Fradley Kathryn, Sirois Fuschia, Bentall Richard, Ray Jaydip, Bishop Rhian, Wadsley Jonathan, Danson Sarah
School of Nursing and Public Health, Manchester Metropolitan University, Manchester, UK.
Department of Psychology, Durham University, Durham, UK.
Br J Health Psychol. 2025 Sep;30(3):e12810. doi: 10.1111/bjhp.12810.
The adverse impact of moral injury on health care workers is well documented, for example during the COVID-19 pandemic. However, currently available measures are unsuitable for assessing moral injury in health care workers living in secular societies such as the United Kingdom. The current study introduces and validates the Health care-Moral Injury Scale (HMIS).
The 10-item HMIS was designed during the COVID-19 pandemic to assess moral injury in health care workers. Between September and October 2020, 858 health care workers completed the scale and other measures. A factor structure was identified by exploratory and confirmatory factor analysis and correlations were used to test the convergent (burnout, hope, mistrust) and divergent (loneliness) validity of the HMIS. Regression analyses tested the criterion-related validity of the HMIS against measures of depression, anxiety and PTSD.
The HMIS was found to be a unidimensional scale comprised of three conceptual components. There was evidence of good convergent validity, with a medium-sized correlation between the total moral injury score and burnout. However, correlations were weaker for loss of hope and loss of trust. Moral injury was not significantly associated with loneliness when controlling for mental health difficulties, indicating good divergent validity. Moral injury scores predicted worse severity of depression, anxiety and PTSD, supporting criterion-related validity. Findings suggest that the HMIS is a valid scale that can be used by researchers to assess moral injury specifically in a health care context.
道德伤害对医护人员的不利影响已有充分记录，例如在新冠疫情期间。然而，目前可用的措施不适用于评估生活在英国等世俗社会的医护人员的道德伤害。本研究引入并验证了医护人员道德伤害量表（HMIS）。
10项HMIS量表是在新冠疫情期间设计的，用于评估医护人员的道德伤害。在2020年9月至10月期间，858名医护人员完成了该量表及其他测评。通过探索性和验证性因素分析确定了因素结构，并使用相关性分析来检验HMIS的聚合效度（倦怠、希望、不信任）和区分效度（孤独感）。回归分析检验了HMIS相对于抑郁、焦虑和创伤后应激障碍测评的效标关联效度。
HMIS被发现是一个单维量表，由三个概念性成分组成。有证据表明其具有良好的聚合效度，道德伤害总分与倦怠之间存在中等程度的相关性。然而，与希望丧失和信任丧失的相关性较弱。在控制心理健康问题时，道德伤害与孤独感无显著关联，表明具有良好的区分效度。道德伤害得分预测了更严重的抑郁、焦虑和创伤后应激障碍，支持效标关联效度。研究结果表明，HMIS是一个有效的量表，研究人员可用于专门评估医护人员背景下的道德伤害。
