Evaluation of a Moral Distress Thermometer as a Screening Tool for Moral Distress

Thursday, 15 July 2010: 4:05 PM

Lucia D. Wocial, RN, PhD
Fairbanks Center for Medical Ethics, Clarian Health, Indiana University School of Nursing, Indianapolis, IN
Michael Weaver, PhD
School of Nursing, Indiana University School of Nursing, Indianapolis, IN

Learning Objective 1: The learner will be able to describe a new tool for measuring Moral Distress.

Learning Objective 2: The learner will be able to evaluate the validity of a new tool for measuring Moral Distress.

Purpose: Moral Distress (MD) is a well documented phenomenon experienced by nurses.  It contributes to burnout, errors and dissatisfaction with nursing.  Identifying an instrument that is practical as well as valid and reliable to measure MD is a priority for nursing. The purpose of this project was to develop and validate a practical screening tool for MD in nurses who practice in the hospital setting: the Moral Distress Thermometer (MDT).  The ultimate goal of the project is to construct a short, user friendly tool that can be used to measure outcomes of interventions designed to decrease MD.
Methods: Following IRB approval, nurses employed at three hospitals within the same health system were invited to participate in an electronic survey to measure their levels of moral distress.  Participants were asked to simultaneously complete Corley’s Moral Distress Scale (MDS) and the newly developed Moral Distress Thermometer (MDT). The MDS was scored as percent of total possible to accommodate pediatric and adult versions of the tool.
Results: SAS Version 9.1 was used for data screening and statistical analyses.  Inferential tests used a .05 level for significance.  529 participants from a variety of clinical areas completed both tools.  The MDT (M=2.9; SD=2.5) and the MDS (M=16.3; SD=10.1) were moderately correlated (Pearson and Spearman coefficients of 0.39 and 0.38, respectively; p < .001).
Conclusion: If we assume that the MDS is the “gold standard” for measuring MD, then these findings provide evidence for the convergent validity of the MDT.  Further data analysis may determine what specifically contributes to MD.  This tool holds promise for further research regarding interventions to alleviate MD.