Introduction
Nursing is a profession that requires ethical decisions that affect the health of patients [1]. Professional values are ideals and beliefs that shape behaviors and provide the basis for decision-making. Professional values are standards that a professional group accepts and provide a framework for behaviors that affect healthcare providers. Nurses and other healthcare providers need professional values to overcome ethical care problems [2]. Targeted education on nursing professional values is essential for the bright future of the nursing profession. Therefore, paying attention to professional values in the curriculum is necessary for training qualified nursing students. Because these values lead to improving the quality-of-care behaviors [3], commitment to them is essential to form the profession’s identity because the decisions made in the nursing profession can create conflicts that confront nurses with complex questions; therefore, understanding professional and committed values is crucial [4]. Adherence to professional values is influenced by various factors, such as culture, personal values, education, job experiences, and organizational position [5]. Many faculties of medical sciences worldwide have included special courses, including medical ethics, early confrontation with the patient, etc. to teach elements related to professionalism in their curriculum. The research shows that the professional values of students change when they enter the university and under the influence of education and various other factors until they finish their studies [6]. 
The American Nursing Association has compiled a set of core values for nurses, including human dignity, independence, honesty, justice, altruism, and truth, which every nurse should apply [7]. Culture is one of the vital factors in the development of professional values of people. Culture refers to values, beliefs, and habits learned during socialization that shape people’s ideas, perceptions, decisions, and behavior. All over the world, every nurse is responsible for certain defined professional values and must act and behave accordingly [8]. Limited research was conducted about the professional values of nursing students in different countries. A review study was conducted regarding the professional values of nursing students [9]. Finding significant factors in professional values in nursing students is crucial because it will not only help the planning of educational and clinical managers of universities but also help provide safe and ethical care. So far, no study has been conducted on reviewing the factors affecting the professional values of nursing students.
Materials and Methods 
In the present narrative review, by searching the databases of Science Direct, Magiran, SID, Iran Medex, Google Scholar, Web of Sciences, and PubMed, and using the keywords “professional values” and “nursing students” and the corresponding translated Persian words (to search in Persian articles), the relevant articles were searched. The inclusion criteria included all Farsi and English articles that examined the spiritual health of nursing students between January 2010 and May 2022. A manual search was also performed on Google. If the full text of the article was not found, it was excluded from the study. After searching the databases, 208 articles were included in the study. The researchers examined 25 articles by applying the inclusion and exclusion criteria and removing duplicates (Figure 1).

Results 
The findings showed that out of 25 studies, most studies (7 studies) were related to Iran. The results showed that nursing students have high professional values, and effective factors can affect their professional values. All included studies have used Weis and Schank’s revised nursing professional values scale (10). It contains 26 items with the dimensions of care (9 items), activism (5 items), trust (5 items), professionalism (4 items), and justice (3 items). It is scored on a 5-point Likert scale from unimportant=1, less important=2, relatively important=3, important=4, to very important=5. 
In the review of the obtained studies, the most crucial components from the student’s point of view were keeping the patient’s confidentiality (care dimension) and maintaining competence in the clinical environment (trust dimension), and the least crucial is the activism and the professionalism dimensions (Table 1).










The study showed two factors affecting students' moral values: Personal and educational (Table 2).


