Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
IRCCS San Raffaele Scientific Institute, Milan, Italy.
Int J Nurs Stud. 2020 Nov;111:103767. doi: 10.1016/j.ijnurstu.2020.103767. Epub 2020 Sep 2.
An increasing number of professionals are challenged by the evolution of modern healthcare and society, often characterized by more expectations with reduced resources. Moral distress is among the psychophysical conditions now most under investigation in order to improve the wellbeing of professionals, the sustainability of organizations and the quality of care. Over the last decades, several instruments have been developed to assess the frequency or intensity of moral distress in different studies. Yet, there has not been, so far, a systematic assessment of the qualitative properties of the various instruments measuring moral distress in healthcare workers based on a universally accepted standardized framework.
(1) To identify all instruments for the measurement of moral distress available in recent literature; (2) to evaluate the evidence regarding their measurement properties; (3) to facilitate the selection of the most appropriate instrument to be adopted in practice and research.
Systematic literature review.
PubMed, CINAHL, and PyscINFO.
The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of the identified studies. The quality of measurement properties of each instrument was evaluated using Terwee's quality criteria.
Among the 1268 studies found, 88 full-text articles evaluated moral distress adopting different tools. Thirty two of them had a methodological design. The measurement instruments assessed in this review are different in terms of targeted population and items. The instruments were then divided into two main categories: (1) Corley's instruments on moral distress (Moral distress scale and Moral Distress Scale - Revised) and (2) instruments not directly derived from Corley's moral distress theory (Moral Distress thermometer, Moral Distress Risk Scale, Ethical Stress Scale or Moral Distress in Dementia Care Survey). The first set is the most frequently studied and used in different clinical settings and healthcare populations. A variety of psychometric properties have been evaluated for each instrument, revealing different qualities in the methodology used.
Several instruments assessing moral distress in healthcare workers have been identified and evaluated in this systematic review. Based on the criteria used here, Corley's instruments on moral distress seems to be the most useful and most appropriate to the clinical setting for practice and research purposes.
The aim of this systematic review was to identify the instruments measuring moral distress now available in the literature, in order to (1) assess the evidence about their measurement properties, (2) support the selection of the most appropriate instrument to be used in practice and research.
越来越多的专业人士面临现代医疗保健和社会发展带来的挑战，其特点通常是期望增加而资源减少。道德困境是目前研究最多的心理生理状况之一，目的是提高专业人员的幸福感、组织的可持续性和护理质量。在过去的几十年中，已经开发出了几种工具来评估不同研究中道德困境的频率或强度。然而，到目前为止，还没有基于普遍接受的标准化框架，对衡量医疗保健工作者道德困境的各种工具的定性属性进行系统评估。
(1)确定最近文献中可用于测量道德困境的所有工具；(2)评估其测量特性的证据；(3)为在实践和研究中选择最合适的工具提供便利。
系统文献综述。
PubMed、CINAHL 和 PyscINFO。
使用共识基础的健康测量工具选择标准检查表来评估确定研究的方法学质量。使用 Terwee 的质量标准评估每个工具的测量特性质量。
在 1268 篇研究中，有 88 篇全文文章采用不同的工具评估了道德困境。其中 32 篇具有方法学设计。本综述评估的测量工具在目标人群和项目方面有所不同。这些工具随后分为两大类：(1)Corley 的道德困境工具(道德困境量表和道德困境量表修订版)和(2)并非直接源自 Corley 道德困境理论的工具(道德困境温度计、道德困境风险量表、伦理压力量表或痴呆症护理道德困境调查)。第一组是研究和使用最多的，用于不同的临床环境和医疗保健人群。已经评估了每种工具的各种心理测量特性，揭示了使用的方法学中的不同质量。
本系统评价中确定并评估了用于评估医疗保健工作者道德困境的几种工具。根据这里使用的标准，Corley 的道德困境工具似乎是最有用的，最适合临床实践和研究目的。
本系统评价的目的是确定文献中现有的衡量道德困境的工具，以便：(1)评估其测量特性的证据；(2)支持选择在实践和研究中使用的最合适的工具。
