title: Moral distress questionnaire for clinical nurses: instrument development.
abstract: OBJECTIVE
  This paper is a report of a study to develop and test the psychometric properties of a culture-sensitive moral distress questionnaire among nurses employed in a variety of work settings.
  
  
  BACKGROUND
  In the course of the last decade, there has been increased interest in capturing healthcare professionals' experiences of stress associated with ethical dilemmas. Ethical issues emerge in grey areas and are often blurred, and have thus received insufficient attention.
  
  
  METHODS
  The study comprised two phases: a qualitative phase to elicit the culture-specific themes and a quantitative phase, comprising the design of a 15-item questionnaire. The questionnaire was then completed by a convenience sample of 179 nurses from a variety of work settings. The data were collected in 2006.
  
  
  RESULTS
  Factor analysis resulted in three factors representing moral distress: (1) problems caused by work relationships among staff; (2) problems due to lack of resources; and (3) problems caused by time pressure. With regard to the construct validity of the questionnaire, differences between community and hospital nurses were tested, and a statistically significant difference was found between them in two among the three factors (relationships and time). The stability of the measures was examined by test-retest reliability and revealed statistically significant results.
  
  
  CONCLUSIONS
  The instrument exhibits acceptable reliability and validity in the Israeli cultural context. Further research is needed to evaluate the measure in other cultural settings.
authors.affiliation: Department of Health Systems Management, Yezreel Valley College, Emek Yezreel, Israel. michalm@yvc.ac.il
authors.forename: Michal Mashiach
authors.initials: MM
authors.lastname: Eizenberg
authors.forename: Helena Syna
authors.initials: HS
authors.lastname: Desivilya
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Hirschfeld
mesh_terms: D000223:Adaptation, Psychological / Q000941:ethics*; D000328:Adult; D001291:Attitude of Health Personnel; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D035863:Moral Development; D015404:Nursing Methodology Research / Q000941:ethics*; D009740:Nursing Staff / Q000523:psychology*; D011594:Psychometrics / Q000941:ethics*; D015203:Reproducibility of Results; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult