Limitations
The present study has some limitations such as the first phase of study was carried out as descriptive study in single-center hospital, and data was collected using self-reported questionnaires. There may be a possibility of bias and exaggeration of scores. The time interval between the intervention and post-test outcome assessment was also short, and thus, the study provided no information about the long‑term effects of education program on moral reasoning, sensitivity and distress. Ultimately, it should be considered that the impact of one session training on nurses through discussion was very high (Hedge’s g effect size), a possible reason for this extreme finding is that the study focused on training low performers. Therefore, the effects that were found would probably be significantly lower for nurses with lesser development needs. For these reasons, the generalization of the findings is limited and also the results should be interpreted with caution. Nevertheless, the findings of the study would be helpful for nurse educators and policy makers to develop continuous training in ethical decision-making to improve nurses’ awareness and understanding of the importance of moral decision-making process and improve the quality of care.