Validation of the German Version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP) and Its Correlation to the Second Victim Phenomenon

Abstract

Introduction: Comparable to second victim phenomenon (SVP), moral injury (MI) affects health professionals (HP) working in stressful environments. Information on how MI and SVP intercorrelate and their part in a psychological trauma complex is limited. We tested and validated a German version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP) instrument, screening for MI and correlated it with the recently developed German version of the Second Victim Experience and Support Tool (G-SVESTR) instrument, testing for SVP. Methods: After translating Moral Injury Symptom and Support Scale for Health Professionals (MISS-HP), we conducted a cross-sectional online survey providing G-MISS-HP and G-SVEST-R to HP. Statistics included Pearson’s interitem correlation, reliability analysis, principal axis factoring and principal components analysis with Promax rotation, confirmatory factor and ROC analyses. Results: A total of 244 persons responded, of whom 156 completed the survey (33% nurses, 16% physicians, 9% geriatric nurses, 7.1% speech and language therapists). Interitem and corrected item-scale correlations did not measure for one item sufficiently. It was, therefore, excluded from further analyses. The nine-item score revealed good reliability (Guttman’s lambda 2 = 0.80; Cronbach’s alpha = 0.79). Factor validity was demonstrated, indicating that a three-factor model from the original study might better represent the data compared with our two-factor model. Positive correlations between G-MISS-HP and G-SVESTR subscales demonstrated convergent validity. ROC revealed sensitivity of 89% and specificity of 63% for G-MISS-HP using a nine-item scale with cutoff value of 28.5 points. Positive and negative predictive values were 62% and 69%, respectively. Subgroup analyses did not reveal any differences. Conclusion: G-MISS-HP with nine items is a valid and reliable testing instrument for moral injury. However, strong intercorrelations of MI and SVP indicate the need for further research on the distinction of these phenomena.

The psychometric properties of the Persian version of the moral injury symptoms scale-health care professionals version

“…The study results indicated that Iranian health care professionals obtained three acceptable factors for the MISS-HP that explained nearly 60% of the variance. The variance obtained in the present study was higher than that reported in the German (Trifunovic-Koenig et al, 2022), Chinese (Zhizhong et al, 2020), and the United States versions (Mantri et al, 2020). In the Chinese version of the MISS-HP, EFA suggested three factors that accounted for 59% of the variance (Zhizhong et al, 2020).…”

“…The study results showed acceptable psychometric properties of the Persian version of MISS-HP. A review of the literature showed that due to the COVID-19 outbreak and the possibility of moral injury of health care professionals, the Chinese (Zhizhong et al, 2020), German (Trifunovic-Koenig et al, 2022), Turkish (Üstün, 2022), and the United States (Mantri et al, 2020) versions of this questionnaire have been used and measured psychometrically.…”

“…These two items were rejected because they contained the religious beliefs of healthcare professionals. In addition, item 10 in the German version was removed because it dealt with the beliefs in God and 25% of all healthcare providers in Germany are atheists/agnostics or not affiliated with religious groups (Trifunovic-Koenig et al, 2022). In order to measure and evaluate this questionnaire better, spiritual, religious and cultural differences of the health care professionals should be considered in future research.…”

“…However, the correlation between items and modified scales for an item was not acceptable in the German version of the MISS-HP. The German version was approved with 9 items and three factors (Trifunovic-Koenig et al, 2022). The Chinese version of the MISS-HP suggested three factors (Zhizhong et al, 2020).…”

Understanding Moral Distress among Eldercare Workers: A Scoping Review

“…Consequently, the employees are found to experience negative emotions such as frustration and anger, emotional exhaustion, cynical attitudes, and depersonalization toward patients, resulting in quitting or considering quitting their position [ 10 ]. Ethical dilemmas and moral distress should be distinguished from more acute and traumatizing care-related effects, such as second victim effects and moral injuries, which result from unforeseeable and acute incidents during treatment [ 11 , 12 ].…”