Katherine E Heinze1, Ginger Hanson2, Heidi Holtz3, Sandra M Swoboda2,4, Cynda H Rushton2,5. 1. Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA. 2. School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA. 3. Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri, USA. 4. Johns Hopkins Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 5. Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abstract
Background: Health care interprofessionals face competing obligations to their patients, employers, and themselves. When ethical conflicts ensue and competing obligations cannot be resolved, health care interprofessionals have reported experiencing symptoms of burnout, moral distress, and other types of moral suffering. Recently, moral resilience or "the capacity of an individual to sustain or restore their integrity in response to moral adversity," has been proposed as a resource to address moral suffering while contributing to well-being. Objectives: Develop and validate an instrument to measure moral resilience. Design: Phase one: item development and expert review. Phase two: focus groups with health care interprofessionals to refine items. Phase three: psychometric testing. Setting/Subjects: Seven hundred twenty-three health care interprofessionals participated; inclusion criteria included being a chaplain, nurse, physician, or social worker, and having practiced at least 1 year. Participants were recruited from seven academic and community hospitals in the Eastern United States. Results: One hundred items were created for expert review. Following focus groups to refine items, 35 items remained for psychometric testing. Eighteen items were removed following item analysis. Exploratory factor analysis (EFA) of the remaining items suggested a four-factor solution, titled Responses to Moral Adversity, Personal Integrity, Moral Efficacy, and Relational Integrity, respectively. Overall reliability was α = 0.84. The Rushton Moral Resilience Scale (RMRS) demonstrated convergent validity with the Connor Davidson Resilience Scale-10 and criterion validity with the Maslach Burnout Inventory-Human Services Survey. Conclusion: The RMRS demonstrated acceptable validity and reliability. Examining the factor structure of moral resilience contributes to burgeoning moral resilience science and enables future research. Moral Resilience offers a promising pathway to support interprofessionals' integrity even when faced with ethical challenges.
Background: Health care interprofessionals face competing obligations to their patients, employers, and themselves. When ethical conflicts ensue and competing obligations cannot be resolved, health care interprofessionals have reported experiencing symptoms of burnout, moral distress, and other types of moral suffering. Recently, moral resilience or "the capacity of an individual to sustain or restore their integrity in response to moral adversity," has been proposed as a resource to address moral suffering while contributing to well-being. Objectives: Develop and validate an instrument to measure moral resilience. Design: Phase one: item development and expert review. Phase two: focus groups with health care interprofessionals to refine items. Phase three: psychometric testing. Setting/Subjects: Seven hundred twenty-three health care interprofessionals participated; inclusion criteria included being a chaplain, nurse, physician, or social worker, and having practiced at least 1 year. Participants were recruited from seven academic and community hospitals in the Eastern United States. Results: One hundred items were created for expert review. Following focus groups to refine items, 35 items remained for psychometric testing. Eighteen items were removed following item analysis. Exploratory factor analysis (EFA) of the remaining items suggested a four-factor solution, titled Responses to Moral Adversity, Personal Integrity, Moral Efficacy, and Relational Integrity, respectively. Overall reliability was α = 0.84. The Rushton Moral Resilience Scale (RMRS) demonstrated convergent validity with the Connor Davidson Resilience Scale-10 and criterion validity with the Maslach Burnout Inventory-Human Services Survey. Conclusion: The RMRS demonstrated acceptable validity and reliability. Examining the factor structure of moral resilience contributes to burgeoning moral resilience science and enables future research. Moral Resilience offers a promising pathway to support interprofessionals' integrity even when faced with ethical challenges.
Entities:
Keywords:
moral obligation; moral resilience; professional burnout; psychological resilience; psychometrics
Authors: Cynda H Rushton; Tessy A Thomas; Inga M Antonsdottir; Katie E Nelson; Danielle Boyce; Anna Vioral; Deborah Swavely; Cathaleen D Ley; Ginger C Hanson Journal: J Palliat Med Date: 2021-10-22 Impact factor: 2.947