Psycometric characteristics of the Moral Distress Scale in Brazilian nursing professionals

Barlem, Edison Luiz Devos; Lunardi, Valéria Lerch; Lunardi, Guilherme Lerch; Tomaschewski-Barlem, Jamila Geri; Almeida, Anderson Sousa de; Hirsch, Carolina Domingues

doi:10.1590/0104-07072014000060013

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Original Article • Texto contexto - enferm. 23 (3) • Jul-Sep 2014 • https://doi.org/10.1590/0104-07072014000060013 copy

Psycometric characteristics of the Moral Distress Scale in Brazilian nursing professionals¹ 1 Extract from the thesis - Reshaping moral distress in nursing: a foucaultian view, submitted to the Nursing Graduate Program (PPGEnf) of the Universidade Federal do Rio Grande (FURG) 2012.

Características psicométricas de la Moral Distress Scale en profesionales de enfermería en Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

The Moral Distress Scale was designed to assess the severity and frequency of the moral distress experienced by nursing professionals in everyday situations. The objective of this study was to analyze the psychometric characteristics of the Moral Distress Scale adapted to Brazilian nursing. Through factor analysis, five constructs were identified: lack of competence in the work team; disregard for patient autonomy, inadequate working conditions, denial of the nursing role as an advocate in terminal patients; denial of the nursing role as an advocate of the patient. The proposed pentafactorial solution is statistically and semantically more appropriate to the Brazilian nursing scenario. Based on these results, the scale is considered to be valid and reliable, showing the necessary requirements regarding convergent and discriminating validity as well as internal consistency to be used while evaluating the intensity and frequency of moral distress in Brazilian nursing professionals.

Validation studies; Burnout, professional; Ethics; Nursing

Variable	Definition
Lack of competence in the work team	Lack of skill or technical expertise that should exist to perform a specific action for each professional category.¹⁰
Disregard for the patient’s autonomy	Disregard for the patient’s self-government, liberty, privacy, individual choice and freedom of will.⁶
Inadequate working conditions	Lack of material and/or human conditions for the completion of the nursing work.²²
Denial of nursing as an advocate for the terminally ill patient	Unused potential by nursing to vindicate the rights of patients in the terminally ill process.²³
Denial of nursing as an advocate for the patient	Unused potential by nursing to vindicate the rights of patients.²³

Indicators	Block	F1	F2	F3	F4	F5
Lack of competence in the work team
q-18. Providing assistance to a physician who, in your opinion, is acting incompetently as regards the patient.	.623	.506	.073	.443	.099	.395
q-25. Working with nursing technicians/assistants who do not possess the necessary competence that the patient’s condition requires.	.670	.710	.150	.250	.203	.200
q-29. Working with nurses who do not have the competency to perform.	.737	.738	.262	.257	.155	.182
q-31. Working with physicians who do not have the competency to perform.	.768	.722	.219	.240	.329	.182
q-32. Working with support services which do not have the competency to perform.	.787	.746	.296	.150	.323	.123
q-33. Working with medical or nursing students who do not have the competency to perform.	.716	.692	.306	.156	.337	.074
Disregard for the patient’s autonomy
q-04. Providing assistance to a physician who is performing a procedure on the patient, without informed consent, even from the family.	.558	.-129	.527	.394	.256	.208
q-21. Complying with the request of the physician not to discuss with the patient regarding their resuscitation, in case of cardiac arrest.	.781	.266	.828	.130	.083	.027
q-22. Complying with the request of the physician not to discuss resuscitation with the family of the patient, in case of cardiac arrest, when the patient is devoid of discernment.	.785	.290	.795	.037	.166	.199
q-23. Complying with the request of the physician not to talk about death with a dying patient who asks about dying.	.664	.265	.678	.206	.189	.237
Inadequate working conditions
q-06. Not having the materials necessary to provide patient care.	.697	.192	.145	.769	.217	.018
q-08. Not having the equipment necessary to meet the urgent needs of a patient.	.635	.347	.000	.655	.245	.158
q-14. Needing to prioritize patients to be cared for due to the lack of human resources.	.681	.336	.126	.649	.320	.292
q-15. Needing to delegate nursing care to family members of patients due to insufficient human resources.	.582	.130	.285	.603	.077	.236
Denial of the nursing role as an advocate for the terminally ill patient
q-34. Avoiding taking action in situations of patient death associated with malpractice.	.504	.415	.076	.110	.439	.168
q-36. Performing with professionals who do not explain to the patient their health status and disease.	.693	.243	.353	.210	.661	.167
q-37. Initiating intensive procedures to save a life when the terminal patient has expressed the wish to die.	.666	.271	.414	.052	.579	.290
q-38. Avoiding taking measures when the abandonment of the dying patient can be seen by the healthcare team.	.752	.441	.117	.233	.667	.211
q-39. Avoiding taking measures when the abandonment of the dying patient can be seen by the family.	.844	.401	.097	.212	.777	.159
Denial of the nursing role as an advocate for the patient
q-10. Allowing medical students to perform painful procedures on patients just to hone their skills.	.676	.422	.087	.362	.288	.554
q-11. Providing assistance to physicians who are performing procedures on patients after cardio-respiratory recovery was not satisfactory.	.766	.092	.202	.068	.231	.812
q-16. Observing, without taking action, when the nursing staff does not respect patient privacy.	.653	.302	.320	.341	.129	.514
q-17. Obeying physician’s orders not to tell the patient the truth, even when the patient asks you for the truth.	.614	.405	.258	.319	.238	.536
Initial Eigenvalue		11.08	1.56	1.40	.958	.840
% variance explained - rotated (68.99%)		48.20	6.80	6.10	4.16	3.65
Cronbach’s alpha (0.95 instrument)		.91	.79	.79	.88	.82
KMO measure of sampling adequacy (KMO = 0.941)
Bartlet test: chi-square = 3305.983 Correlation matrix determinant(1.63)

