Revising And Application Of The Chinese Version Of The Moral Distress Scale-revised For Nurses

Objective:(1)Translate and develop the Chinese version of Moral Distress Scale-Revised for Nurses. (2)Examine the reliability and validity of the scale.(3)Apply the scale to investigate the nurses'level of moral distress in China, and explore the factors that affect the nurses'level of moral distress.Methods:(1)Cross-cultural adaptation process was applied to translate and develop the Chinese version of Moral Distress Scale-Revised for Nurses. (2) 238 nurses from two hospitals in Taian City were selected by random sampling to answer the scale and general information questinaire. (3)All data obtained was analyzed statistically by software package SPSS13.0 for windows. Correlation coefficient and critical ratio were used to delete or retain an item. Statistical methods such as Cronbach'a coefficient,split-half reliability, test-retest,exploratory factor analysis were used to evaluate the reliability and val idity of the scale. Descriptive statistics, ANOVA and multivariable linear regression were used to describe the nurses'level of moral distress and the factors that affect the nurses'level of moral distress.Results:(1) Through cross-cultural adaptation process and item analysis,a 22-item Chinese version of moral distress scale-revised was developed. Content validity index is 0.909. Construct val idity of validity analysis:exploratory factor analysis of the items identified that the scale had 4 factors,explaning 54.583% of the total variance. Four factors were labeled as follows:individual responsibility,not in patients'best interest, value conflict, damage patients'interest. Reliability analysis:The Cronbach'a coefficients for the MDS-R dimensions were 0.846,0.724,0.738 and 0.566, and 0.879 for the total scale. The split-half reliability coefficient for MDS-R was 0.851. The test-retest reliability coefficient for MDS-R was 0.80.(2)Nurses reported a low level of moral distress overall. Highest levels of distress were associated with "Follow the family's wishes to continue life support even though I believe it is not in the best interest of the patient" "Initiate extensive life-saving actions when I think they only prolong death" " "Continue to participate in care for a hopelessly ill person who is being sustained on a ventilator, when no one will make a decision to withdraw support". There were significant differences in the level of moral distress among different groups of age, years of nursing experience, professional title, position, educational level.(3)The result of multiple linear regression show that department, professional title and position influence the level of moral distress, where regression coefficients are 0.138,0.213,0.233.Conclusions:(1)The Chinese version of Moral Distress Scale-Revised for nurses has good reliability and validity in the measurement of Chinese nurses.(2)Nurses reported a low level of moral distress overall. Highest levels of distress were associated with futile care.(3) Department, professional title and posi tion may be the major influent facor of moral distress in nurses.