• Cynda Hylton Rushton, Sandra M Swoboda, Nancy Reller, Kimberly A Skarupski, Michelle Prizzi, Peter D Young, and Ginger C Hanson.
• Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics at Berman Institute of Bioethics and a professor of nursing and pediatrics, Johns Hopkins University School of Nursing and School of Medicine, Baltimore, Maryland.
• Am. J. Crit. Care. 2021 Jan 1; 30 (1): e1-e11.

BackgroundEthical challenges in clinical practice significantly affect frontline nurses, leading to moral distress, burnout, and job dissatisfaction, which can undermine safety, quality, and compassionate care.ObjectivesTo examine the impact of a longitudinal, experiential educational curriculum to enhance nurses' skills in mindfulness, resilience, confidence, and competence to confront ethical challenges in clinical practice.MethodsA prospective repeated-measures study was conducted before and after a curricular intervention at 2 hospitals in a large academic medical system. Intervention participants (192) and comparison participants (223) completed study instruments to assess the objectives.ResultsMindfulness, ethical confidence, ethical competence, work engagement, and resilience increased significantly after the intervention. Resilience and mindfulness were positively correlated with moral competence and work engagement. As resilience and mindfulness improved, turnover intentions and burnout (emotional exhaustion and depersonalization) decreased. After the intervention, nurses reported significantly improved symptoms of depression and anger. The intervention was effective for intensive care unit and non-intensive care unit nurses (exception: emotional exhaustion) and for nurses with different years of experience (exception: turnover intentions).ConclusionsUse of experiential discovery learning practices and high-fidelity simulation seems feasible and effective for enhancing nurses' skills in addressing moral adversity in clinical practice by cultivating the components of moral resilience, which contributes to a healthy work environment, improved retention, and enhanced patient care.©2021 American Association of Critical-Care Nurses.

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