ETHOS: a modular ethics-informed online mindfulness program for emotional well-being, moral resilience and burnout prevention in hospital practitioners — protocol for a mixed-methods single-arm proof-of-concept study

Abstract Background Burnout and emotional exhaustion among hospital practitioners are common and are frequently intensified by sustained workload and morally challenging clinical situations. Mindfulness-based interventions can improve stress and well-being, yet uptake in hospital settings is often constrained by long session formats, shift work and limited protected time. We developed ETHOS (Ethics-informed Training for Hospital practitioners: Online Skills for mindful practice), a brief, modular mindfulness program that integrates micro-skills for responding to moral adversity and value conflict.

Methods: This mixed-methods, single-arm proof-of-concept study will recruit approximately 30 hospital practitioners from a French hospital. ETHOS comprises six weekly online modules delivered via a secure platform. Each week includes a formal session split into two 30-minute parts (≈ 60 minutes/week core dose): mindfulness training plus ethics-informed moral-resilience application that can be completed on separate days. Participants will also access guided audio practices offered in two brief formats (5 and 10 minutes) and 60–90-second ‘micro-practices’ designed for clinical workflow. A booster online module will be delivered four weeks after the program. Assessments will be completed at baseline (T0), post-intervention (T1, week 6), pre-booster (T2, week 10; brief assessment), and follow-up (T3, week 18). Primary outcomes are feasibility and acceptability (recruitment, retention, module completion, home practice adherence, participant-reported acceptability and burden). Secondary outcomes include emotional exhaustion and other burnout dimensions, psychological well-being, stress, mindfulness, self-compassion, and ethics-related outcomes (moral distress and moral resilience). A purposive subsample will be invited to participate in semi-structured interviews to explore mechanisms of change, usability and engagement with the online format, contextual facilitators and barriers, and perceived ethical relevance. After completion of the T3 follow-up (end of the parent study), participants will be offered an optional advanced extension course (Phase 2) evaluated under a separate protocol; extension outcomes will be reported separately.

Discussion: This protocol addresses an implementation-critical question: can a short, modular mindfulness program with an ethics-informed component be feasible and acceptable for hospital practitioners while showing a signal of change in well-being and burnout-related outcomes? Findings will inform refinement of the intervention and the design of a subsequent randomized trial. Trial registration : The study will be registered prior to enrolment of the first participant. At the time of protocol submission, registration had not yet been completed because recruitment had not started and the protocol was still being finalized.