Instruments for Detecting Moral Distress in Clinical Nurses: A Systematic Review

Area of Science:

• Nursing Research
• Healthcare Ethics
• Psychometrics

Background:

• Moral distress (MD) is a significant issue for healthcare professionals, particularly nurses.
• Accurate detection of MD is crucial for developing effective interventions.
• Validated instruments are essential for reliable MD assessment.

Purpose of the Study:

• To systematically review and summarize evidence on instruments for detecting MD in clinical nurses.
• To evaluate the reliability and validity of existing MD detection tools.
• To identify gaps in current assessment methods and suggest future research directions.

Main Methods:

• Systematic literature review of studies from PubMed, EMBASE, and CNKI (up to June 2020).
• Inclusion of 16 eligible studies analyzing 10 original and 6 revised/modified instruments.
• Data extraction and critical appraisal using a modified tool to assess reliability and validity.

Main Results:

• Overall quality of instruments was moderate, with inadequate test-retest reliability examination in most.
• MDS-revised (MDS-R) showed broad validation across settings and specific MD detection.
• Moral Distress Risk Scale (MDSR) and Moral Distress Thermometer (MDT) require further validation.

Conclusions:

• Several instruments for detecting MD in nurses exist, but many have insufficient psychometric properties.
• Test-retest reliability and cross-cultural validation are key areas needing improvement.
• Further studies should focus on validating existing instruments to ensure reliable MD detection in clinical nurses.