Program Demonstrates Sustained Impact on Moral Resilience

May 02, 2023

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Study in American Journal of Critical Care examines the long-term effects of completing an experiential educational program about mindful ethical practice and resilience

ALISO VIEJO, Calif. - May 2, 2023 - A program developed by Cynda Hylton Rushton, PhD, RN, FAAN, and her team from Johns Hopkins University led to sustained improvements in nurses' ability to effectively address ethical challenges, according to research published in American Journal of Critical Care (AJCC).

"The Mindful Ethical Practice and Resilience Academy: Sustainability of Impact" examines the long-term impact on nurses who completed an experiential educational program designed to improve their skills in mindfulness, resilience and competence in confronting ethical challenges.

The Mindful Ethical Practice and Resilience Academy (MEPRA) consists of six, four-hour workshops conducted over 12 weeks. The curriculum includes facilitated discussion, role play, guided mindfulness and reflective practices, case studies and high-fidelity simulation training.

Rushton serves as principal investigator for the program is the Anne and George L. Bunting Professor of Clinical Ethics at Johns Hopkins University Berman Institute of Bioethics and School of Nursing in Baltimore.

"It's increasingly important that we address ethical concerns in a sustainable way and support the integrity and well-being of nurses. In our sample, more than 95% of participating nurses reported confronting ethical challenges in their workplace, but only 15% had previously received formal ethics training," Rushton said. "Our findings offer a promising path forward in strengthening the skills, tools and resources for nurses to address moral adversity in clinical practice and to amplify their moral resilience."

Current threats to the nursing workforce require targeted interventions with long-term impact, and many interventions are one-time programs that have not been systematically evaluated or been accompanied by efforts to sustain the gains that were made.

Through an academic-practice partnership, Rushton's team developed, implemented and evaluated MEPRA's impact on cultivating the components of moral resilience in direct care nurses. It takes the unique approach of combining education with mindfulness and experiential learning to address the complex moral and ethical issues confronted by nurses at the point of care.

The study involved surveys of 245 nurses at four points during the intervention: at baseline, immediately after completing the program, and at three and six months afterward. This work was performed at Johns Hopkins Hospital, Baltimore, and Sibley Memorial Hospital, Washington, D.C.

The results of the intervention were generally sustained for months afterward. The most robust improvements were in ethical confidence, moral competence, resilience, work engagement and mindfulness, and decreased emotional exhaustion, depression and anger. Turnover intentions were reduced initially and at three months, but improvements were not sustained at six months. Some outcomes, including anxiety and empathy, were not improved immediately after the intervention but were significantly improved at three months.

To access the article and full-text PDF, visit the AJCC website at

The American Association of Critical-Care Nurses (AACN) has honored Rushton with its 2023 Distinguished Research Lectureship, and the May issue of AJCC also includes the abstract of her lecture to be presented during AACN's annual conference, the National Teaching Institute & Critical Care Exposition, May 22-24 in Philadelphia. A complete manuscript will be published in the July issue.

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of about 130,000 acute and critical care nurses and can be accessed at

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization's vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world's largest specialty nursing organization, with about 130,000 members and over 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000;;;