Discussion
This study was conducted to review the factors related to the professional values of nursing students, and the results indicate that two factors influencing the moral values of students include personal and educational factors. 
The effective individual factors on the professional values of students in different countries included age, sex, family economic conditions, city of study, marital status, education level, educated father, one of the parents being educated, choosing a profession with interest and knowledge, considering professional conditions for job selection, personality type, awareness of individual values, cultural difference, level of human dignity, caring behaviors, moral idealism. 
Age was one of the factors affecting professional values. It has had different results in different studies. A significant positive relationship was observed between age and professional values in Vafadar et al.'s study [1]. In the study conducted by Pasalak et al., older students had a higher professional value score, which was consistent with a study conducted in Spain [7, 28]. In the study conducted by Pourama et al., a significant inverse relationship was observed between age and professional values; that is, with increasing age, the average scores of professional values dimensions decreased [4]. While in Martin et al.'s study, no significant relationship was observed between the scores of professional values and age [29]. Therefore, conducting studies with a more accurate statistical method and a suitable sample size is suggested.
Gender was another factor affecting professional values. In some studies, female students scored higher than male students in professional values [9, 27, 30]. While the scores of male students in Hong Kong and Taiwan were higher than those of female students [31]. Gender is vital in developing professional values, especially in female students. From this point of view, it can be said that many male students know nursing as a job and not a profession; they have a higher chance of getting into university with easy admission requirements, diverse career options, and possibly a job. However, female students view it as a caring and altruistic profession. Gender was reported as an influential factor in the professional values of nursing students, but affecting it in different countries is different [9]. A qualitative study by Schmidt et al. stated that male nursing students value care but may show it differently than their female counterparts [32]. 
In the present study, it was found that the criteria for choosing a nursing job can be one of the factors affecting professional values. A comparison between Turkish and American students showed that American students had higher professional and career values. Their choice of nursing was primarily based on their personal goals and suitability for the profession. In contrast, Turkish students primarily considered the conditions of life to choose a job, which is consistent with the study conducted in the United States [33].
The education level of parents in this study was one of the effective factors in the professional values of students, so in Spanish students, the education level of parents had a significant positive relationship with professional values. However, in another study conducted on Turkish and Tanzanian students, professional values had a significant relationship only with the father's education level [7]. Research has shown that culture and educational and occupational environments greatly impact the development of professional values in nursing students [34, 35]. According to Alfred et al.'s study, the different aspects of the culture of each country are influential and further research among countries at the same level with similar cultures is required [26]. In this study, students who entered the nursing field with interest had a higher professional value score than others [25]. This study considered marriage  a positive factor in nursing students' professional value scores [36]. 
The present study's findings showed that clinical decision-making in nursing students has a significant correlation with their professional values, and the total score of professional value in all dimensions, except the dimension of professionalism, had a significant relationship with clinical decision-making. Because junior and senior students make decisions regardless of their clinical experience, consider being in a position with professional values because a difference exists between the clinical experience of senior and junior students regarding professionalism. This shows that students have flexibility in clinical decision-making [37]. The present study's findings showed that personality traits were among the factors affecting professional values. Also, the study's results showed that among the dimensions of adherence to professional values, nursing students give more importance to the dimension of trust, which is exactly similar to the findings of another study [38].
Among the other effective factors on professional values were caring behaviors, so with the increase in the professional value score, the caring behavior score was higher. Previous research shows that the crucial professional values for nursing students in China [31] and Indonesia [20] belong to the moral dimension, while in Iran, in the study conducted by Porchengizi et al., students give more importance to the dimension of professional mastery [19]. A study showed that sophomore students had a lower score of caring behaviors than freshman, junior, and senior students. According to Cohen’s theory, with increasing years of education, professional skills, and values, caring behaviors increase. The reason for low-care behaviors in sophomores is that they were exposed to homework and diseases for the first time. On the other hand, students’ self-confidence increases with increasing skills in the years of study [39].
In the present study, it was found that the academic year of the students does not affect their importance to the values of the nursing profession, which is consistent with other studies, which can be concluded that the nursing students had the desire to join this profession with their internal motivation [27, 30, 40]. According to this study, increasing the level of education and training is associated with a better understanding of professional values, which is consistent with some studies that indicate that a higher level of education has led to greater awareness and application of nursing professional values during nurses’ clinical work [41].
In the present study, no significant relationship was found between the education levels of pre-nursing, second year of nursing, bachelor’s and master’s degrees, and professional values. It was reported that professional values were not created in the individual by the beginning of nursing education. It is possible that professional values were related to the individual’s values, which was not consistent with the studies of Lenners and colleagues [42]. It needs more extensive studies in this regard. 
Conclusion
The present study was conducted to investigate the professional values of nursing students and related factors, which include personal and educational effects. Therefore, the solutions to increase attention to the professional values of nursing students through education, attention to individual values and the attitudes and views of nursing students to the career and profession of nursing before entering the university, as well as attention to age and gender according to the needs and culture of different societies can be the influential factors in students’ professional values. It is suggested to conduct studies on the factors related to the professional values of students with appropriate methodology and sample size. It is also suggested that a meta-analysis of existing studies is needed due to the importance of professional values. 

Ethical Considerations
Compliance with ethical guidelines
This article is the result of a review study and did not have any human or animal samples. Therefore, there was no need for a code of ethics. Ethical issues such as avoiding plagiarism, ensuring robustness in collecting relevant data, and publishing rights were considered.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Writing the article and searching the articles: Elaheh Arabameri, Mahsa Kamali and Fereshteh Araghiyan Mojarad; A critical review of the article: Hedayat Jafari.

Conflict of interest
The authors declared no conflict of interest. 

Acknowledgments
We thank the site manager, Nasiba Sari College of Nursing and Midwifery library staff, and other professors and colleagues who helped us in this research. 

