Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA.
School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
J Palliat Med. 2021 Jun;24(6):865-872. doi: 10.1089/jpm.2020.0328. Epub 2020 Nov 16.
Health care interprofessionals face competing obligations to their patients, employers, and themselves. When ethical conflicts ensue and competing obligations cannot be resolved, health care interprofessionals have reported experiencing symptoms of burnout, moral distress, and other types of moral suffering. Recently, moral resilience or "the capacity of an individual to sustain or restore their integrity in response to moral adversity," has been proposed as a resource to address moral suffering while contributing to well-being. Develop and validate an instrument to measure moral resilience. Phase one: item development and expert review. Phase two: focus groups with health care interprofessionals to refine items. Phase three: psychometric testing. Seven hundred twenty-three health care interprofessionals participated; inclusion criteria included being a chaplain, nurse, physician, or social worker, and having practiced at least 1 year. Participants were recruited from seven academic and community hospitals in the Eastern United States. One hundred items were created for expert review. Following focus groups to refine items, 35 items remained for psychometric testing. Eighteen items were removed following item analysis. Exploratory factor analysis (EFA) of the remaining items suggested a four-factor solution, titled Responses to Moral Adversity, Personal Integrity, Moral Efficacy, and Relational Integrity, respectively. Overall reliability was = 0.84. The Rushton Moral Resilience Scale (RMRS) demonstrated convergent validity with the Connor Davidson Resilience Scale-10 and criterion validity with the Maslach Burnout Inventory-Human Services Survey. The RMRS demonstrated acceptable validity and reliability. Examining the factor structure of moral resilience contributes to burgeoning moral resilience science and enables future research. Moral Resilience offers a promising pathway to support interprofessionals' integrity even when faced with ethical challenges.
医疗保健专业人员面临着对患者、雇主和自身的竞争义务。当出现伦理冲突且竞争义务无法解决时，医疗保健专业人员报告称出现了倦怠、道德困境和其他类型的道德痛苦症状。最近，道德韧性或“个体在面对道德困境时维持或恢复其完整性的能力”被提议作为一种资源，以应对道德痛苦并促进幸福感。开发并验证一种衡量道德韧性的工具。第一阶段：项目开发和专家审查。第二阶段：与医疗保健专业人员进行焦点小组讨论以完善项目。第三阶段：心理测试。共有 723 名医疗保健专业人员参与；纳入标准包括牧师、护士、医生或社会工作者，且至少有 1 年的从业经验。参与者是从美国东部的 7 家学术和社区医院招募的。为专家审查创建了 100 个项目。在进行焦点小组讨论以完善项目后，仍有 35 个项目可用于心理测试。经过项目分析，有 18 个项目被删除。剩余项目的探索性因素分析（EFA）表明，分别有四个因素解决方案，分别为应对道德逆境、个人诚信、道德效能和关系诚信。整体信度为 = 0.84。Rushton 道德韧性量表（RMRS）与 Connor-Davidson 韧性量表-10 具有收敛效度，与 Maslach 职业倦怠量表-人类服务调查具有效标效度。RMRS 具有可接受的有效性和可靠性。研究道德韧性的结构有助于促进蓬勃发展的道德韧性科学，并为未来的研究提供依据。道德韧性为支持专业人员的诚信提供了一条有前途的途径，即使他们面临伦理挑战。
