Measuring moral distress and moral injury: A systematic review and content analysis of existing scales

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dc.contributor.authorStephanie A. Houle
dc.contributor.authorNatalie Ein
dc.contributor.authorJulia Gervasio
dc.contributor.authorRachel A. Plouffe
dc.contributor.authorBrett T. Litz
dc.contributor.authorR. Nicholas Carleton
dc.contributor.authorKevin T. Hansen
dc.contributor.authorJenny J.W. Liu
dc.contributor.authorAndrea R. Ashbaugh
dc.contributor.authorWalter Callaghan
dc.contributor.authorMegan M. Thompson
dc.contributor.authorBethany Easterbrook
dc.contributor.authorLorraine Smith-MacDonald
dc.contributor.authorSara Rodrigues
dc.contributor.authorStéphanie A.H. Bélanger
dc.contributor.authorKatherine Bright
dc.contributor.authorRuth A. Lanius
dc.contributor.authorClara Baker
dc.contributor.authorWilliam Younger
dc.contributor.authorSuzette Bremault-Phillips
dc.contributor.authorFardous Hosseiny
dc.contributor.authorJ. Don Richardson
dc.contributor.authorAnthony Nazarov
dc.date.accessioned2024-02-01T20:05:28Z
dc.date.available2024-02-01T20:05:28Z
dc.date.issued2024-03
dc.description© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0).
dc.description.abstractBackground: Moral distress (MD) and moral injury (MI) are related constructs describing the negative conse- quences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use. Method: We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific out- comes measured by each scale. Results: We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes.
dc.description.sponsorshipFunding for this study was provided by the Atlas Institute for Vet- erans and Families.
dc.identifier.doi10.1016/j.cpr.2023.102377
dc.identifier.issn0272-7358
dc.identifier.urihttps://hdl.handle.net/10294/16214
dc.language.isoen
dc.publisherElsevier BV
dc.relation.ispartofClinical Psychology Review
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.titleMeasuring moral distress and moral injury: A systematic review and content analysis of existing scales
dc.typejournal-article
oaire.citation.volume108
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