Cross-cultural adaptation and validation of the Moral Distress Scale-Revised for nurses

Ramos, Aline Marcelino; Barlem, Edison Luiz Devos; Barlem, Jamila Geri Tomaschewski; Rocha, Laurelize Pereira; Dalmolin, Graziele de Lima; Figueira, Aline Belletti

doi:10.1590/0034-7167-2016-0518

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Revista Brasileira de Enfermagem

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RESEARCH • Rev. Bras. Enferm. 70 (5) • Sep-Oct 2017 • https://doi.org/10.1590/0034-7167-2016-0518 copy

Cross-cultural adaptation and validation of the Moral Distress Scale-Revised for nurses

Adaptación cultural y validación de la Moral Distress Scale-Revised para enfermeros

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Cross-culturally adapt and validate the Moral Distress Scale-Revised for nurses.

Method:

Quantitative, analytical cross-sectional study conducted with 157 nurses of two hospital institutions of Southern Brazil, one public and one philanthropic. Procedures conducted: cultural adaptation of the instrument according to international recommendations; validation for the Brazilian context.

Results:

Face and content validation was considered satisfactory as assessed by a specialist committee and a pretest. The instrument demonstrated satisfactory internal consistency through frequency and intensity analysis per question in the 157 items and per subgroups of the various hospital units. Cronbach’s alpha was 0.88 for the instrument and between 0.76 and 0.94 for hospital units. Pearson’s correlation found a moderate association for moral distress among nurses.

Conclusion:

The Moral Distress Scale-Revised – Brazilian version is a valid instrument for the assessment of moral distress in nurses.

Descriptors:
Moral; Nursing; Nursing Ethics; Moral Development; Validation Studies

Question	Score
1. Offer care that has less than ideal quality due to pressure from managers or the institution to cut costs.	4.38
2. Witness health professionals giving "false hopes" to patients or families.	3.20
3. Follow the wishes of families to maintain life, even if it is not patients' best interest.	4.14
4. Begin cardiorespiratory resuscitation when I believe that it will only prolong death.	4.32
5. Meet families' requests to avoid discussing death with terminal patients who ask about it.	3.53
6. Follow medical instructions in relation to exams and unnecessary treatments.	5.83
7. Keep investing in patients with irreversible injuries who are kept on ventilators when no one will make the decision not to invest.	4.24
8. Avoid taking action/reporting when I find out that a physician or nurse colleague made an error that goes unreported.	3.28
9. Participate in a procedure with a physician who is administering inadequate care.	3.15
10. Be forced to care for patients I do not feel qualified to treat.	3.36
11. Let medical students conduct painful procedures on patients only to improve their skills.	4.29
12. Administer therapeutic measures that do not alleviate patient suffering because physicians suppose increasing the dose of pain medication could cause death.	2.99
13. Follow physicians' requests to avoid discussing patient prognostics with patients or their families.	4.08
14. Administer a dose of sedatives/narcotics to unconscious patients when I believe it will hasten their deaths.	1.32
15. Not take action on a witnessed ethical issue because the team member involved asked not to do anything.	1.87
16. Follow families' wishes even when I do not agree with them, doing so for fear of professional complaints.	1.80
17. Work with nurses or others health professionals (except for physicians) who are not qualified to perform care required by patients.	4.52
18. Ignore suspicions of patient maltreatment by families/caregivers.	1.78
19. Ignore situations in which patients are not correctly informed to guarantee educated consent.	1.88
20. Observe problems in patient care due to lack of conditions to keep treatment continuity.	3.52
21. Work with nursing professionals or other health professionals who I consider insecure.	5.72
General score	(92.22)

Situation	I	C	II	C	III	C	IV	C	V	C	VI	C	VII	C
Begin cardiorespiratory resuscitation when I believe that it will only prolong death.	5.96 (5.69)	1^a	4.30 (4.66)	7^a	5.50 (5.30)	8^a	4.33 (4.52)	5^a	1.64 (2.61)	19^a	7.70 (5.71)	2^a	2.71 (4.76)	10^a
Work with nursing professionals or other health professionals who I consider insecure.	5.54 (5.27)	2^a	4.97 (5.25)	4^a	7.59 (6.16)	1^a	4.11 (5.34)	6^a	7.68 (6.15)	1^a	5.70 (4.49)	7^a	4.75 (3.76)	1^a
Follow medical instructions in relation to exams and unnecessary treatments.	5.42 (5.64)	3^a	5.76 (5.51)	1^a	5.91 (5.08)	4^a	6.33 (5.72)	1^a	5.82 (5.90)	3^a	9.40 (6.02)	1^a	4.42 (4.68)	2^a
Keep investing in patients with irreversible injuries who are kept on ventilators when no one will make the decision not to invest.	5.25 (5.78)	4^a	4.73 (5.05)	5^a	5.55 (4.93)	6^a	4.89 (5.07)	4^a	2.41 (4.17)	16^a	4.80 (4.56)	10^a	2.25 (3.81)	12^a
Work with nurses or others health professionals (except for physicians) who are not qualified to perform care required by patients.	5.00 (6.19)	5^a	3.62 (4.29)	9^a	6.41 (5.47)	2^a	2.50 (3.33)	10^a	5.86 (5.75)	2^a	6.10 (5.50)	5^a	3.33 (3.57)	5^a
Let medical students conduct painful procedures on patients only to improve their skills.	4.88 (5.78)	6^a	3.49 (5.27)	10^a	5.68 (5.59)	5^a	3.44 (3.65)	7^a	4.14 (5.10)	7^a	6.60 (6.04)	4^a	3.46 (4.29)	4^a

Question	Slight, almost imperceptible	Mild, but defined	Moderate
Q01	.182^* * Correlation at the 95% level; + correlation at 99% level.
Q02	.180^* * Correlation at the 95% level; + correlation at 99% level.
Q04		.287**
Q05		.209**
Q06		.223**
Q07	.181^* * Correlation at the 95% level; + correlation at 99% level.
Q08		.260**
Q11	.174^* * Correlation at the 95% level; + correlation at 99% level.
Q12	.167^* * Correlation at the 95% level; + correlation at 99% level.
Q13		.311**
Q14		.269**
Q15		.355**
Q16		.253**
Q17		.279**
Q19		.247**
Q20		.390**
Q21			.516**

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[1] CORRESPONDING AUTHOR: Aline Marcelino Ramos. E-mail: aline-ramos-@hotmail.com