The Moral Distress-Appraisal Scale: Scale development and validation study

Moral distress-arising when one is constrained from moral action-has been receiving increased attention in nursing research. The phenomenon is associated with negative outcomes and is shown to impact a broad range of healthcare professions. The context-specific nature of existing measures, however, makes it difficult, if not impossible, to compare the prevalence and impact of moral distress across nursing settings and healthcare professions. This study presents an appraisal approach to the assessment of moral distress. The aims of this study were to develop and to investigate the reliability and validity of the Moral Distress-Appraisal Scale as a context-independent assessment instrument for moral distress.

This is a cross-sectional correlational validation study.

Between September 2018 and June 2019, a total of 406 healthcare employees (mainly nurses) completed a quantitative survey consisting of a standard moral distress measure (Moral Distress Scale-Revised) and the Moral Distress-Appraisal Scale. A subsample (n = 164) received extra questions on work characteristics, well-being and attitudinal outcomes. Confirmatory factor analysis, Pearson correlations and regression analyses were conducted in order to evaluate the psychometric properties of the newly developed scale.

Confirmatory factor analysis provided evidence for the predicted structure of the 8-item Moral Distress-Appraisal Scale. As expected, the scale is positively correlated with the Moral Distress Scale-Revised and with job demands, burnout, depressive symptoms, and turnover intentions and negatively with job resources and job satisfaction. Furthermore, the scale showed incremental validity in predicting wellbeing and attitudinal outcomes above and beyond both known predictive work characteristics and the Moral Distress Scale-Revised.

This study provides first empirical evidence for the reliability and validity of the Moral Distress-Appraisal Scale.

The Moral Distress-Appraisal Scale can be used across healthcare professions and contexts. The proposed appraisal approach may facilitate integration of the scale into occupational health research and practice.