. In parallel with our results, it has been reported that undergraduate nursing students experience moderate and frequent ethical distress in clinical settings (Mehdipour Rabori et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Escolar-Chua, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The researchers considered this situation optimistic concerning students' ability to recognize unethical practices. A review of nursing students revealed that many unethical practices of doctors and other nursing students were observed (Albert et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, it was surprising to the researchers that they experienced these situations during their student lives.\u003c/p\u003e \u003cp\u003eAs a result of the qualitative analysis of the students\u0026rsquo; responses to the question \u0026ldquo;If you have experienced ethical problems, please explain,\u0026rdquo; two main themes emerged. Ethical problems related to healthcare team members were grouped under the \"team members with ethical problems\" theme. The data of students who observed ethical problems among healthcare team members were also reported in the literature (Chen et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Eriksson et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Albert et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It was emphasized that communication was necessary for the professional work of the healthcare team, so ethical problems were an obstacle to communication (Adams et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Lemonidou et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) reported that students experienced ethical problems with health professionals regarding ethical principles not being followed and violations of patients' rights.\u003c/p\u003e \u003cp\u003e In this study, the nursing students stated that autonomy or respect for the individual was the most common ethical principle violation. Similarly, Blondeau et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) reported that ethical principle violations are related to restricting autonomy. In another study conducted with nursing students, the authors reported that the ethical principle of doing no harm-benefit was violated the most in the clinic (Akın Korhan et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Failure to pay attention to patient rights and inadequate information, inappropriate communication, failure to ensure the ethical principle of confidentiality and privacy, and inadequate support of students by nurse educators and nurses are some of the ethical challenges frequently experienced and observed by nursing students (Mehdipour Rabori et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Although nursing students learn ethical principles during their education, they may need more support and guidance in clinical settings (Albert et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Sinclair et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) reported that more than two-thirds of nursing students violated the ethical principles of privacy and respect for the individual, and 87% encountered unsafe working conditions. The fact that students take an ethics course makes them more sensitive to ethical issues. In this respect, they are in an excellent position to identify ethical problems, and this situation contributes positively to their experience and attitudes.\u003c/p\u003e \u003cp\u003eIt is crucial for researchers who are educators to be aware of issues of concern to support role models and encourage the development of ethical attitudes (Sinclair et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Therefore, clinical educators have been role models in solving ethical issues identified by students in the clinic. Nurse researchers need to be sensitive to ethical situations in the clinic. In both clinical and academic settings, nurse educators encourage nurses and students to identify ethical issues and plan action, even in the face of institutional limitations. In clinical settings, educators and clinicians should be involved in developing a culture of collaboration and patient advocacy (Albert et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The researchers in this study planned sessions about ethical situations observed by students and their solutions. Studies also show that students realize that they apply ethical values in practice but feel restricted due to the culture of the clinical environment, which allows unethical practices (Solum et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Yeh et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). It was thought that nurse educators should be role models in providing appropriate conditions for students to express ethical situations, preparing the groundwork for this culture, and conveying ways to follow when expressing ethical situations. A study conducted in New Zealand reported that although ethics education was provided in the nursing undergraduate program, it was unsuccessful in raising ethically competent graduates. For this reason, educators with a leadership role in clinical practice should encourage students to raise ethical issues through institutional procedures (Albert et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sinclair et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the literature, it has been emphasized that nursing students are encouraged to practice moral dilemmas, necessary training is provided, and tools are provided to address ethical issues (Khatiban et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Sinclair et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Epstein \u0026amp; Carlin, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In this study, the researchers initiated the necessary work to report the ethical situations experienced in the clinic observed by the nursing students and themselves and to transfer them to those responsible. They recommended risk analysis to prevent incident recurrence, transfer and express students' observations, and fulfil their ethical duties.\u003c/p\u003e \u003cp\u003eNursing students can express their opinions and values, participate in ethical discussions, and gain a sense of autonomy and ownership in patient care by using institutional infrastructure and role modelling (Mehdipour Rabori et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Truglio-Londrigan \u0026amp; Slyer, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). It also reportedly reduces the danger of improper patient care and needless emotional anguish by prioritizing patients\u0026rsquo; desires and preferences. To allow nursing students and staff to voice issues without worrying about how they would affect their work, it was also recommended that anonymous whistleblower platforms be set up where needed (Heng \u0026amp; Shorey, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNursing students may develop disappointment when care is not as centralized as they believe. In the literature, unprofessional behaviors of healthcare staff, expectations of students to complete paperwork and do things in a short time, patients' right to privacy and autonomy, communication, listening, insufficient time to evaluate the preferences and values of the patient individual, and insufficient time for individualized patient care have been reported (Krautscheid et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Mehdipour Rabori et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Palese et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Therefore, inappropriate or inadequate care can cause ethical distress among nursing students.