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.
Sandra M. Swoboda is the Department of Surgery research program coordinator and prelicensure masters entry program simulation coordinator/educator, Johns Hopkins University School of Nursing and School of Medicine.
Am J Crit Care. 2021 Jan 1;30(1):e1-e11. doi: 10.4037/ajcc2021359.
Ethical challenges in clinical practice significantly affect frontline nurses, leading to moral distress, burnout, and job dissatisfaction, which can undermine safety, quality, and compassionate care.
To 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.
A 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.
Mindfulness, 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).
Use 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.
临床实践中的伦理挑战对一线护士影响重大，导致道德困境、倦怠和工作不满，从而影响安全性、质量和关爱护理。
研究一项纵向、体验式教育课程对增强护士应对临床实践中伦理挑战的技能的影响，包括正念、韧性、信心和能力。
在一家大型学术医疗系统的 2 家医院进行了前瞻性重复测量研究，在课程干预前后进行。干预组（192 名）和对照组（223 名）完成了评估目标的研究工具。
干预后，正念、伦理信心、伦理能力、工作投入和韧性显著提高。韧性和正念与道德能力和工作投入呈正相关。随着韧性和正念的提高，离职意愿和倦怠（情绪疲惫和去人性化）降低。干预后，护士报告抑郁和愤怒症状显著改善。该干预措施对重症监护病房和非重症监护病房的护士（除情绪疲惫外）以及不同工作年限的护士（除离职意愿外）均有效。
体验式发现学习实践和高保真模拟似乎可行且有效，可通过培养道德韧性的组成部分来增强护士在临床实践中应对道德困境的技能，从而促进健康的工作环境、提高留用率和增强患者护理。
