Moral Injury and Organisational Influences on ICU Nurse Wellbeing: Insights from Patient-Centred Nursing and Compassion Research
| Thursday, May 21, 2026 |
| 4:25 PM - 4:26 PM |
Speaker
Dr Samantha Jakimowicz
Professor In Nursing
Charles Sturt University (Australia)
Moral Injury and Organisational Influences on ICU Nurse Wellbeing: Insights from Patient-Centred Nursing and Compassion Research
Abstract Document
Background:
Intensive Care Unit (ICU) nurses work in high-pressure environments where organisational constraints and resource shortages can impede patient-centred, compassionate care. When nurses cannot act in line with their moral and professional values, they may experience moral distress, which can progress to moral injury, a profound psychological and spiritual harm now recognised in the DSM-5-TR (1). Understanding organisational factors that influence moral injury is critical for workforce wellbeing, retention and patient outcomes.
Aim:
To synthesise findings from research exploring patient-centred nursing, compassion satisfaction and fatigue, and organisational determinants of moral distress and injury among ICU nurses.
Methods:
This synthesis draws on a concept analysis, a cross-sectional survey (n=117), and a grounded theory study examining ICU nurses’ experiences of compassion, patient-centred care, and organisational expectations.
Results:
Patient-centred nursing in ICU integrates biomedical expertise, patient identity, compassionate presence, and advocacy. Organisational support including adequate staffing, education, and positive culture, enables nurses to meet these expectations (2). Compassion satisfaction was higher among experienced nurses and those with postgraduate education and supportive workplaces, while burnout and compassion fatigue were more common among early-career nurses and those with less support (3). A core theme was “expectations”: when nurses cannot meet their own or organisational expectations, moral conflict and distress arise, which may escalate to moral injury if systemic barriers persist (4). Since these studies, the COVID-19 pandemic has intensified organisational pressures, and reports of moral injury among ICU nurses have markedly increased.
Conclusion:
Organisational systems can mitigate or exacerbate moral injury. Interventions that foster compassion satisfaction, support professional development, and remove systemic barriers are essential for prevention and recovery. The pandemic has amplified the urgency for organisational and policy-level responses to avoid moral injury.
References:
1. Mattson S, VanderWeele TJ, Lu F, Carey LB, Cowden RG, Fung EN, et al. Moral, Religious, or Spiritual Problem: An Expanded Z Code Diagnostic Category in the: DSM-5-TR. The Journal of Nervous and Mental Disease. 2025;213(11).
2. Jakimowicz S, Perry L. A concept analysis of patient-centred nursing in the intensive care unit. J Adv Nurs. 2015;71(7):1499-517.
3. Jakimowicz S, Perry L, Lewis J. Compassion satisfaction and fatigue: A cross-sectional survey of Australian intensive care nurses. Australian critical care. 2018;31(6):396-405.
4. Jakimowicz S, Perry L, Lewis J. Insights on compassion and patient‐centred nursing in intensive care: A constructivist grounded theory. Journal of clinical nursing. 2018;27(7-8):1599-611.
Intensive Care Unit (ICU) nurses work in high-pressure environments where organisational constraints and resource shortages can impede patient-centred, compassionate care. When nurses cannot act in line with their moral and professional values, they may experience moral distress, which can progress to moral injury, a profound psychological and spiritual harm now recognised in the DSM-5-TR (1). Understanding organisational factors that influence moral injury is critical for workforce wellbeing, retention and patient outcomes.
Aim:
To synthesise findings from research exploring patient-centred nursing, compassion satisfaction and fatigue, and organisational determinants of moral distress and injury among ICU nurses.
Methods:
This synthesis draws on a concept analysis, a cross-sectional survey (n=117), and a grounded theory study examining ICU nurses’ experiences of compassion, patient-centred care, and organisational expectations.
Results:
Patient-centred nursing in ICU integrates biomedical expertise, patient identity, compassionate presence, and advocacy. Organisational support including adequate staffing, education, and positive culture, enables nurses to meet these expectations (2). Compassion satisfaction was higher among experienced nurses and those with postgraduate education and supportive workplaces, while burnout and compassion fatigue were more common among early-career nurses and those with less support (3). A core theme was “expectations”: when nurses cannot meet their own or organisational expectations, moral conflict and distress arise, which may escalate to moral injury if systemic barriers persist (4). Since these studies, the COVID-19 pandemic has intensified organisational pressures, and reports of moral injury among ICU nurses have markedly increased.
Conclusion:
Organisational systems can mitigate or exacerbate moral injury. Interventions that foster compassion satisfaction, support professional development, and remove systemic barriers are essential for prevention and recovery. The pandemic has amplified the urgency for organisational and policy-level responses to avoid moral injury.
References:
1. Mattson S, VanderWeele TJ, Lu F, Carey LB, Cowden RG, Fung EN, et al. Moral, Religious, or Spiritual Problem: An Expanded Z Code Diagnostic Category in the: DSM-5-TR. The Journal of Nervous and Mental Disease. 2025;213(11).
2. Jakimowicz S, Perry L. A concept analysis of patient-centred nursing in the intensive care unit. J Adv Nurs. 2015;71(7):1499-517.
3. Jakimowicz S, Perry L, Lewis J. Compassion satisfaction and fatigue: A cross-sectional survey of Australian intensive care nurses. Australian critical care. 2018;31(6):396-405.
4. Jakimowicz S, Perry L, Lewis J. Insights on compassion and patient‐centred nursing in intensive care: A constructivist grounded theory. Journal of clinical nursing. 2018;27(7-8):1599-611.
Biography
Dr. Samantha Jakimowicz, an Associate Professor in Nursing and a qualified psychotherapist, has made significant contributions to research and academia. Her impressive track record includes over $2.2 million in research funding. Dr. Jakimowicz currently serves as the Associate Head of School Research & Graduate Studies in the School of Nursing Paramedicine and Healthcare Sciences. In this leadership role, she oversees research initiatives and graduate programs within the school, supporting growing research capacity and capability of all academics. Her own research explores how compassion and empathy impact patient care, healthcare professionals, and overall well-being. Her work delves into understanding the experiences of both patients and healthcare workers, aiming to improve quality of care and health professional wellbeing. She is well published in these areas.
