Tomoko Fujii1,2, Shinshu Katayama3, Kikuko Miyazaki4, Hiroshi Nashiki5, Takehiro Niitsu6, Tetsuhiro Takei7, Akemi Utsunomiya8, Peter Dodek9, Ann Hamric10, Takeo Nakayama4. 1. Intensive Care Unit, Jikei University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan. tofujii-tky@umin.net. 2. Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan. tofujii-tky@umin.net. 3. Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan. 4. Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan. 5. Intensive Care Unit, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, Iwate, Japan. 6. Department of Pediatric Critical Care Medicine, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama, Japan. 7. Intensive Care Unit, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa, Japan. 8. Department of Critical Care Nursing, Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan. 9. Center for Health Evaluation and Outcomes Sciences and Division of Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. 10. Virginia Commonwealth University School of Nursing, E Leigh St, Richmond, VA, USA.
Abstract
OBJECTIVES: Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. We aimed to assess the validity and reliability of the Japanese translation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). METHODS: We translated the questionnaire into Japanese according to the instructions of EORTC Quality of Life group translation manual. All physicians and nurses who were directly involved in patient care at nine departments of four tertiary hospitals in Japan were invited to a survey to assess the construct validity, reliability and factor structure. Construct validity was assessed with the relation to the intention to leave the clinical position, and internal consistency was assessed with Cronbach's alpha. Confirmatory factor analysis was conducted. RESULTS: 308 responses were eligible for the analysis. The mean total score of MMD-HP (range, 0-432) was 98.2 (SD, 59.9). The score was higher in those who have or had the intention to leave their clinical role due to moral distress than in those who do not or did not have the intention of leaving (mean 113.7 [SD, 61.3] vs. 86.1 [56.6], t-test p < 0.001). The confirmatory factor analysis and Cronbach's alpha confirmed the validity (chi-square, 661.9; CMIN/df, 2.14; GFI, 0.86; CFI, 0.88; CFI/TLI, 1.02; RMSEA, 0.061 [90%CI, 0.055-0.067]) and reliability (0.91 [95%CI, 0.89-0.92]) of the instrument. CONCLUSIONS: The translated Japanese version of the MMD-HP is a reliable and valid instrument to assess moral distress among physicians and nurses.
OBJECTIVES: Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. We aimed to assess the validity and reliability of the Japanese translation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). METHODS: We translated the questionnaire into Japanese according to the instructions of EORTC Quality of Life group translation manual. All physicians and nurses who were directly involved in patient care at nine departments of four tertiary hospitals in Japan were invited to a survey to assess the construct validity, reliability and factor structure. Construct validity was assessed with the relation to the intention to leave the clinical position, and internal consistency was assessed with Cronbach's alpha. Confirmatory factor analysis was conducted. RESULTS: 308 responses were eligible for the analysis. The mean total score of MMD-HP (range, 0-432) was 98.2 (SD, 59.9). The score was higher in those who have or had the intention to leave their clinical role due to moral distress than in those who do not or did not have the intention of leaving (mean 113.7 [SD, 61.3] vs. 86.1 [56.6], t-test p < 0.001). The confirmatory factor analysis and Cronbach's alpha confirmed the validity (chi-square, 661.9; CMIN/df, 2.14; GFI, 0.86; CFI, 0.88; CFI/TLI, 1.02; RMSEA, 0.061 [90%CI, 0.055-0.067]) and reliability (0.91 [95%CI, 0.89-0.92]) of the instrument. CONCLUSIONS: The translated Japanese version of the MMD-HP is a reliable and valid instrument to assess moral distress among physicians and nurses.
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Keywords:
Factor analysis; Healthcare professional; Japanese; Moral distress; Validation