Resilience Equine-Assisted Learning for Undergraduate Nursing Students: A Pilot Randomized Controlled Trial

Background Burnout among undergraduate nursing students is a global concern. Resilience protects against stress that leads to burnout. Equine-assisted learning interventions promote resilience and reduce stress and burnout in diverse populations. Purpose To assess the feasibility of the Resilience Equine-Assisted Learning (REAL) intervention as an outdoor experiential education activity and explore within-group changes in stress, burnout, and resilience among nursing students, using a three-group experimental design with random assignment. Method Students were recruited from the School of Nursing and randomly assigned to a group: REAL intervention, unstructured horse interaction (UHI) active control, or treatment-as-usual control. Recruitment, retention, intervention adherence, acceptability, appropriateness, feasibility, fidelity, and safety were compared to benchmarks. Self-report tools measured stress, burnout, and resilience. Findings Seventeen students (38% of benchmark) were recruited; 100% completed data collection. REAL group adherence was poor (average 53%), with schedule conflicts (100%) and winter weather (30%) as barriers. Students in the REAL and UHI groups reported high treatment acceptability, appropriateness, and feasibility (>15). REAL intervention fidelity was high (>90%), and no adverse events occurred. Only the REAL group showed decreased post-intervention burnout-cynicism from baseline ( p = .04). Implications The REAL intervention was appropriate and acceptable, though extracurricular interventions present adherence challenges despite reductions in burnout.