Measuring moral distress in nurses during a pandemic: Development and validation of the COVID‐MDS

Abstract

The COVID‐19 pandemic created novel patient care circumstances that may have increased nurses' moral distress, including COVID‐19 transmission risk and end‐of‐life care without family present. Well‐established moral distress instruments do not capture these novel aspects of pandemic nursing care. The purpose of this study was to develop and evaluate the psychometric properties of the COVID‐19 Moral Distress Scale (COVID‐MDS), which was designed to provide a short MDS that includes both general and COVID‐19‐specific content. Researcher‐developed COVID‐19 items were evaluated for content validity by six nurse ethicist experts. This study comprised a pilot phase and a validation phase. The pilot sample comprised 329 respondents from inpatient practice settings and the emergency department in two academic medical centers. Exploratory factor analysis (EFA) was conducted with the pilot data. The EFA results were tested in a confirmatory factor analysis (CFA) using the validation data. The validation sample comprised 5042 nurses in 107 hospitals throughout the United States. Construct validity was evaluated through CFA and known groups comparisons. Reliability was assessed by the omega coefficient from the CFA and Cronbach's alpha. A two‐factor CFA model had good model fit and strong loadings, providing evidence of a COVID‐19‐specific dimension of moral distress. Reliability for both the general and COVID‐19‐specific moral distress subscales was satisfactory. Known groups comparisons identified statistically significant correlations as theorized. The COVID‐MDS is a valid and reliable short tool for measuring moral distress in nurses including both broad systemic sources and COVID‐19 specific sources.

Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS

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“…The following supporting information can be downloaded at: , File S1: Excel spreadsheet containing complete metadata of references retrieved for description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS. (References [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 …”

Moral Distress and Intention to Leave During COVID

“…The COVID Moral Distress Scale (COVID-MDS) 18 was used to measure morally distressing situations nurses experience during the pandemic. The tool has 3 subscales related to moral distress: 1) patient issues; 2) team/system (circumstances) issues; and 3) COVID-19–specific issues (such as family not being present with a sick or dying patient).…”

Does moral distress in emergency department nurses contribute to intentions to leave their post, specialisation, or profession: A systematic review

“…The MDS-R has recently been revised to the Measure of Moral Distress for Healthcare Professionals (MMD-HP), ( Epstein et al., 2019 ) and this may represent the most up-to-date understanding of the causes of moral distress, demonstrating good reliability across a number of healthcare settings ( Epstein et al., 2019 ). Also developed recently is the COVID‐19 Moral Distress Scale (COVID‐MDS), ( Cramer et al., 2022 ) which was reported as showing satisfactory levels of validity and reliability for both intensive care and emergency nurses.…”