The psychometric properties of the moral distress scale-revised among pediatric nurses

Moral distress (MD) is a major problem among nurses in all clinical settings. Pediatric nurses are more at risk for MD because of their greater exposure to moral conflicts among their child clients, families, and colleagues. MD can negatively affect nurses' physical and emotional well-being, job satisfaction, and job retention. The Moral Distress Scale-Revised (MDS-R) is a valid and reliable instrument for assessing morally distressful situations. This study aimed to evaluate the psychometric properties of the Persian MDS-R among pediatric nurses.

This methodological study was carried out between 2024 and 2025. The MDS-R was translated into Persian via the forward‒backward method of the World Health Organization. Facial validity was evaluated through cognitive interviewing, content validity was evaluated on the basis of the comments of experts, and construct validity was evaluated through exploratory and confirmatory factor analyses. Data for factor analyses were collected from 447 pediatric nurses selected from a university children's hospital in Tehran, Iran. Reliability was also evaluated via internal consistency and test-retest stability methods.

The content validity index (CVI) values of all the items were greater than 0.8, and the CVI of the whole scale was 0.92. Exploratory factor analysis revealed that the scale had four factors with an eigenvalue of more than 1. The factors were healthcare providers' limited competency; care provisions under the pressure of personal, organizational, patient-related, and family-related factors; futile care; and lack of moral courage, which explained 53.22% of the total variance. Confirmatory factor analysis revealed the good fit of the four-factor model (Chi-square test value = 366.43 with a degree of freedom of 183 (P < 0.001); CMIN/DF = 2; NFI = 0.90; NNFI = 0.94; PNFI = 0.79; CFI = 0.95; IFI = 0.95; SRMR = 0.072; and AGFI = 0.82). The Cronbach's alpha coefficient and the test-retest intraclass correlation coefficient of the scale were 0.89 and 0.90, respectively.

The Persian MDS-R has acceptable validity and reliability and can be used to assess pediatric nurses' MD and develop strategies to reduce it.