TY - JOUR
T1 - Measuring moral distress and moral injury
T2 - A systematic review and content analysis of existing scales
AU - Houle, Stephanie A.
AU - Ein, Natalie
AU - Gervasio, Julia
AU - Plouffe, Rachel A.
AU - Litz, Brett T.
AU - Carleton, R. Nicholas
AU - Hansen, Kevin T.
AU - Liu, Jenny J. W.
AU - Ashbaugh, Andrea R.
AU - Callaghan, Walter
AU - Thompson, Megan M.
AU - Easterbrook, Bethany
AU - Smith-MacDonald, Lorraine
AU - Rodrigues, Sara
AU - Bélanger, Stéphanie A. H.
AU - Bright, Katherine
AU - Lanius, Ruth A.
AU - Baker, Clara
AU - Younger, William
AU - Bremault-Phillips, Suzette
AU - Hosseiny, Fardous
AU - Richardson, J. Don
AU - Nazarov, Anthony
AU - Atlas Institute Moral Injury Research Community of Practice
N1 - Copyright:
© 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.
PY - 2024/3
Y1 - 2024/3
N2 - Background: Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use.Method: We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific outcomes measured by each scale.Results: We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes.Conclusions: Results show how the terms MD and MI are applied in research. Several scales were identified as appropriate for research and clinical use. Recommendations for the application, development, and validation of MD and MI scales are provided.
AB - Background: Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use.Method: We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific outcomes measured by each scale.Results: We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes.Conclusions: Results show how the terms MD and MI are applied in research. Several scales were identified as appropriate for research and clinical use. Recommendations for the application, development, and validation of MD and MI scales are provided.
KW - Moral distress
KW - Moral injury
KW - Psychometrics
KW - Scale development
KW - Measurement
U2 - 10.1016/j.cpr.2023.102377
DO - 10.1016/j.cpr.2023.102377
M3 - Review article
C2 - 38218124
SN - 0272-7358
VL - 108
JO - Clinical psychology review
JF - Clinical psychology review
M1 - 102377
ER -