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Keywords:

  • moral distress;
  • staff nurse stress;
  • turnover;
  • ethical environment;
  • job satisfaction;
  • critical care nurses;
  • role conflict;
  • staffing adequacy;
  • physician-nurse relationships;
  • deception

Development and evaluation of a moral distress scale

Aim of the study: This methodological research developed and evaluated the moral distress scale from 1994 to 1997.

Background/Rationale: Although nurses confront moral questions in their practice daily, few instruments are available to measure moral concepts. The methodological design used a convenience sample consisted of 214 nurses from several Unites States hospitals. The framework guiding the development of the moral distress scale (MDS) included Jameton’s conceptualization of moral distress, House and Rizzo’s role conflict theory, and Rokeach’s value theory. Items for the MDS were developed from research on the moral problems that nurses confront in hospital practice. The MDS consists of 32 items in a 7-point Likert format; a higher score reflects a higher level of normal distress.

Results: Mean scores on each item ranged from 3·9 to 5·5, indicating moderately high levels of moral distress. The item with the highest mean score (M=5·47) was working where the number of staff is so low that care is inadequate. Factor analysis yielded three factors: individual responsibility, not in the patient’s best interest, and deception. No demographic or professional variables were related to moral distress. Fifteen percent of the nurses had resigned a position in the past because of moral distress.

Conclusions: The results support the reliability and validity of the MDS.