References

1. Vafadar Z, Rahmati-Najarkolaei F, Parandeh A. [Professional values from nursing students’ perspective in a selected Military University in Tehran in 2019 (Persian)]. J Mil Med. 2020; 22(4):393-400. [Link]
2. Hoseini F S, Parvan K, Zamanzadeh V. [Professional values of the nursing students’ perspective in type 1 universities of medical sciences (Persian)]. Q J Nurs Manage. 2012; 1(1):69-82. [Link]
3. Parvan K, Hosseini F, Zamanzadeh V. [Professional values from nursing students’ perspective in Tabriz University of Medical Sciences: A Pilot Study (Persian)]. Iran J Nurs. 2012; 25(76):28-41. [Link]
4. Pourama A, Azizzadeh Forouzi M, Asadabadi A. [Professional values from nursing students’ perspective in Kerman province: A descriptive study (Persian)]. Iran J Med Ethics Hist Med. 2015; 7(6):79-88. [Link]
5. Jasemi M, Cheraghi R, Azimzadeh R, Namadi F. The relationship between personality characteristics and adherence to professional values among nursing students. Nurs Midwifery Stud. 2020; 9(1):29-35. [DOI:10.4103/nms.nms_28_19]
6. Sajadi M, Baradaran R, Saeghian A, Basiri Moghadam K. [Standardization of nursing professional values scale in Mashhad School of Nursing Students (Persian)]. Educ Ethic Nurs. 2019; 8(3):21-9. [Link]
7. Paşalak Şİ, Subaş F, Kaya N, Seven M. Professional values in a sample of nursing students from different countries. Florence Nightingale J Nurs. 2021; 29:93-102. [DOI:10.5152/FNJN.2021.19200] [PMID] [PMCID]
8. de los Ángeles Rodríguez-Gázquez M, Hoyuelos SB, González-López JR. Countries’ cultures and professional nursing values: Cross-cultural evidence from Spanish and Colombian nursing students. Nurs Educ Pract. 2021; 50:102953. [DOI:10.1016/j.nepr.2020.102953] [PMID]
9. Parandeh A, Khaghanizade M, Mohammadi E, Nouri JM. Factors influencing development of professional values among nursing students and instructors: A systematic review. Glob J Health Sci. 2015; 7(2):284-93. [DOI:10.5539/gjhs.v7n2p284] [PMID] [PMCID]
10. Weis D, Schank MJ. An instrument to measure professional nursing values. J Nurs Scholarsh. 2000; 32(2):201-4. [DOI:10.1111/j.1547-5069.2000.00201.x] [PMID]
11. Aydın GÖ, Turan N, Irmak AY, Çelikkalp Ü, Aygün A, Çakır Z. Nursing students’ individual values, inclination to ethical and professional values. Perspect Psychiatr Care. 2022; 58(2):850-60. [DOI:10.1111/ppc.12863] [PMID]
12. Caldwell HE, Miller KL. Professional values in Baccalaureate nursing students. Akron: The University of Akron; 2016. [Link]
13. Arries EJ. Professional values and ethical ideology: Perceptions of nursing students. Nurs Ethics. 2020; 27(3):726-40. [DOI:10.1177/0969733019889396] [PMID]
14. Conejo T, Loyd L. Professional values development during a baccalaureate nursing degree completion program. Teach Learn Nurs. 2020; 15(2):116-20. [DOI:10.1016/j.teln.2019.12.006]
15. Ibrahimoglu O, Mersin S, Kilic HS, Kahraman BB. Professional Values of Nursing Students in Turkey. Int J Caring Sci. 2020; 13(2):878-84. [Link]
16. Bleda S, Alvarez I, Prat M. The perceptions of professional values among students at a Spanish Nursing School. Healthcare. 2020; 8(2):74. [DOI:10.3390/healthcare8020074] [PMID] [PMCID]
17. Fernández‐Feito A, Basurto‐Hoyuelos S, Palmeiro‐Longo M, García‐Díaz V. Differences in professional values between nurses and nursing students: A gender perspective. Int Nurs Rev. 2019; 66(4):577-89. [DOI:10.1111/inr.12543] [PMID]
18. Chikeme PC, Ogbonnaya NP, Anarado AN, Ihudiebube-Splendor CN, Madu O, Israel CE. Professional values of Nigerian nursing students. Int J Med Res Health Sci. 2019; 8(3):26-35. [Link]
19. Poorchangizi B, Borhani F, Abbaszadeh A, Mirzaee M, Farokhzadian J. Professional values of nurses and nursing students: A comparative study. BMC Med Educ. 2019; 19(1):438. [DOI:10.1186/s12909-019-1878-2] [PMID] [PMCID]
20. Abdullah KL, Chong MC. Factors influencing professional values among Indonesian undergraduate nursing students. Nurse Educ Pract. 2019; 41:102648. [DOI:10.1016/j.nepr.2019.102648] [PMID]
