Adaptation of Moral Distress Scale for Nursing Students into Turkish: A Validity and Reliability Study
Abstract
Aim: Nursing students witness ethical and moral problems in health care settings and can even be involved in these situations. A student who wants to act for a solution with a sense of responsibility cannot take action due to his/her position and may feel powerless, inadequate, and helpless. This condition, defined as Moral Distress (MD), should be recognized, evaluated, and intervened by nurse educators to protect students' health, prevent weakness and provide qualified education. The study aims to introduce a valid and reliable measuring instrument to the Turkish Language and Culture that can be used to measure the MD levels of nursing students.
Material and Methods: The sample of the study, which was carried out in methodological type, consisted of 410 3rd and 4th-grade nursing students studying at 48 different universities in 35 cities in Turkey. The data were collected online using the Participant Information form and Moral Distress Scale for Nursing Students (MDS-NS).
Results: As a result of the explanatory factor analysis, different from the original scale structure, a three-factor structure that explains 47.64% of the total variance was determined. The reliability of the MDS-NS was evaluated with the Cronbach Alpha coefficient, test-retest method, and the item-total correlation coefficient. The Cronbach Alpha coefficient was .94 for the total scale and .85-.92 for the sub-dimensions.
Conclusion: With its 41-item and three-factor structure, the MDS-NS is a valid and reliable tool for measuring the moral distress of nursing students. It is recommended to utilize MDS-NS in studies conducted to recognize, identify and measure MD, reduce MD and cope with MD.
References
- Bordignon SS, Lunardi VL, Barlem ELD, Dalmolin GdL, da Silveira RS, Ramos FRS, et al. Moral distress in undergraduate nursing students. Nurs Ethics. 2019;26(7-8):2325-39.
- Rennó HMS, Ramos FRS, Brito MJM. Moral distress of nursing undergraduates: Myth or reality? Nurs Ethics. 2018;25(3):304-12.
- Akbaş M, Tuncer İ, Kadioğlu S. Lisans düzeyindeki hemşirelik okullarında etik eğitiminin durumu. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi. 2014;7(3):206-11.
- 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(2):422-9.
- Powell SB, Engelke MK, Swanson MS. Moral distress among school nurses. J. Sch. Nurs. 2018;34(5):390-7.
- Krautscheid L, DeMeester DA, Orton V, Smith A, Livingston C, McLennon SM. Moral distress and associated factors among baccalaureate nursing students: a multisite descriptive study. Nurs Educ Perspect. 2017;38(6):313-9.
- Bordignon SS, Lunardi VL, Barlem EL, Silveira RSd, Ramos FR, Dalmolin GdL, et al. Nursing students facing moral distress: strategies of resistance. Rev Bras Enferm. 2018;71:1663-70.
- Pratt M, Martin L, Mohide A, Black M, editors. A descriptive analysis of the impact of moral distress on the evaluation of unsatisfactory nursing students. Nurs Forum. 2013;48(4):231-239.
- Corley MC. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics. 2002;9(6):636-50.
- Jameton A. What moral distress in nursing history could suggest about the future of health care. AMA J. Ethics. 2017;19(6):617-28.
- Hamric AB. A case study of moral distress. J Hosp Palliat Nurs. 2014;16(8):457-63.
- Hamric AB. Empirical research on moral distress: issues, challenges, and opportunities. HEC Forum. 2012;24(1):39-49.
- Jameton A. What moral distress in nursing history could suggest about the future of health care. AMA J. Ethics. 2017;19(6):617.
- Loredana Sasso FC. Moral distress in undergraduate nursing students: A systematic review. Nurs Ethics. 2016;23(5):523-534.
- Nadiah A. Baghdadi WLTD. Moral distress among nursing students during clinical training. IJNRHN. 7(3):269-76.
- Bordignon SS, Lunardi VL, Barlem ELD, Lunardi Filho W, Tomaschewski-Barlem JG, Ramos AM. Moral distress among undergraduate nursing students who question the choice of professional career. J Nurs Socioe Health. 2014;1(1):63-9.
- Escolar-Chua RL. Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students. Nurs Ethics. 2018;25(4):458-69.
- Grady A. Experiencing moral distress as a student nurse. Impr. 2014;61(2):40-42.
- Monrouxe LV, Rees CE, Dennis I, Wells SE. Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies. BMJ. 2015;5(5):1-13.
- Theobald A. Moral distress in baccalaureate nursing students. Ky Nurse. 2013;61(2):5-6.
- Wiggleton C, Petrusa E, Loomis K, Tarpley J, Tarpley M, O'Gorman ML, et al. Medical students' experiences of moral distress: development of a web-based survey. Acad Med. 2010;85(1):111-7.
- Giannetta N, Villa G, Pennestrì F, Sala R, Mordacci R, Manara DF. Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. Int. J. Nurs. 2020;111:1-34.
- Brown TA. Confirmatory factor analysis for applied research. 2th ed. New York: Guilford publications; 2015.
- Bordignon SS, Lunardi VL, Barlem EL, de Lima Dalmolin G, da Silveira RS, Ramos FRS, et al. Development and Validation of a Moral Distress Scale for Nursing Students. J Nurs Meas. 2020;28(3):583-97.
