Moral Distress Among Long-Term Care Social Workers

Abstract

Objective: To describe the quantitative validation of a unique questionnaire to measure moral distress among social workers in long-term care facilities in Israel. Method: Overall, 216 long-term care facilities' social workers took part in the pilot study that included psychometric evaluation and construct validation. Moral distress was examined by two scales, measuring the frequency and the intensity of morally loaded events. A third scale was created, representing the product of the frequency and intensity scores for each item separately. Results: Two items with high floor effect were removed. The internal reliability of each of the three Moral Distress Scales was .92. An exploratory factor analysis suggested a single-factor solution. The construct validity was approved. In its final version, the questionnaire consisted of 15 items. Conclusions: We believe that the questionnaire can contribute by broadening and deepening ethics discourse and research with regard to social workers' moral conflicts and moral distress.

Evaluation of the mental health of care home staff in the Covid‐19 era. What price did care home workers pay for standing by their patients?

“…Many care homes were instructed not to send older adults meeting certain medical criteria to hospital, 4 despite having insufficient resources, with back‐up healthcare personnel, PPE and diagnostic tests, arriving ‘too little, too late.’ 4 , 5 , 6 The workload and emotional demands of care home workers were already particularly high, 7 and their associations with psychosocial risks such as burnout, moral distress, and compassion fatigue are well known. 5 , 8 , 9 In many care homes, the workload has now increased exponentially due to the Covid‐19 crisis. 10 The increased burden has been not only physical but also emotional.…”

Conceptualising Work-Related Moral Suffering—Exploring and Refining the Concept of Moral Distress in the Context of Social Work

“…The moral distress questionnaire that has been developed to assess the frequency and intensity of moral distress among social workers (Lev and Ayalon, 2016; is also based on the idea of predefined morally loaded events that has arisen in the context of social work in long-term care facilities. As a compound instrument akin to the previously mentioned instruments, it consist of two scales: the first aims to assess the frequency of predefined moral phenomena as the authors term them (altogether 15 items), such as acting in contradiction to one's professional beliefs, and a feeling of being driven more by financial interests than by the interests of one's clients (Lev and Ayalon, 2016;. The second aims to assess the existence and the intensity of distress as a response to these moral phenomena (Lev and Ayalon, 2016;.…”

“…As a compound instrument akin to the previously mentioned instruments, it consist of two scales: the first aims to assess the frequency of predefined moral phenomena as the authors term them (altogether 15 items), such as acting in contradiction to one's professional beliefs, and a feeling of being driven more by financial interests than by the interests of one's clients (Lev and Ayalon, 2016;. The second aims to assess the existence and the intensity of distress as a response to these moral phenomena (Lev and Ayalon, 2016;. This prompts the interesting question of whether an instrument designed to measure moral distress should or should not include such predefined root causes.…”

“…However, the indicators of moral distress used in the empirical studies on the issue have tended to emphasise institutional and organisational constraints (e.g. Corley et al, 2001;Lev and Ayalon, 2016), and, as mentioned earlier, to view these constraints as root causes. This is problematic, as focusing exclusively on external obstacles to ethical action could limit our understanding of the phenomenon.…”

“…This concept, first introduced by the American bioethicist Andrew Jameton during the early 1980s, has resonated strongly among nursing scholars (see Jameton, 1984). Study of the phenomenon has become increasingly popular over the past thirty years in the field of nursing and bioethics and has also gained a foothold among social work scholars (see Weinberg 2009;Sunderland et al, 2010;Mänttäri-van der Kuip, 2016;Lynch and Forde, 2016;Lev and Ayalon, 2016;Fantus et al, 2017).…”