Instruments for Detecting Moral Distress in Clinical Nurses: A Systematic Review

Abstract

Moral distress (MD) has become a seriously negative problem experienced by healthcare professionals, especially clinical nurses. Early and accurate detection of MD by the validated and reliable instrument is critically important to further develop an effective intervention strategy. We performed the current systematic review to comprehensively summarize the evidence of instruments for the detection of MD in clinical nurses. The research design was a systematic literature review. We assigned 2 investigators to independently search potential studies in PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI) from their inception to June 2020. We used data extraction table extracting essential information, and the modified critical appraisal tool evaluating the reliability and validity of eligible instruments. Finally, we qualitatively summarized results of all included instruments. No ethical approval was required because this systematic review was performed based on published studies. We included 16 eligible studies covering 10 original and 6 revised or modified instruments for the final analysis. The overall quality of all instruments was moderate because test-retest reliability was inadequately examined in most instruments. Of 16 instruments, MDS-revised (MDS-R) was broadly validated and employed in different working or cultural settings. Meanwhile, it also extensively expands to specifically detect MD. Moreover, other instruments including moral distress risk scale (MDSR) and moral distress thermometer (MDT) should be further validated and utilized because it covered the gap missed by most instruments. Although several instruments have been made available for clinical nurses, some of them have inadequate psychometric properties test, especially test-retest reliability evaluation. Meanwhile, most of them have not be validated and employed in other working or cultural settings. We therefore suggested further studies to validate the psychometric properties of existing instruments and then employed instruments with high reliability and validity to detect MD in clinical nurses.

Moral Distress among Frontline Physicians and Nurses in the Early Phase of COVID-19 Pandemic in Italy

“…Within the Italian context, this might also be due to the lack of context-specific instruments. Indeed, to date, several moral distress scales have been specifically designed for healthcare workers (e.g., the Moral Distress Thermometer) [ 21 ] and some measures have been targeted for specific groups of healthcare professionals (e.g., The Italian Pediatric Moral Distress Scale-Revised [ 47 ]; The Italian version of the Moral Distress Scale for Nursing Students [ 48 ]; The Italian Moral Distress Scale-Revised for critical care clinicians [ 49 ]). However, there was not yet a reliable instrument to specifically measure morally distressing situations experienced by healthcare professionals during the COVID-19 pandemic.…”

“…From a research point of view, different instruments have been proposed in the literature to study moral distress [ 21 ]. However, moral distress has been mainly investigated through the Moral Distress Scale—MDS, firstly developed by Corley and then revised and validated in many languages and cultures [ 21 ].…”

“…From a research point of view, different instruments have been proposed in the literature to study moral distress [ 21 ]. However, moral distress has been mainly investigated through the Moral Distress Scale—MDS, firstly developed by Corley and then revised and validated in many languages and cultures [ 21 ]. Although this scale has been used in different healthcare contexts [ 8 , 21 ], its items are particularly focused on palliative care and life-threatening settings.…”

“…However, moral distress has been mainly investigated through the Moral Distress Scale—MDS, firstly developed by Corley and then revised and validated in many languages and cultures [ 21 ]. Although this scale has been used in different healthcare contexts [ 8 , 21 ], its items are particularly focused on palliative care and life-threatening settings. This is the main reason for searching for new scales that can detect moral distress regardless of the specific medical specialty.…”

A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic

“…Among these studies, some assessed the intensity of moral distress for specific situations [ 15 , 20 ], some assessed both the frequency and intensity of moral distress for specific situations [ 13 , 14 , 17 , 18 , 21 , 22 , 24 , 25 ] and others assessed it with a global measure of moral distress without anchoring the assessment to specific potentially-morally-distressing situations [ 11 , 19 , 23 ]. The systematic reviews by Gianetta and colleagues [ 1 ] and by Tian and colleagues [ 26 ] provide comprehensive discussions of instruments that have been used to measure moral distress.…”