Thai Translation and Psychometric Testing of the Measure of Moral Distress for Healthcare Professionals
DOI:
https://doi.org/10.31584/jhsmr.2023976Keywords:
measurement, moral distress, reliability, Thailand, translation, validityAbstract
Objective: This study aimed to describe the translation process and to test the psychometric properties of the Measure of Moral Distress for Healthcare Professionals (MMD-HP) among Thai nurses.
Material and Methods: The MMD-HP was administered via an electronic survey to registered nurses at 2 large tertiary care hospitals in a southern province in Thailand. The MMD-HP was translated into the Thai language using the modified Brislin’s cross-cultural instrument translation method. Reliability was analyzed using Cronbach’s alpha coefficient and validity was assessed using exploratory factor analysis with promax rotation.
Results: In total, 448 surveys were included in the final analysis. A three-factor structure was understandable and appropriate. The 3 factors were labeled as system-level, team-level, and patient/family-level root causes of moral distress. The overall internal consistency of the MMD-HP was 0.94; with 0.89, 0.89, and 0.85 for the system-level, team-level, and patient/family-level root causes, respectively.
Conclusion: Our analysis found that the 3-factor solutions of the Thai version of the MMD-HP was most appropriate in our context. Our study found it to be a reliable, valid, and useful tool to measure moral distress among nurses in the Thai context. It is an appropriate tool to be used cross-culturally.
References
Johnson-Coyle L, Opgenorth D, Bellows M, Dhaliwal J, Richardson-Carr S, Bagshaw SM. Moral distress and burnout among cardiovascular surgery intensive care unit healthcare professionals: A prospective cross-sectional survey. Can J Crit Care Nurs 2016;27:27–36.
Neumann JL, Mau L-W, Virani S, Denzen EM, Boyle DA, Boyle NJ, et al. Burnout, moral distress, work–life balance, and career satisfaction among hematopoietic cell transplantation professionals. Biol Blood Marrow Transplant 2018;24:849–60. doi: 10.1016/j.bbmt.2017.11.015.
Beck J, Randall CL, Bassett HK, O’Hara KL, Falco CN, Sullivan EM, et al. Moral distress in pediatric residents and pediatric hospitalists: sources and association with burnout. Acad Pediatr 2020;20:1198–205. doi: 10.1016/j.acap.2020.05.017.
Colville G, Dawson D, Rabinthiran S, Chaudry-Daley Z, Perkins-Porras L. A survey of moral distress in staff working in intensive care in the UK. J Intensive Care Soc 2019;20:196–203. doi: 10.1177/1751143718787753.
Epstein EG, Whitehead PB, Prompahakul C, Thacker LR, Hamric AB. Enhancing understanding of moral distress: the measure of moral distress for health care professionals. AJOB Empir Bioeth 2019;10:113–24. doi: 10.1080/23294515.2019.1586008.
Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Prim Res 2012;3:1–9. doi: 10.1080/21507716.2011.652337.
Trotochaud K, Coleman JR, Krawiecki N, McCracken C. Moral distress in pediatric healthcare providers. J Pediatr Nurs 2015;30:908–14. doi: 10.1016/j.pedn.2015.03.001.
Whitehead PB, Herbertson RK, Hamric AB, Epstein EG, Fisher JM. Moral distress among healthcare professionals: report of an institution-wide survey. J Nurs Scholarsh 2015;47:117–25. doi:10.1111/jnu.12115.
Jameton A. Nursing practice: The ethical issues. New Jersey: Prentice-Hall; 1984.
Dodek PM, Wong H, Norena M, Ayas N, Reynolds SC, Keenan SP, et al. Moral distress in intensive care unit professionals is associated with profession, age, and years of experience. J Crit Care 2016;31:178–82. doi: 10.1016/j.jcrc.2015.10.011.
Ashida K, Kawashima T, Kawakami A, Tanaka M. Moral distress among critical care nurses: A cross-cultural comparison. Nurs Ethics 2022;29:1341–52. doi: 10.1177/09697330221085773.
Rodriguez-Ruiz E, Campelo-Izquierdo M, Veiras PB, Rodríguez MM, Estany-Gestal A, Hortas AB, et al. Moral distress among healthcare professionals working in intensive care units in Spain. Med Intensiva (Engl Ed) 2021;46:383-91. doi: 10.1016/j.medine.2021.06.005.
Prompahakul P, Keim-Malpass J, LeBaron V, Yan G, Epstein EG. Moral distress among nurses: A mixed-methods study. Nurs Ethics 2021;28:1165-82. doi: 10.1177/0969733021996028.
Glassman A, Temin M. Million saved: new cases of proven success in global health. Washington DC: Center of Global Development; 2016.
Jongudomsuk P, Srithamrongsawat S, Patcharanarumol W, Limwattananon S, Pannarunothai S, Vapatanavong P, et al. The kingdom of Thailand health system review. Health Syst Transit 2015;5:1–299.
Nantsupawat A, Nantsupawat R, Kunaviktikul W, Turale S, Poghosyan L. Nurse burnout, nurse-reported quality of care, and patient outcomes in Thai hospitals. J Nurs Scholarsh 2016;48:83–90. doi: 10.1111/jnu.12187.
Nantsupawat A, Kunaviktikul W, Nantsupawat R, Wichaikhum OA, Thienthong H, Poghosyan L. Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. Int Nurs Rev 2017;64:91–98. doi: 10.1111/inr.12342.
