Moral injury in secure mental healthcare: part I: exploratory and confirmatory factor analysis of the Moral Injury Events Scale

Morris, Deborah; Webb, Elanor Lucy; Trundle, Grace; Caetano, Gabriella

doi:10.1080/14789949.2022.2111318

Cited by 8 publications

(12 citation statements)

References 39 publications

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“…Second, the MIES factor structure was evaluated through confirmatory factor analysis conducted in Mplus with the Maximum likelihood with robust standard errors (MLR) estimator (Muthén & Muthén, 2017 ). Three separate models were tested: (a) the original two-factor model of Nash et al ( 2013 ) with factors representing Perceived Transgressions (by self or others) and Perceived Betrayal by leaders; (b) the alternative two-factor model from Morris et al ( 2022 ), with factors representing Transgressions by Self and Transgressions by Others (transgressions and betrayals); and (c) the three-factor model of Bryan et al ( 2016 ) with factors representing Transgressions by Self, Transgressions by Others and Betrayal by Others. Model fit was evaluated using the chi-square test, root mean square error of approximation (RMSEA), comparative fit index (CFI), and Tucker–Lewis index (TLI).…”

Section: Methodsmentioning

confidence: 99%

“…Although several tools specific for healthcare settings that assessing exposure to and impact of MI are being developed (Mantri et al, 2020 ), the MIES scale originally created and tested on military personnel (Nash et al, 2013 ) remains the most used measure for assessing exposure and response to PMIEs across a variety of occupational categories including healthcare professionals (Hines et al, 2021 ; Maftei & Holman, 2021 ; Williamson et al, 2021 ). Notably, previous validation studies of the MIES yielded inconsistent factor structures, reflecting differential experiences of MI across professional groups, that may be related to differences in contexts, job roles and demographic profiles impacting the exposure to and experience of PMIEs (Bryan et al, 2016 ; Morris et al, 2022 ; Papazoglou et al, 2019 ; Plouffe et al, 2021 ; Richardson et al, 2020 ). For instance, the original Nash et al ( 2013 ) study on military personnel identified a two-factor model of (1) ‘transgressions by self or others’ and (2) ‘betrayal by leaders’.…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, only one study (Morris et al, 2022 ) has examined the MIES factor structure in a sample of professionals working in a healthcare setting, providing some support for the alternative two-factor model of ‘transgressions and betrayals by others’ and ‘transgressions by self’ (Plouffe et al, 2023 ; Richardson et al, 2020 ). Despite the recent explosion of studies using the MIES in healthcare settings, an investigation of psychometric properties of the scale amongst healthcare professionals active during the COVID-19 pandemic is currently lacking.…”

Section: Introductionmentioning

confidence: 99%

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Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting

Fino,

Daniels,

Micheli

et al. 2023

European Journal of Psychotraumatology

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Background: When exposed to events that transgress one’s moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting. Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity. Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect. Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 ‘perceived transgressions by others’; Factor 2 ‘perceived transgressions by self’; and Factor 3 ‘perceived betrayals by others’. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout. Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting

Fino,

Daniels,

Micheli

et al. 2023

European Journal of Psychotraumatology

View full text Add to dashboard Cite

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“…Although a range of relevant occupations and balance of gender demographics were captured, the nature of the recruitment platform used meant that participants OCCUPATIONAL MORAL INJURY SCALE were primarily White, English-speaking, and educated at a tertiary level. This is significant because recent research suggests that moral injury may present differently according to ethnicity and gender, and measures of moral injury likewise may not be appropriate for use with other ethnicities if developed using primarily White, Western samples (Morris et al, 2022). Healthcare systems may also differ between cultures, meaning the OMIS may not be valid for use with Eastern healthcare workers unless validated for use in this way.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

The Occupational Moral Injury Scale: Development and validation in frontline health and first responder workers.

Thomas,

Bizumic,

Quinn

2023

Traumatology

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Moral injury is an emerging construct that has been primarily examined in military groups but is increasingly expanding to a broader range of nonmilitary occupational settings. A key barrier to this research on moral injury in broader occupational groups has been the lack of valid and reliable measures specifically developed for nonmilitary settings. The current article addresses this gap by developing the Occupational Moral Injury Scale (OMIS), a measure designed to capture both morally injurious events (MIEs) and primary markers of moral injury (guilt, shame, anger, loss of trust, existential conflict) in any occupational setting, without the need for modification. A combination of confirmatory factor analyses and item response theory analyses was used in scale development and refinement. Drawing upon a sample of 1,454 primarily frontline health and first responder workers across two studies, factor analytic results revealed an expected bifactor structure of five primary factors capturing exposure to MIEs (commission with agency, commission under duress, act of omission, witnessing, betrayal) and a general factor of moral injury. Subscales demonstrated excellent internal consistency, and when compared to theoretically relevant constructs OMIS scores demonstrated strong convergent and divergent validity. Differential validity was also observed among the OMIS subscales. The OMIS provides a psychometrically validated tool for assessing moral injury risk in any occupational setting. The OMIS will help facilitate further research and understanding of how moral injury presents in high-risk occupational settings beyond the military and allow for direct comparison between these groups for the first time.

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“…Vicarious trauma is recognized as an occupational hazard for nurses (Isobel & Thomas, 2022), particularly for those working in forensic mental health (Bradford & Chaimowitz, 2020). Importantly, forensic mental health nurses working in inpatient settings have exposure to distressing material in their professional role, including the aversive details of patients' own extreme trauma histories (Ireland et al, 2022; Morris et al, 2022; Newman et al, 2021). One hundred percent of forensic mental health patients have been found to have been exposed to a traumatic event in their lifetime, including 75% having been exposed to trauma during childhood, 65% having exposure to multiple traumatic events and 13% experiencing trauma related to their offending behavior (McKenna et al, 2019).…”

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confidence: 99%

Vicarious Trauma and Health Outcomes in Forensic Mental Health Nurses

Newman,

Roche,

Elliott

2023

Journal of Forensic Nursing

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Background Nurses working in forensic mental health settings are at risk of vicarious trauma because of their exposure to traumatized patients and distressing material such as the aversive details of patient crimes. Aim The aim of this study was to determine the incidence of vicarious trauma and explore its impact on health and absence from work. Methods A cross-sectional descriptive correlational study was undertaken. All 205 forensic mental health nurses working in a high-security inpatient facility were invited to participate. An online survey included the Vicarious Trauma Scale and the SF-36v2 to measure mental and physical health. Absence from work was also explored. Results Sixty-seven respondents completed the survey. Almost half of respondents had a moderate level of vicarious trauma, and only over one-quarter experienced high levels. Higher levels of vicarious trauma were associated with poorer mental health (r = −0.59, p < 0.000) and absence from work (r = 0.27, p < 0.010). Conclusions Forensic mental health nurses are at a greater risk of vicarious trauma than nurses working in mainstream mental health services, given their exposure to aversive details of patients' violent crimes. Adverse mental health consequences of vicarious trauma, and other forms of workplace trauma experienced by forensic mental health nurses, are likely to include trauma-related symptoms, depression, and anxiety. Forensic mental health nurses experiencing vicarious trauma may use sick leave as time away from work to care for their own mental health or a coping mechanism for workplace-induced psychological distress.

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Moral injury in secure mental healthcare: part I: exploratory and confirmatory factor analysis of the Moral Injury Events Scale

Cited by 8 publications

References 39 publications

Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting

Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting

The Occupational Moral Injury Scale: Development and validation in frontline health and first responder workers.

Vicarious Trauma and Health Outcomes in Forensic Mental Health Nurses

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