	M	SD	Fq	SD	A	B	C	D	E
A	4.36	1.26	2.57	1.19	-	.576*	.661*	.779*	.718*
B	3.77	1.26	1.98	1.26	.576*	-	.514*	.578*	.598*
C	4.09	1.24	2.54	1.30	.661*	.514*	-	.589*	.653*
D	4.14	1.30	2.26	1.25	.779*	.578*	.589*	-	.665*
E	4.19	1.23	2.37	1.33	.718*	.598*	.653*	.665*	-
MD	4.11	1.25	2.34	1.31	-	-	-	-	-

Validated		Original - DS	Included
	q-01. Performing improvisations to face the lack of material in the care of patients.		×
	q-02. Following the family’s wishes in order to maintain the patient’s life, although it is not the best for him/her.	×
	q-03. Avoiding taking measures to find leftover medicines in the patient’s box.		×
✔	q-04. Providing assistance to a physician who is performing a procedure on the patient, without informed consent, even from the family.	×
	q-05. Initiating intensive procedures to save a life, when you believe that they only delay death.	×
✔	q-06. Not having the materials necessary to provide patient care.		×
	q-07. Ignoring situations where the patient was not given the appropriate information to ensure their informed consent.	×
✔	q-08. Not having the equipment necessary to meet the urgent needs of a patient.		×
	q-09. Avoiding taking measures to discover that a member of the nursing team applies the wrong medication and fails to report it.	×
✔	q-10. Allowing medical students to perform painful procedures on patients just to hone their skills.	×
✔	q-11. Providing assistance to physicians who are performing procedures on patients after cardio-respiratory recovery was not satisfactory.	×
	q-12. Performing medical prescriptions to conduct unnecessary tests and treatments in terminally ill patients.	×
	q-13. Working with the nursing staff at a level considered to be “unsafe”.	×
✔	q-14. Needing to prioritize patients to be cared for due to the lack of human resources.		×
✔	q-15. Needing to delegate nursing care to family members of patients due to insufficient human resources.		×
✔	q-16. Observing, without taking action, when the nursing staff does not respect patient privacy.	×
✔	q-17. Obeying physician’s orders not to tell the patient the truth, even when the patient asks you for the truth.	×
✔	q-18. Providing assistance to a physician who, in your opinion, is acting incompetently as regards the patient.	×
	q-19. Demanding better working conditions for the care of patients.		×
	q-20. Performing with professionals who do not respect patients’ demonstrations on the nursing care.		×
✔	q-21. Complying with the request of the physician not to discuss with patients regarding their resuscitation, in case of cardiac arrest.	×
✔	q-22. Complying with the request of the physician not to discuss resuscitation with the family of the patient, in case of cardiac arrest, when the patient is devoid of discernment.	×
✔	q-23. Complying with the request of the physician not to talk about death with a dying patient who asks about dying.	×
	q-24. Working with nurses who do not possess the necessary competence that the patient’s condition requires.	×
✔	q-25. Working with nursing technicians/assistants who do not possess the necessary competence that the patient’s condition requires.	×
	q-26. Working with medical or nursing students who do not possess the necessary competence that the patient’s condition requires.	×
	q-27. Working with physicians who do not possess the necessary competence that the patient’s condition requires.	×
	q-28. Working with support services which do not possess the necessary competence that the patient’s condition requires.	×
✔	q-29. Working with nurses who do not have the competency to perform.		×
	q-30. Working with technicians/assistants who do not have the competency to perform.		×
✔	q-31. Working with physicians who do not have the competency to perform.		×
✔	q-32. Working with support services which do not have the competency to perform.		×
✔	q-33. Working with medical or nursing students who do not have the competency to perform.		×
✔	q-34. Avoiding taking action in situations of patient death associated with malpractice.		×
	q-35. Being required to care for patients, and not feeling prepared to take care of them.	×
✔	q-36. Performing with professionals who do not explain to the patient their health status and disease.		×
✔	q-37. Initiating intensive procedures to save a life when the terminal patient has expressed the wish to die.		×
✔	q-38. Avoiding taking measures when the abandonment of the dying patient can be seen by the healthcare team.		×
✔	q-39. Avoiding taking measures when the abandonment of the dying patient can be seen by the family.		×

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Edison Luiz Devos Barlem Rua Doutor Nascimento, 367, ap. 701 96200-300 - Centro, Rio Grande, RS, Brasil E-mail: ebarlem@gmail.com

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Psycometric characteristics of the Moral Distress Scale in Brazilian nursing professionals1 1 Extract from the thesis - Reshaping moral distress in nursing: a foucaultian view, submitted to the Nursing Graduate Program (PPGEnf) of the Universidade Federal do Rio Grande (FURG) 2012.

Características psicométricas de la Moral Distress Scale en profesionales de enfermería en Brasil

Psycometric characteristics of the Moral Distress Scale in Brazilian nursing professionals¹ 1 Extract from the thesis - Reshaping moral distress in nursing: a foucaultian view, submitted to the Nursing Graduate Program (PPGEnf) of the Universidade Federal do Rio Grande (FURG) 2012.