Sawaengdee K, Tangcharoensathien V, Theerawit T, Thungjaroenkul P, Thinkhamrop W, Prathumkam P, et al. Thai nurse cohort study: cohort profiles and key findings. BMC Nursing 2016;15:1–12. doi: 10.1186/s12912-016-0131-0.
Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. J Adv Nurs 2001;33:250–56. doi: 10.1111/j.1365-2648.2001.01658.x.
Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med 2007;35:422–29. doi: 10.1097/01.CCM.0000254722.50608.2D.
Asgari S, Shafipour V, Taraghi Z, Yazdani-Charati J. Relationship between moral distress and ethical climate with job satisfaction in nurses. Nurs Ethics 2019;26:346–56. doi: 10.1177/0969733017712083.
Chae Y, Yu S, Lee EJ, Kang KJ, Park MS, Yu, M. Validity and reliability of the Korean version of the moral distress scalerevised for Korean hospital nurses. J Korean Acad Soc Nurs Educ 2016;22:228–39. doi: 10.5977/jkasne.2016.22.2.228.
Soleimani MA, Sharif SP, Yaghoobzadeh A, Sheikhi MR, Panarello B. Psychometric evaluation of the Moral Distress Scale-Revised among Iranian Nurses. Nurs Ethics 2019;26:1226–42. doi: 10.1177/0969733016651129.
Wenwen Z, Xiaoyan W, Yufang Z, Lifeng C, Congcong S. Moral distress and its influencing factors: a crosssectional study in China. Nurs Ethics 2016;25:470–80. doi: 10.1177/0969733016658792.
Bruce CR, Miller SM, Zimmerman JL. A qualitative study exploring moral distress in the ICU team: the importance of unit functionality and intrateam dynamics. Crit Care Med 2015;43:823–31. doi: 10.1097/CCM.0000000000000822.
Penny NH, Bires SJ, Dockery AN, Dockery AN, Pettit NL. Moral distress scale for occupational therapists: part 1. Instrument development and content validity. Am J Occup 2016;70:1–8. doi: 10.5014/ajot.2015.018358.
Brislin RW. Back translation for cross-cultural research. J Cross-Cult Psychol 1970;1:185–216. doi: 10.1177/135910457000100301.
Fabrigar LR, Wgener DT. Factor analysis. New York: Oxford University Press; 2012.
Nunnally C, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
Kaiser HF. The varimax criterion for analytic rotation in factor analysis. Psychometrika 1958;23:187–200.
Cattell RB. The scree test for the number of factors. Multivariate Behav Res 1966;1:245–76. doi: 10.1207/s15327906mbr0102_10.
Horn JL. A rationale and test for the number of factors in factor analysis. Psychometrica 1965;30:179–85.
Pituch KA, Stevens JP. Applied multivariate statistics for the social sciences. 6th ed. New York: Taylor & Francis; 2016.
Lamiani G, Setti I, Barlascini L, Vegni E, Argentero P. Measuring moral distress among critical care clinicians: validation and psychometric properties of the Italian moral distress scale-revised. Crit Care Med 2017;45:430–37. doi: 10.1097/CCM.0000000000002187.
Schaefer R, Zoboli EL, Vieira MM. Psychometric evaluation of the moral distress risk scale: a methodological study. Nurs Ethics 2019;26:434–42. doi: 10.1177/0969733017707347.
Karagozoglu S, Yildirim G, Ozden D, Cinar Z. Moral distress in Turkish intensive care nurses. Nurs Ethics 2017;24:209–24. doi: 10.1177/0969733015593408.
Hamric AB, Epstein EG. A health system-wide moral distress consultation service: development and evaluation. HEC Forum 2017;29:127–43. doi: 10.1007/s10730-016-9315-y.
Austin CL, Saylor R, Finley PJ. Moral distress in physicians and nurses: impact on professional quality of life and turnover. Psychol Trauma 2017;9:399–406. doi: 10.1037/tra0000201.
Trautmann J, Epstein E, Rovnyak V, Snyder A. Relationships among moral distress, level of practice independence, and intent to leave of nurse practitioners in emergency departments: results from a national survey. Adv Emerg Nurs J 2015;37:134–45. doi: 10.1097/TME.0000000000000060.
Allen R, Judkins-Cohn T, deVelasco R, Forges E, Lee R, Clark L, et al. Moral distress among healthcare professionals at a health system. JONAS Healthc Law Ethics Regul 2013;15:111–18. doi: 10.1177/0969733014557139.
Henrich NJ, Dodek PM, Alden L, Keenan SP, Reynolds S, Rodney P. Causes of moral distress in the intensive care unit: a qualitative study. J Crit Care 2016;35:57–62. doi: 10.1016/j.jcrc.2016.04.033.
Hiler CA, Hickman RL, Reimer AP, Wilson K. Predictors of moral distress in a US sample of critical care nurses. Am J Crit Care 2018;27:59–66. doi: 10.4037/ajcc2018968.
Burnard P, Naiyapatana,W. Culture and communication in Thai nursing: a report of an ethnographic study. Int J Nurs Stud 2004;41:755-65. doi: 10.1016/j.ijnurstu.2004.03.002.
Manasurakarn J, Chaowalit A, Suttharangsee W, Isaramalai S, Geden E. Values underlying end-of-life decisions of Thai Buddhist patients and their families. J Health Sci Med Res 2008;26:549-59.
Nijinikaree N, Chaowalit A, & Hatthakit U. The perspectives of end-of-life decisions in chronically ill Thai Muslim patients in the five border provinces of southern Thailand. J Health Sci Med Res 2008;26:43139.
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