Validation of the Greek version of the Revised Moral Distress Scale in critical care nurses

Abstract

• The revised Moral Distress Scale (MDS-R, 21 items) has been employed extensively for the assessment of moral distress associated with critical care nursing practice, and it has been validated in several countries with evidence of variation with regard to its construct validity. • The aim of this study was to explore the applicability, reliability and validity of the Greek version of the MDS-R (21 items). • The MDS-R (21 items) was translated into the Greek language and back-translated into English. Internal consistency and test-retest reliability were tested in random samples of critical care nurses in Greece. Construct and content validity were assessed through a panel of experts and by factor analysis. • The internal consistency was adequate. Cronbach's alpha was 0.863 for the entire scale and 0.836, 0.847 for the moral distress frequency and intensity subscale, respectively. Test-retest reliability was satisfactory (Kendall's τ = 0.989). Initial factor analysis resulted in a 3-factor solution accounting for 52% of variance. However, the majority of items loaded on the first factor, and 7 items exhibited high cross-loadings at the other two factors. Taking into account conceptual congruency, the one factor solution was deemed as more plausible. Support for predictive validity was provided by a statistically significant positive association with responders' intention to quit (r = 0.369, p < 0.0001) and an inverse association with reported work satisfaction (r =-0.285, p = 0.014). The overall mean total MDS-R (21-items) score was 93.01 ± 55.03 (scale range:0-336). • It is concluded that the reliability and validity of the Greek version of the MDS-R (21-items) scale are supported; however, further qualitative and quantitative studies are needed to elucidate the dimensions of Greek MDS-R (21-items).