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. LIMITATIONS","content":"\u003cp\u003eThe greatest strength of this study is the size of the sample. Experienced researchers collected the data. One limitation of the study is that the results were based on the self-reports and experiences of the nursing students. Participants' self-reporting is considered a limitation, as it is a subjective evaluation. Another limitation is that the study was conducted with students who enrolled and attended the course in the spring semester of the 2022\u0026ndash;2023 academic year.\u003c/p\u003e"},{"header":"6. CONCLUSION","content":"\u003cp\u003eThere is a need to improve the quality of nursing students' learning ability due to the increasingly complex and variable medical environments. In this study, the students' SEPCTN and SRLS-CNP scores were not at the desired level, but a significant correlation was obtained between the scales. This situation can be used in nursing education programs to improve self-learning success, integrate SRL strategies into the clinic, and improve judgment ability and clinical reasoning skills. In addition, the ability to recognize ethical problems in the clinic increased as the students' mean scores on the SEPCTN and SRLS-CNP increased in the clinic. The qualitative interviews revealed that students in the clinic could have ethical problems with nurses, friends, and patients. The students determined that ethical problems occur within the team and that the most common ethical problem violates the principles of autonomy and respect for the individual. Students should be encouraged to identify these problems\u0026rsquo; primary sources and prevent violations before they occur.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003e6.1. Integration into clinical education\u003c/h2\u003e \u003cp\u003e It has been suggested that creating an SRL environment is necessary for nursing students to recognize ethical situations without instructor guidance and to comply with professional ethical principles. Nursing students must be aware of their values as they adapt to their professional values and new roles during their education, which may be related to SRL. The results of this study revealed that students with high SRL status can recognize ethical issues in clinical teaching. In line with these data, course content and clinical teaching should be organized and improved to enhance students' self-regulation skills in the clinic. The importance of the clinical environment cannot be overlooked, given that students look to their clinical educators as role models, helping them develop coping skills while gaining experience in caring and thus contributing to ethical competence. In addition, students should be allowed to express their ethical concerns and develop an autonomous and professional attitude. Strengthening ethical content in theoretical courses will prepare students for the complex situations they will encounter in clinical practice.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRB: Conceptualization, validation, formal analysis, investigation, resources, data curation, writing - original draft, writing - review \u0026amp; editing, visualization.OD: Methodology, validation, formal analysis, data curation, writing - original draft, writing - review \u0026amp; editing, supervision\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank all nursing students who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdams, A. M. N., Mannix, T., \u0026amp; Harrington, A. (2017). Nurses\u0026apos; communication with families in the intensive care unit\u0026ndash;a literature review. \u003cem\u003eNursing in Critical Care\u003c/em\u003e, 22(2), 70-80. https://doi.org/10.1111/nicc.12141\u003c/li\u003e\n\u003cli\u003eAkın Korhan, E., Ceylan, B., \u0026Uuml;st\u0026uuml;n, \u0026Ccedil;., et al. (2018). Ethical problems in the clinical setting from the perspective of nursing students \u003cem\u003eEge Journal of Medicine\u003c/em\u003e, 57, 75-81.\u003c/li\u003e\n\u003cli\u003eAkutay, S., \u0026amp; Ceyhan, \u0026Ouml;. (2022). Determination of nursing students\u0026rsquo; ethical problems in clinical teaching. \u003cem\u003eG\u0026uuml;m\u0026uuml;şhane University Journal of Health Sciences\u003c/em\u003e, 11, 1452-1459.\u003c/li\u003e\n\u003cli\u003eAlbert, J. S., Younas, A., \u0026amp; Sana, S. (2020). 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Cultural and hierarchical influences: Ethical issues faced by Taiwanese nursing students. \u003cem\u003eMedical Education\u003c/em\u003e, 5, 475\u0026ndash;484. https://doi.org/10.1111/j.1365-2923.2009.03589.x\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ethics, self-regulate, principle, nursing student, clinical teaching, mixed methods","lastPublishedDoi":"10.21203/rs.3.rs-5898417/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5898417/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe clinical education process, which is essential for nursing education, must be carried out by contributing to students' ethical values and self-regulated learning situations.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe study was conducted to evaluate the relationship between self-regulated learning situations and the ethical problems experienced by nursing students in clinical teaching and to determine their views.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study used a mixed-method design with 371 nursing students. Data were collected using the Socio-Demographic Data Form, the Self-Regulated Learning Scale in Clinical Nursing Practice, and The Scale of Ethical Problems in Clinical Teaching in Nursing. The qualitative part was completed with 67 students who reported ethical issues.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was a weak, positive, and significant relationship between self-regulated learning in clinical practice and ethical problems in clinical teaching. Qualitative data were analyzed in two themes: \"Team members with ethical problems\" and \"Ethical violation principles\".\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIt was determined that nursing students experienced fewer ethical problems in clinical teaching as their self-regulated learning level increased. They also reported ethical problems within the team and that the most common violations were patient autonomy and respect for the individual.\u003c/p\u003e","manuscriptTitle":"Effect of Self-Regulated Learning by Nursing Students on Ethical Problems in Clinical Teaching","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-28 15:52:32","doi":"10.21203/rs.3.rs-5898417/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d9b3a8c-cb28-42ee-a22d-8900f2f757fe","owner":[],"postedDate":"January 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-02T23:53:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-28 15:52:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5898417","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5898417","identity":"rs-5898417","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}