Narrative therapy group intervention for nurses’ moral resilience: A feasibility study

Abstract

Background

Ethically complex care exposes nurses to persistent moral distress, harming well-being, integrity, and care quality. Moral resilience offers a targeted response, but intervention evidence is scarce. Because narrative therapy enables meaning-making and identity re-authoring, it may cultivate moral agency and integrity.

Aim

To develop and refine a narrative therapy–based group intervention for nurses’ moral resilience and to examine its feasibility and acceptability in a pilot study, with exploratory assessment of outcome trends.

Design

A preliminary group intervention program aimed at supporting nurses’ moral resilience was initially developed through a literature review based on evidence-based principles. The Delphi method and a pilot study were subsequently employed to refine and finalize the intervention program.

Participants and research context

Eleven experts from seven provinces in China participated in the Delphi process, bringing diverse disciplinary and regional perspectives. Feasibility was examined with five clinical orthopaedic nurses, who completed outcome assessments at baseline, immediately post-intervention, and 1 month later, alongside evaluations of intervention acceptability.

Ethical considerations

This study was approved by the ethical board of Quanzhou Orthopedic - Traumatological Hospital (Approval No. IRB-2023-047).

Findings

Nine studies informed the development of the initial intervention draft, which was refined through two rounds of Delphi consultation with eleven experts. The finalized Nurse-MRNT (Moral Resilience Narrative Therapy for Nurses) comprised four thematic modules: Professional Journey, Journey Obstacles I & II, Journey Strategies, and Journey Reflections. In the pilot study, descriptive trends suggested short-term improvements in mental health and occupational burnout and reductions in moral distress. Moral resilience scores increased from pre- to post-intervention; however, the overall change across the three assessment time points was not statistically significant in this small pilot sample.

Conclusion

The narrative group intervention (Nurse-MRNT) was developed through a rigorous, theory-informed process and showed good feasibility and acceptability in this pilot study. Larger controlled studies are warranted to evaluate its effectiveness and sustainability.