21. Alkaya SA, Yaman Ş, Simones J. Professional values and career choice of nursing students. Nurs Ethics. 2018; 25(2):243-52. [DOI:10.1177/0969733017707007] [PMID]
22. Abou Ramadan AH, El-Demerdash SM. The relationship between professional values and clinical decision making among nursing student. J Nurs Health Sci. 2017; 6(7):19-26. [Link]
23. Aktas YY, Karabulut N. Professional values in Turkish undergraduate nursing students and its reflection on caring behaviour. Kontakt. 2017; 19(2):e116-21. [Link]
24. Riklikiene O, Karosas L, Kaseliene S. General and professional values of student nurses and nurse educators. J Adv Nurs. 2018; 74(3):666-76. [DOI:10.1111/jan.13473] [PMID]
25. Donmez RO, Ozsoy S. Factors influencing development of professional values among nursing students. Pak J Med Sci. 2016; 32(4):988-93. [PMCID]
26. Alfred D, Yarbrough S, Martin P, Mink J, Lin YH, Wang LS. Comparison of professional values of Taiwanese and United States nursing students. Nurs Ethics. 2013; 20(8):917-26. [DOI:10.1177/0969733013484486] [PMID]
27. Bang KS, Kang JH, Jun MH, Kim HS, Son HM, Yu SJ, et al. Professional values in Korean undergraduate nursing students. Nurse Educ Today. 2011; 31(1):72-5. [DOI:10.1016/j.nedt.2010.03.019] [PMID]
28. Jiménez-López FR, Roales-Nieto JG, Seco GV, Preciado J. Values in nursing students and professionals: An exploratory comparative study. Nurs Ethics. 2016; 23(1):79-91. [DOI:10.1177/0969733014557135] [PMID]
29. Martin P, Yarbrough S, Alfred D. Professional values held by baccalaureate and associate degree nursing students. J Nurs Scholarsh. 2003; 35(3):291-6. [DOI:10.1111/j.1547-5069.2003.00291.x] [PMID]
30. Hayes TL. Exploration of professional values held by baccalaureate and associate degree nursing students [MA thesis]. Florida:The Florida State University; 2006. [Link]
31. Lin YH, Li J, Shieh SI, Kao CC, Lee I, Hung SL. Comparison of professional values between nursing students in Taiwan and China. Nurs Ethics. 2016; 23(2):223-30. [DOI:10.1177/0969733014561912] [PMID]
32. Schmidt BJ. Core professional nursing values of baccalaureate nursing students who are men. Nurs Ethics. 2016; 23(6):674-84. [DOI:10.1177/0969733015579310] [PMID]
33. Wilkes L, Cowin L, Johnson M. The reasons students choose to undertake a nursing degree. Collegian. 2015; 22(3):259-65. [DOI:10.1016/j.colegn.2014.01.003] [PMID]
34. Fernández-Feito A, Palmeiro-Longo MdR, Hoyuelos SB, García-Díaz V. How work setting and job experience affect professional nurses’ values. Nurs Ethics. 2019; 26(1):134-47. [DOI:10.1177/0969733017700238] [PMID]
35. Yeom HA, Ahn SH, Kim SJ. Effects of ethics education on moral sensitivity of nursing students. Nurs Ethics. 2017; 24(6):644-52. [DOI:10.1177/0969733015622060] [PMID]
36. Ayla IA, Ozyazicioglu N, Atak M, Surenler S. Determination of professional values in nursing students. Int J Caring Sci. 2018; 11(1):254-61. [Link]
37. Phillips BC. Clinical decision making in last semester senior baccalaureate nursing students [PhD dissertation]. Milwaukee: The University of Wisconsin-Milwaukee; 2015. [Link]
38. Clark DK. Professional values: A study of education and experience in nursing students and nurses [PhD dissertation]. Minnesota: Capella University; 2009. [Link]
39. Loke JC, Lee KW, Lee BK, Noor AM. Caring behaviours of student nurses: Effects of pre-registration nursing education. Nurse Educ Pract. 2015; 15(6):421-9. [DOI:10.1016/j.nepr.2015.05.005] [PMID]
40. Parvan K, Zamanzadeh V, Hosseini FA. Assessment of professional values among Iranian nursing students graduating in universities with different norms of educational services. Thrita. 2012; 1(2):37. [DOI:10.5812/thrita.6441]
41. Sibandze BT, Scafide KN. Among nurses, how does education level impact professional values? A systematic review. Int Nurs Rev. 2018; 65(1):65-77. [DOI:10.1111/inr.12390] [PMID]
42. Leners DW, Roehrs C, Piccone AV. Tracking the development of professional values in undergraduate nursing students. J Nurs Educ. 2006; 45(12):504-11. [DOI:10.3928/01484834-20061201-06] [PMID]