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In JMIR research protocols ; h5-index 26.0

BACKGROUND : Stress, anxiety, distress, and depression are high among healthcare workers during the COVID-19 pandemic, and they have reported acting in ways that are contrary to their moral values and professional commitments that degrade their integrity. This creates moral distress and injury due to constraints they have encountered, such as limited resources.

OBJECTIVE : The purpose of this study is to develop and show the feasibility of digital platforms (a virtual reality (VR) and a mobile platform) to understand the causes and ultimately reduce the moral distress of healthcare providers during the COVID-19 pandemic. This project is a proof-of-concept integration of concepts/applications to demonstrate viability over six months and guide future studies to develop these state-of-the-art technologies to help frontline healthcare workers work in complex moral contexts. In addition, the project will develop innovations that can be used for future pandemics and in other contexts prone to producing moral distress and injury.

METHODS : This will be a prospective, single cohort, pre- and post-test study examining the effect of a brief informative video describing moral distress on perceptual, psychological, and physiological indicators of stress and decision-making during the scenario known to potentially elicit moral distress. To accomplish this, we have developed a VR simulation scenario that will be used before and after the digital intervention for monitoring short-term impacts. The simulation involves an ICU setting during the COVID-19 pandemic, and participants will be placed in a morally challenging situation. The participants will be engaged in an educational intervention at the individual, team, and organizational levels. During each test, data will be collected for a) physiological measures of stress and after each test, data will be collected regarding b) thoughts, feelings and behaviours during a morally challenging situation, and c) perceptual estimates of psychological stress. We aim to create an effective compound intervention composed of the VR-based simulation educational intervention that is examined through the data collected from mental health questionnaires. In addition, participants will continue to be monitored for moral distress and other psychological stresses for eight weeks through our Digital intervention/intelligence Group mobile (DiiG) platform for a longer-term impact. Finally, a comparison will be conducted using machine learning and biostatistical techniques to analyze the short- and long-term impacts of the VR intervention.

RESULTS : Funded in (November, 2020), approved by REB in (March, 2021), the study is ongoing.

CONCLUSIONS : This project aims to demonstrate the feasibility of using digital platforms to understand the continuum of moral distress that can lead to moral injury. Demonstration of feasibility will lead to future studies to examine the efficacy of digital platforms to reduce moral distress.

CLINICALTRIAL : Trial registry name:, registration/identifier number: NCT05001542, URL:, Unity Health Toronto protocol record: 21-066.

Nguyen Binh, Torres Andrei, Sim Walter, Kenny Deborah, Campbell Douglas M, Beavers Lindsay, Lou Wendy, Kapralos Bill, Peter Elizabeth, Dubrowski Adam, Krishnan Sridhar, Bhat Venkat