Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain.
Chongqing University Cancer Hospital, Chongqing, China.
Inquiry. 2021 Jan-Dec;58:46958021996499. doi: 10.1177/0046958021996499.
Moral distress (MD) has become a seriously negative problem experienced by healthcare professionals, especially clinical nurses. Early and accurate detection of MD by the validated and reliable instrument is critically important to further develop an effective intervention strategy. We performed the current systematic review to comprehensively summarize the evidence of instruments for the detection of MD in clinical nurses. The research design was a systematic literature review. We assigned 2 investigators to independently search potential studies in PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI) from their inception to June 2020. We used data extraction table extracting essential information, and the modified critical appraisal tool evaluating the reliability and validity of eligible instruments. Finally, we qualitatively summarized results of all included instruments. No ethical approval was required because this systematic review was performed based on published studies. We included 16 eligible studies covering 10 original and 6 revised or modified instruments for the final analysis. The overall quality of all instruments was moderate because test-retest reliability was inadequately examined in most instruments. Of 16 instruments, MDS-revised (MDS-R) was broadly validated and employed in different working or cultural settings. Meanwhile, it also extensively expands to specifically detect MD. Moreover, other instruments including moral distress risk scale (MDSR) and moral distress thermometer (MDT) should be further validated and utilized because it covered the gap missed by most instruments. Although several instruments have been made available for clinical nurses, some of them have inadequate psychometric properties test, especially test-retest reliability evaluation. Meanwhile, most of them have not be validated and employed in other working or cultural settings. We therefore suggested further studies to validate the psychometric properties of existing instruments and then employed instruments with high reliability and validity to detect MD in clinical nurses.
道德困境（MD）已成为医疗保健专业人员，尤其是临床护士面临的一个严重的负面问题。通过经过验证和可靠的工具及早准确地发现 MD，对于进一步制定有效的干预策略至关重要。我们进行了这项系统评价，以全面总结用于检测临床护士 MD 的工具的证据。研究设计为系统文献回顾。我们分配了 2 名调查员独立检索从成立到 2020 年 6 月在 PubMed、EMBASE 和中国国家知识基础设施（CNKI）中潜在的研究。我们使用数据提取表提取基本信息，并使用改良的关键评估工具评估合格工具的可靠性和有效性。最后，我们对所有纳入工具的结果进行了定性总结。由于这是基于已发表的研究进行的系统评价，因此不需要伦理批准。我们纳入了 16 项合格研究，涵盖了 10 项原始工具和 6 项修订或修改后的工具，最终进行了分析。由于大多数工具都没有充分检查重测信度，因此所有工具的整体质量均为中等。在 16 种工具中，MDS-revised（MDS-R）得到了广泛的验证，并在不同的工作或文化环境中使用。同时，它还广泛扩展到专门检测 MD。此外，其他工具包括道德困境风险量表（MDSR）和道德困境温度计（MDT）也应该进一步验证和使用，因为它们涵盖了大多数工具错过的差距。尽管已经为临床护士提供了几种工具，但其中一些工具的心理测量学特性测试不足，尤其是重测信度评估。同时，大多数工具尚未在其他工作或文化环境中得到验证和使用。因此，我们建议进一步研究验证现有工具的心理测量学特性，然后使用可靠性和有效性高的工具来检测临床护士的 MD。
