JMIR Publications

ABSTRACT

Background:

Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among healthcare workers. Many healthcare workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may cause them to act in ways that are contrary to their moral values, integrity, and professional commitments. These circumstances can lead to moral distress and moral injury, which can further limit healthcare workers’ capacity for care delivery and negatively impact their well-being.

Objective:

The objective of this study is to characterize and reduce stress and moral distress related to decision-making in morally complex situations for nursing professionals. To do so, we will use virtual reality (VR) to subject participants to a simulated clinical scenario which includes decision-making in difficult circumstances and a didactic intervention to increase literacy of stress and moral distress. Additionally, we will collect data on participants’ subjective and physiological states before, during, and after the VR simulation to create a personal digital phenotype profile (pDPP) that characterizes stress and moral distress at the individual level.

Methods:

This will be a single cohort, pre- and post-test study of 100 nursing professionals in Ontario, Canada. Participants will undergo a VR simulation that requires them to make morally complex decisions related to patient care, which will be administered before and after an educational video on techniques to mitigate distress. During the VR session, participants will complete questionnaires measuring their distress and moral distress and physiological data (electrocardiogram, electrodermal activity, plethysmography, and respiration) will be collected to assess their stress response. In a subsequent 12-week follow-up period, participants will complete regular assessments measuring clinical outcomes including distress, moral distress, anxiety, depression, and loneliness. A wearable device will also be used to collect continuous data for two weeks prior, throughout, and for 12 weeks after the VR session. A pre-post comparison will be conducted to analyze the effects of the VR intervention and machine learning will be used to create a pDPP for each participant using the physiological, wearable, and self-report data. Finally, thematic analysis of post-VR debriefing sessions and exit interviews will examine reoccurring codes and overarching themes expressed across participants’ experiences.

Results:

The study was funded in 2022 and received research ethics board approval in April 2023. The study is ongoing.

Conclusions:

This study will contribute to the understanding and prevention of stress and moral distress in healthcare professionals. Models of digital phenotypes developed and integrated with wearables could allow for the prediction of risk and the assessment of treatment response in individuals experiencing moral distress in real-time and naturalistic contexts. This paradigm could also be used in other populations prone to moral distress and injury, such as military and public safety personnel. Clinical Trial: ClinicalTrials.gov NCT05923398. Registered on June 28, 2023.