The impact of simulation-based ethical education on nursing students' moral distress levels

Objectives The purpose of this study was to determine whether integrating ethical simulation-based education (SBE) into prelicensure nursing students' curriculum would impact moral distress levels.Methods A longitudinal mixed methods design was used to measure moral distress levels and collect qualitative data related to the SBE.Results In the final sample (n=48), there was no statistically significant difference among moral distress scores over the three measured time points. Thematic analysis revealed four primary themes: (1) powerlessness as a student; (2) students have a basic moral understanding; (3) discomfort in speaking up with integrity; and (4) students understand the importance of emotional intelligence.Conclusions The final and lowest survey score, combined with the results of the thematic analysis, indicates that integrating ethical SBE throughout curriculum could impact moral distress. In addition, training educators in maintaining psychologically safe environments can empower students and potentially reduce burnout.