Purpose: Nurses frequently encounter morally complex clinical situations that generate moral distress, which, if unresolved, may accumulate as moral residue and progress to moral injury. This review synthesizes current evidence on moral resilience and ethical practice environments and proposes an integrated framework for sustainable ethical practice in hospitals. Methods: A narrative review of literature was conducted to examine moral distress, moral injury, moral resilience, ethical climate, psychological safety, and speaking-up climate. Conceptual integration was undertaken to present a multilevel strategy framework and a stepwise model linking individual, relational, and organizational factors. Results: Moral resilience, defined as the capacity to maintain or restore moral integrity under moral adversity, comprises four domains: response to moral adversity, personal integrity, relational integrity, and moral efficacy. Higher moral resilience is associated with lower burnout, turnover intention, and quiet quitting and may mediate the relationship between ethical climate and work engagement. However, individual resilience alone is insufficient in hierarchically structured and psychologically unsafe environments. In such contexts, sustainable ethical practice requires institutionalized ethical climate, psychological safety, protected speaking-up systems, and structured ethics support. Conclusion: Sustainable ethical practice is achieved when moral resilience is strengthened at the individual level and embedded within team culture and organizational policy.

Ⅰ. 서 론
    1. 연구의 필요성
    2. 연구목적
    3. 윤리적 고려
Ⅱ. 본 론
    1. 도덕적 회복탄력성과 윤리적 실무환경
    2. 도덕적 회복탄력성 강화 전략과 윤리적 실무환경 조성 전략
    3. 도덕적 회복탄력성과 윤리적 실무환경을연계한 통합 모델
Ⅲ. 결론 및 제언
    1. 결론
    2. 간호 실무 및 조직 수준 제언
    3. 교육 및 리더십 개발에 대한 제언
    4. 연구 및 정책 제언
    5. 맺음말
참고문헌

• 김은아(호남대학교 간호학과) | Kim Eun A (Department of Nursing, Honam University) Corresponding author