Development and Psychometric Properties of the ICU Nurses' Moral Resilience Scale

Moral resilience is defined as one's capacity to sustain or restore integrity in response to moral complexity, confusion, distress or setbacks. To maintain a healthy and lasting workforce within a system, it is essential to promote moral resilience among employees.

The purpose of this study was to develop a valid and reliable scale to measure moral resilience among Iranian nurses.

This study is part of a sequential, exploratory and mixed method research that was conducted between January 2021 and July 2024. Phase one of this study involved a directed content analysis to explain the concept of moral resilience among ICU nurses. The findings of this phase, which have been reported previously, were used to generate the initial pool of items for the ICU Nurses' Moral Resilience Scale (INMRS). To enrich the pool of items, statements were extracted from the literature review and existing scales. In phase two, the data from 550 nurses were gathered through both paper-based and online questionnaires using a convenience sampling technique. In this phase, the COSMIN checklist was used to evaluate the psychometric properties of INMRS. Consequently, face and content validity, construct validity (using exploratory and confirmatory factor analysis), convergent and divergent validity, reliability (including stability and internal consistency), responsiveness and interpretability of the scale were evaluated.

The findings showed that the INMRS with 14 items contains three factors that explain 46.64% of the total variance. These factors include emotion management (3 items), continuous effort (8 items) and moral comfort (3 items). The fit indices indicated that the model has an acceptable goodness of fit (TLI, CFI, IFI > 0.9; PNFI, PCFI > 0.7; RMSEA < 0.057; CMIN/DF = 1.693). The reliability assessment also revealed acceptable internal consistency and stability (> 0.7).

The study revealed that INMRS consists of three key factors that can be used to assess the moral resilience of Iranian nurses. Given the acceptable psychometric properties of INMRS, this scale is a suitable tool to assess moral resilience among ICU nurses.

Nursing managers can utilize these findings to design training and support programmes aimed at enhancing the moral resilience of critical care nurses. Also, the INMRS is a reliable and valid scale for evaluating this concept in future studies.