- Erdoğan S, Nahcivan N, ve Esin MN. (Eds.). Hemşirelikte araştırma: süreç, ugulama ve kritik. 2. baskı. İstanbul: Nobel Tıp Kitabevi; 2014.
- Erkan S, Gömleksiz M. Eğitimde ölçme ve değerlendirme. Ankara: Nobel Yayınevi; 2014.
- Alpar R. Spor, sağlık ve eğitim bilimlerinden örneklerle uygulamalı istatistik ve geçerlik-güvenirlik. Ankara: Detay Yayıncılık; 2018.
- Ercan İ, İsmet K. Ölçeklerde güvenirlik ve geçerlik. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2004;30(3):211-6.
- Erkorkmaz Ü, Etikan İ, Demir O, Özdamar K, Sanisoğlu SY. Doğrulayıcı faktör analizi ve uyum indeksleri. Turkiye Klinikleri Journal of Medical Sciences. 2013;33(1):210-23.
- Lewis TF. Evidence regarding the internal structure: Confirmatory factor analysis. Measurement and Evaluation in Counseling and Development. 2017;50(4):239-47.
- Büyüköztürk Ş. Sosyal Bilimler için Veri Analizi El Kitabı, 7. baskı. Ankara: Pegem A Yayıncılık; 2007.
- Krautscheid L, DeMeester DA, Orton V, Smith A, Livingston C, McLennon SM. Moral Distress and Associated Factors Among Baccalaureate Nursing Students: A Multisite Descriptive Study. Nurs Educ Perspect. 2017;38(6):313-9.
- 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(2):113-24.
- Jameton A. Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall, 1984.
- Wilkinson JM. Moral distress in nursing practice: experience and effect. Nursing Forum. 1987;23(1):16-29.
- Kathryn M. Ganske. Moral Distress in Academia. OJIN: The Online Journal of Issues in Nursing. 2010;15(3).
Hemşirelik Öğrencileri İçin Moral Distres Ölçeği’nin Türkçe Uyarlaması: Geçerlik ve Güvenirlik Çalışması
Abstract
Amaç: Hemşirelik öğrencileri, sağlık bakım ortamlarında etik ve ahlaki sorunları gözlemlemekte hatta bu durumların içerisinde olabilmektedir. Sorumluluk duygusuyla sorunun çözümü için harekete geçme isteği duyan öğrenci, pozisyonu nedeniyle eyleme geçememekte, kendini güçsüz, yetersiz ve çaresiz hissedebilmektedir. Moral Distres olarak tanımlanan bu durum, öğrencilerin sağlığını korumak, güçsüzlüğü önlemek ve nitelikli eğitimi sağlamak için hemşire eğitimciler tarafından tanınmalı, değerlendirilmeli ve müdahale edilmelidir. Bu çalışmanın amacı, hemşirelik öğrencilerinin, moral distres düzeyinin ölçülmesinde kullanılabilecek geçerli ve güvenilir bir ölçüm gerecini Türk dili ve kültürüne kazandırmaktır.
Gereç ve Yöntem: Metodolojik tipte gerçekleştirilen çalışmanın örneklemini, Türkiye’deki 35 ilde 48 farklı üniversitede eğitim alan 410, 3. ve 4. sınıf hemşirelik öğrencisi oluşturmuştur. Veriler, Katılımcı Bilgi formu ve Hemşirelik Öğrencileri için Moral Distres Ölçeği (HÖ-MDÖ) ile online olarak toplanmıştır.
Bulgular: Açımlayıcı faktör analizi sonucunda orijinal ölçek yapısından farklı olarak toplam varyansın %47.64’ünü açıklayan üç faktörlü yapı belirlenmiştir. HÖ-MDÖ’nün güvenirliği Cronbach Alfa katsayısı, test tekrar test yöntemi ve madde bütün korelasyon katsayısı ile değerlendirilmiştir. Cronbach Alfa katsayısı toplam ölçek için .94, alt boyutların .85-.92 aralığında bulunmuştur.
Sonuç: HÖ-MDÖ’nün, 41 madde ve üç alt faktörlü yapısı, hemşirelik öğrencilerinin moral distres düzeylerini ölçmede geçerli ve güvenilir bir gereçtir. Moral distresi tanıma, belirleme ve ölçme, moral distresi azaltma ve baş etmeye yönelik çalışmalarda, HÖ-MDÖ’nün kullanılması önerilmektedir.
References
- Bordignon SS, Lunardi VL, Barlem ELD, Dalmolin GdL, da Silveira RS, Ramos FRS, et al. Moral distress in undergraduate nursing students. Nurs Ethics. 2019;26(7-8):2325-39.
- Rennó HMS, Ramos FRS, Brito MJM. Moral distress of nursing undergraduates: Myth or reality? Nurs Ethics. 2018;25(3):304-12.
- Akbaş M, Tuncer İ, Kadioğlu S. Lisans düzeyindeki hemşirelik okullarında etik eğitiminin durumu. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi. 2014;7(3):206-11.
- 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(2):422-9.
