Development and validation of moral distress scale in pre-hospital emergency service providers
International Journal of Emergency Services
ISSN: 2047-0894
Article publication date: 25 January 2022
Issue publication date: 9 August 2022
Abstract
Purpose
The uniqueness of the pre-hospital setting and the need for quick decision-making confronts pre-hospital emergency personnel with various moral conflicts that can lead to moral distress (MD) in them. This study aimed to design a valid scale for the assessment of MD in emergency medical service (EMS) staff.
Design/methodology/approach
This exploratory mixed-method study was conducted among the EMS provider's community. In the qualitative section, data were gathered and analyzed with semi-structured interviews and conventional content analysis, respectively. The initial pool of items was formed and the primary scale was designed. In the quantitative section, a methodological study was carried out to determine the psychometric properties of the scale including qualitative-quantitative face validity, qualitative-quantitative content validity with content validity ratio and index (CVR/CVI), construct validity by exploratory factor analysis (EFA), and convergent validity, internal consistency (Cronbach's alpha/ Omega McDonald's/ floor and ceiling effect) and stability with intra-class correlation (ICC).
Findings
After interviews with 14 emergency technicians, the initial scale was designed with 60 items. Of the total items, 17 poor items were dropped during face and qualitative content validity. In the content validity phase, the items with CVR > 0.62, modified Kappa > 0.74 were retained, which eliminated 23 items. EFA was conducted with 20 items and lead to the 5 factors. The floor and ceiling effect for the whole scale was zero. Finally, the reliability of the scale was confirmed (a = 0.83, O = 0.86, ICC = 0.95).
Originality/value
The developed 20-item scale is a valid and reliable scale for the assessment of the MD in EMS providers.
Keywords
Acknowledgements
This article was derived from a PhD thesis of nursing with project number 1396.210, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. The authors would like to acknowledge the research deputy at the University of Social Welfare and Rehabilitation for their support. The authors also are thankful to all emergency staff who participated in this study.
Funding: This study was supported by the University of Social Welfare & Rehabilitation Sciences, Tehran, Iran. The funding body had no role in the study design, the collection, analysis and interpretation of data, writing the manuscript or in the decision to submit the manuscript for publication.
Availability of data and materials: The datasets analyzed during the current study are available from the corresponding author on reasonable request.
Ethics approval and consent to participate: This study was approved by the ethics committee of the University of Social Welfare & Rehabilitation Sciences, Tehran, Iran. The written informed consent was obtained from the participants.
Consent for publication: Not applicable.
Competing interests: The authors declare that they have no competing interests.
Author's contributions: MH, HK, SM, contributed to designing the study. Data were analyzed by AE, MH and MJ prepared the initial draft of this manuscript. All authors read and approved the final manuscript.
Citation
Jafari, M., Ebadi, A., Khankeh, H.R., Maddah, S.S.B. and Hosseini, M. (2022), "Development and validation of moral distress scale in pre-hospital emergency service providers", International Journal of Emergency Services, Vol. 11 No. 2, pp. 263-276. https://doi.org/10.1108/IJES-05-2021-0028
Publisher
:Emerald Publishing Limited
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