From depletion to distress - identifying the nonlinear relationship and core intervention target through computational simulation modelling between compassion fatigue and moral distress among ICU nurses: a cross-sectional study

Q: How were compassion fatigue and moral distress measured?

Compassion fatigue was assessed using the Professional Quality of Life Scale, and moral distress was assessed using the Moral Distress Scale-Revised.

Q: What nonlinear pattern was found between compassion fatigue and moral distress?

Moral distress increased sharply at moderate levels of compassion fatigue and then plateaued, indicating a significant nonlinear association.

Q: Which compassion fatigue symptoms were identified as core intervention targets?

Three core symptoms showed the strongest influence on moral distress: feeling trapped in the helping system, difficulty remembering important work aspects, and being a very sensitive person.

Sep 30, 2026

Uploaded by Stanley

Intensive Care Unit (ICU) nurses face high risk of compassion fatigue and moral distress. Based on the Conservation of Resources Theory, the study tests whether compassion fatigue depletes emotional resources and thereby intensifies moral distress, while clarifying the pathway and key components driving this link. A nationwide cross-sectional online survey of 645 ICU nurses in China (July–December 2023) applies restricted cubic splines and network analysis with in silico interventions to identify core symptoms that most influence moral distress. Results show a significant nonlinear pattern and actionable targets.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Background

Objective

Methods

Results

Conclusion

Introduction

Zheng et al. BMC Nursing (2026) 25:13 [https://doi.org/10.1186/s12912-025-04196-1](https://doi.org/10.1186/s12912-025-04196-1) BMC Nursing RESEARCH Open Access From depletion to distress: identifying the nonlinear relationship and core intervention target through computational simulation modelling between compassion fatigue and moral distress among ICU nurses: a crosssectional study Xutong Zheng1, Xiaoquan Zhu2 and Aiping Wang1* Abstract Background Intensive Care Unit (ICU) nurses are at high risk for compassion fatigue and moral distress. Grounded in the Conservation of Resources Theory, this study proposes that compassion fatigue depletes emotional resources, thereby intensifying moral distress. However, the specific pathway and key components driving this relationship remain unclear. Objective To investigate the nonlinear relationship between compassion fatigue and moral distress among ICU nurses and to identify core symptoms of compassion fatigue that most significantly influence moral distress. Methods A nationwide cross-sectional online survey was conducted from July to December 2023, recruiting 645 ICU nurses from China. Compassion fatigue and moral distress were assessed using the Professional Quality of Life Scale and the Moral Distress Scale-Revised, respectively. The dose-response relationship was analyzed using restricted cubic splines, with moral distress as the outcome and compassion fatigue as the predictor, and network analysis with insilico interventions was applied to identify key compassion fatigue symptoms affecting moral distress. Results A significant nonlinear relationship was identified of compassion fatigue on moral distress (nonlinear F = 10 . 02, p < 0. 01; adjusted model R² = 0 . 161), with moral distress increasing sharply at moderate compassion fatigue levels before plateauing. Network analysis and in silico simulations revealed three core compassion fatigue symptoms with the strongest influence on moral distress: “feeling trapped in the helping system”(a burnout symptom),“difficulty remembering important work aspects”(a secondary traumatic stress symptom), and “being a very sensitive person”(a secondary traumatic stress-related trait) . Adjusting these symptoms led to significant changes in moral distress levels. *Correspondence: Aiping Wang[apwang@cmu.edu.cn](apwang@cmu.edu.cn) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/.)[.](http://creativecommons.org/licenses/by/4.0/.) Zheng et al. BMC Nursing (2026) 25:13 Page 2 of 14 Conclusion This study confirms a nonlinear relationship of compassion fatigue on moral distress and identifies actionable targets for intervention. Addressing specific compassion fatigue symptoms can disrupt the resource loss spiral, offering a strategic approach to enhancing ICU nurse well-being and care quality. Clinical trial number Not applicable. Keywords Compassion fatigue, Moral distress, ICU nurses, Conservation of resources theory, Network analysis, DoseResponse relationship, Bridge symptoms, In silico interv

FAQs

What is the main research objective of this study?

To investigate the nonlinear relationship between compassion fatigue and moral distress among ICU nurses and to identify core compassion fatigue symptoms that most significantly influence moral distress.

How were compassion fatigue and moral distress measured?

Compassion fatigue was assessed using the Professional Quality of Life Scale, and moral distress was assessed using the Moral Distress Scale-Revised.

What nonlinear pattern was found between compassion fatigue and moral distress?

Moral distress increased sharply at moderate levels of compassion fatigue and then plateaued, indicating a significant nonlinear association.

Which compassion fatigue symptoms were identified as core intervention targets?

Three core symptoms showed the strongest influence on moral distress: feeling trapped in the helping system, difficulty remembering important work aspects, and being a very sensitive person.

Sep 30, 2026

Uploaded by Stanley