Abstract
Moral distress occurs when nurses are constrained from acting ethically or are forced into ethically inappropriate actions, leading to feelings of complicity and wrongdoing. This phenomenon is common among nurses, especially when institutional constraints prevent them from doing what they believe is right. Moral distress can cause negative physical, psychological, and emotional consequences, potentially leading to burnout, compassion fatigue, or even leaving the profession if unaddressed. Most evidence of these effects comes from subjective reports or workforce studies linking moral distress to nursing turnover; However, no studies to date have objectively measured the biometric effects of moral distress among nurses. This study aims to explore the physiological, psychological, and emotional responses to moral distress in critical care nurses. Following IRB approval, a concurrent mixed-methods design will be used to collect and compare quantitative and qualitative data. Ten critical care nurses will participate in two simulated scenarios while wearing the EmotiBit wearable device, which measures heart rate, variability, respiration, body temperature, emotional status, and movement. One scenario involves a morally distressing event, while the other represents a typical clinical situation. Baseline biometric data will be recorded before the simulations, and additional data will be collected during each scenario. Observation notes will document the timing of morally distressing events and observable participant responses, which will guide post-simulation interviews. Participants will complete a demographics questionnaire prior to the study and the Moral Distress Thermometer (MDT) after each scenario. Data collection will occur between May and July 2025, with findings expected by October 2025. Quantitative data will undergo descriptive, correlation, and regression analysis, while qualitative interview transcripts will be analyzed using content analysis. Cross-impact analysis, triangulation, and a joint display will be conducted to compare and integrate findings. The anticipated outcome is a deeper understanding of critical care nurses' responses to moral distress, offering insights into its physiological, psychological, and emotional dimensions. These findings may inform strategies to mitigate its impact and support nurses in managing moral distress.
Notes
References:
1. Epstein EG, Shah R, Marshall MF. Effect of a moral distress consultation service on moral distress, empowerment, and a healthy work environment. HEC Forum. Apr 3 2021;doi:10.1007/s10730-021-09449-5
2. Hamric AB. A case study of moral distress. Journal of Hospice and Palliative Nursing. 2014;16(8):457 - 463.
3. Jameton A. Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONN's Clinical Issues in Perinatal and Women's Health Nursing. 1993;4(4):542-51.
4. Varcoe C, Pauly B, Webster G, Storch J. Moral distress: Tensions as springboards for action. HEC Forum. Mar 2012;24(1):51-62. doi:10.1007/s10730-012-9180-2
5. Henrich NJ, Dodek PM, Gladstone E, et al. Consequences of moral distress in the intensive care unit: A qualitative study. American Journal of Critical Care. Jul 2017;26(4):e48-e57. doi:10.4037/ajcc2017786
6. Austin CL, Saylor R, Finley PJ. Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Psychological Trauma: Theory, Research, Practice, and Policy. 2017;9(4):399-406. doi:10.1037/tra0000201
7. Ulrich B, Cassidy L, Barden C, Varn-Davis N, Delgado SA. National Nurse Work Environments - October 2021: A Status Report. Crit Care Nurse. Oct 1 2022;42(5):58-70. doi:10.4037/ccn2022798
8. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. 3rd ed. SAGE Publications, Inc.; 2018.
9. Montgomery SM, Nair N, Chen P, Dikker S. Introducing EmotiBit, an open-source multi modal sensor for measuring research-grade physiological signals. Science Talks. 2023/05/01/ 2023;6:100181. doi:https://doi.org/10.1016/j.sctalk.2023.100181
10. Wocial LD, Weaver MT. Development and psychometric testing of a new tool for detecting moral distress: The Moral Distress Thermometer. J Adv Nurs. Jan 2013;69(1):167-74. doi:10.1111/j.1365-2648.2012.06036.x
Sigma Membership
Beta Phi at-Large
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Ethics, Workforce, Simulation, Global Health Issues and Ethics, Critical Care Nurses
Recommended Citation
Miller, Preston H.; Bail, Jennifer; Modi, Shikha; Morrison, Katherine; Jovanov, Emil; and Epstein, Elizabeth, "Exploring the Impacts of Moral Distress on Critical Care Nurses Using Biometric Sensors" (2025). Biennial Convention (CONV). 26.
https://www.sigmarepository.org/convention/2025/posters_2025/26
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-11-20
Funder(s)
The University of Alabama in Huntsville
Exploring the Impacts of Moral Distress on Critical Care Nurses Using Biometric Sensors
Indianapolis, Indiana, USA
Moral distress occurs when nurses are constrained from acting ethically or are forced into ethically inappropriate actions, leading to feelings of complicity and wrongdoing. This phenomenon is common among nurses, especially when institutional constraints prevent them from doing what they believe is right. Moral distress can cause negative physical, psychological, and emotional consequences, potentially leading to burnout, compassion fatigue, or even leaving the profession if unaddressed. Most evidence of these effects comes from subjective reports or workforce studies linking moral distress to nursing turnover; However, no studies to date have objectively measured the biometric effects of moral distress among nurses. This study aims to explore the physiological, psychological, and emotional responses to moral distress in critical care nurses. Following IRB approval, a concurrent mixed-methods design will be used to collect and compare quantitative and qualitative data. Ten critical care nurses will participate in two simulated scenarios while wearing the EmotiBit wearable device, which measures heart rate, variability, respiration, body temperature, emotional status, and movement. One scenario involves a morally distressing event, while the other represents a typical clinical situation. Baseline biometric data will be recorded before the simulations, and additional data will be collected during each scenario. Observation notes will document the timing of morally distressing events and observable participant responses, which will guide post-simulation interviews. Participants will complete a demographics questionnaire prior to the study and the Moral Distress Thermometer (MDT) after each scenario. Data collection will occur between May and July 2025, with findings expected by October 2025. Quantitative data will undergo descriptive, correlation, and regression analysis, while qualitative interview transcripts will be analyzed using content analysis. Cross-impact analysis, triangulation, and a joint display will be conducted to compare and integrate findings. The anticipated outcome is a deeper understanding of critical care nurses' responses to moral distress, offering insights into its physiological, psychological, and emotional dimensions. These findings may inform strategies to mitigate its impact and support nurses in managing moral distress.
Description
This in-progress study investigates critical care nurses' physiological, psychological, and emotional responses to moral distress. Using a mixed-methods approach, ten nurses will participate in simulated scenarios—one involving moral distress—while wearing biometric devices to measure heart rate, respiration, movement, and emotional status. Observations and interviews will complement biometric data. Findings may provide insights into moral distress and inform strategies to address its impacts.