Moral distress in long-term care questionnaire modification and psychometric evaluation

Licensed nurses working in long-term care facilities experience ethical challenges if not resolved can lead to moral distress. There is a lack of an English-language validated tool to adequately measure moral distress in the long-term care setting.To describe the modification and psychometric evaluation of the Moral Distress Questionnaire.Instrument development and psychometric evaluation. Internal consistency using Cronbach's α to establish reliability was conducted using SPSS version 27.0 while SPSS Amos version 27.0 was used to perform a confirmatory factor analysis of the Moral Distress Questionnaire.A national sample of US-licensed nurses who provided direct resident care in long-term care settings were recruited via a targeted sampling method using Facebook from 7 December 2020 to 7 March 2021.The study was approved by the university's human research protection program. Informed consent was provided to all participants.A total of 215 participants completed the surveys. Confirmatory analysis indicated that the 21-item scale with a 4-factor structure for the Moral Distress Questionnaire model met the established criteria and demonstrates an acceptable model fit (CMIN/DF = 2.0, CFI = 0.82, TLI = 0.77, RMSEA = 0.07). Factor loadings for each item depict a moderate to a strong relationship (range 0.36-0.70) with the given underlying construct. Cronbach's α coefficient was 0.87 for the overall scale and 0.60-0.74 for its subscales which demonstrate good reliabilities.This is the first English-language validated tool to adequately measure moral distress in the long-term care setting experienced by US long-term care nurses. This reliable and well-validated tool will help identify moral distress situations experienced by US long-term care nurses.The modified 21-item English version of the Moral Distress Questionnaire is reliable tool that demonstrates good psychometric properties to validly measure sources of moral distress among direct resident care nurses.