- Powell SB, Engelke MK, Swanson MS. Moral distress among school nurses. J. Sch. Nurs. 2018;34(5):390-7.
- Krautscheid L, DeMeester DA, Orton V, Smith A, Livingston C, McLennon SM. Moral distress and associated factors among baccalaureate nursing students: a multisite descriptive study. Nurs Educ Perspect. 2017;38(6):313-9.
- Bordignon SS, Lunardi VL, Barlem EL, Silveira RSd, Ramos FR, Dalmolin GdL, et al. Nursing students facing moral distress: strategies of resistance. Rev Bras Enferm. 2018;71:1663-70.
- Pratt M, Martin L, Mohide A, Black M, editors. A descriptive analysis of the impact of moral distress on the evaluation of unsatisfactory nursing students. Nurs Forum. 2013;48(4):231-239.
- Corley MC. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics. 2002;9(6):636-50.
- Jameton A. What moral distress in nursing history could suggest about the future of health care. AMA J. Ethics. 2017;19(6):617-28.
- Hamric AB. A case study of moral distress. J Hosp Palliat Nurs. 2014;16(8):457-63.
- Hamric AB. Empirical research on moral distress: issues, challenges, and opportunities. HEC Forum. 2012;24(1):39-49.
- Jameton A. What moral distress in nursing history could suggest about the future of health care. AMA J. Ethics. 2017;19(6):617.
- Loredana Sasso FC. Moral distress in undergraduate nursing students: A systematic review. Nurs Ethics. 2016;23(5):523-534.
- Nadiah A. Baghdadi WLTD. Moral distress among nursing students during clinical training. IJNRHN. 7(3):269-76.
- Bordignon SS, Lunardi VL, Barlem ELD, Lunardi Filho W, Tomaschewski-Barlem JG, Ramos AM. Moral distress among undergraduate nursing students who question the choice of professional career. J Nurs Socioe Health. 2014;1(1):63-9.
- Escolar-Chua RL. Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students. Nurs Ethics. 2018;25(4):458-69.
- Grady A. Experiencing moral distress as a student nurse. Impr. 2014;61(2):40-42.
- Monrouxe LV, Rees CE, Dennis I, Wells SE. Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies. BMJ. 2015;5(5):1-13.
- Theobald A. Moral distress in baccalaureate nursing students. Ky Nurse. 2013;61(2):5-6.
- Wiggleton C, Petrusa E, Loomis K, Tarpley J, Tarpley M, O'Gorman ML, et al. Medical students' experiences of moral distress: development of a web-based survey. Acad Med. 2010;85(1):111-7.
- Giannetta N, Villa G, Pennestrì F, Sala R, Mordacci R, Manara DF. Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. Int. J. Nurs. 2020;111:1-34.
- Brown TA. Confirmatory factor analysis for applied research. 2th ed. New York: Guilford publications; 2015.
- Bordignon SS, Lunardi VL, Barlem EL, de Lima Dalmolin G, da Silveira RS, Ramos FRS, et al. Development and Validation of a Moral Distress Scale for Nursing Students. J Nurs Meas. 2020;28(3):583-97.
- Erdoğan S, Nahcivan N, ve Esin MN. (Eds.). Hemşirelikte araştırma: süreç, ugulama ve kritik. 2. baskı. İstanbul: Nobel Tıp Kitabevi; 2014.
- Erkan S, Gömleksiz M. Eğitimde ölçme ve değerlendirme. Ankara: Nobel Yayınevi; 2014.
- Alpar R. Spor, sağlık ve eğitim bilimlerinden örneklerle uygulamalı istatistik ve geçerlik-güvenirlik. Ankara: Detay Yayıncılık; 2018.
- Ercan İ, İsmet K. Ölçeklerde güvenirlik ve geçerlik. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2004;30(3):211-6.
- Erkorkmaz Ü, Etikan İ, Demir O, Özdamar K, Sanisoğlu SY. Doğrulayıcı faktör analizi ve uyum indeksleri. Turkiye Klinikleri Journal of Medical Sciences. 2013;33(1):210-23.
- Lewis TF. Evidence regarding the internal structure: Confirmatory factor analysis. Measurement and Evaluation in Counseling and Development. 2017;50(4):239-47.
- Büyüköztürk Ş. Sosyal Bilimler için Veri Analizi El Kitabı, 7. baskı. Ankara: Pegem A Yayıncılık; 2007.
- Krautscheid L, DeMeester DA, Orton V, Smith A, Livingston C, McLennon SM. Moral Distress and Associated Factors Among Baccalaureate Nursing Students: A Multisite Descriptive Study. Nurs Educ Perspect. 2017;38(6):313-9.
- 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(2):113-24.
- Jameton A. Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall, 1984.
- Wilkinson JM. Moral distress in nursing practice: experience and effect. Nursing Forum. 1987;23(1):16-29.
- Kathryn M. Ganske. Moral Distress in Academia. OJIN: The Online Journal of Issues in Nursing. 2010;15(3).
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 31, 2022 |
| Submission Date | August 2, 2021 |
| Published in Issue | Year 2022 Volume: 9 Issue: 2 |
