• culture-sensitive instrument;
  • ethics;
  • instrument development;
  • moral distress;
  • nursing;
  • questionnaire validation


Title. Moral distress questionnaire for clinical nurses: instrument development.

Aim.  This paper is a report of a study to develop and test the psychometric properties of a culture-sensitive moral distress questionnaire among nurses employed in a variety of work settings.

Background.  In the course of the last decade, there has been increased interest in capturing healthcare professionals’ experiences of stress associated with ethical dilemmas. Ethical issues emerge in grey areas and are often blurred, and have thus received insufficient attention.

Method.  The study comprised two phases: a qualitative phase to elicit the culture-specific themes and a quantitative phase, comprising the design of a 15-item questionnaire. The questionnaire was then completed by a convenience sample of 179 nurses from a variety of work settings. The data were collected in 2006.

Results.  Factor analysis resulted in three factors representing moral distress: (1) problems caused by work relationships among staff; (2) problems due to lack of resources; and (3) problems caused by time pressure. With regard to the construct validity of the questionnaire, differences between community and hospital nurses were tested, and a statistically significant difference was found between them in two among the three factors (relationships and time). The stability of the measures was examined by test-retest reliability and revealed statistically significant results.

Conclusions.  The instrument exhibits acceptable reliability and validity in the Israeli cultural context. Further research is needed to evaluate the measure in other cultural settings.