Abstract：
The COVID-19 pandemic created novel patient care circumstances that may have increased nurses\' moral distress, including COVID-19 transmission risk and end-of-life care without family present. Well-established moral distress instruments do not capture these novel aspects of pandemic nursing care. The purpose of this study was to develop and evaluate the psychometric properties of the COVID-19 Moral Distress Scale (COVID-MDS), which was designed to provide a short MDS that includes both general and COVID-19-specific content. Researcher-developed COVID-19 items were evaluated for content validity by six nurse ethicist experts. This study comprised a pilot phase and a validation phase. The pilot sample comprised 329 respondents from inpatient practice settings and the emergency department in two academic medical centers. Exploratory factor analysis (EFA) was conducted with the pilot data. The EFA results were tested in a confirmatory factor analysis (CFA) using the validation data. The validation sample comprised 5042 nurses in 107 hospitals throughout the United States. Construct validity was evaluated through CFA and known groups comparisons. Reliability was assessed by the omega coefficient from the CFA and Cronbach\'s alpha. A two-factor CFA model had good model fit and strong loadings, providing evidence of a COVID-19-specific dimension of moral distress. Reliability for both the general and COVID-19-specific moral distress subscales was satisfactory. Known groups comparisons identified statistically significant correlations as theorized. The COVID-MDS is a valid and reliable short tool for measuring moral distress in nurses including both broad systemic sources and COVID-19 specific sources.
摘要：
COVID-19大流行创造了新的病人护理环境，可能增加了护士的道德困扰，包括COVID-19传播风险和没有家人在场的临终关怀。完善的道德困扰工具无法捕捉到大流行护理的这些新颖方面。这项研究的目的是开发和评估COVID-19道德困扰量表（COVID-MDS）的心理测量特性，它旨在提供一个简短的MDS，包括一般内容和COVID-19特定内容。研究人员开发的COVID-19项目由六名护士伦理学家专家评估了内容有效性。本研究包括试验阶段和验证阶段。试点样本包括来自两个学术医疗中心的住院诊所和急诊科的329名受访者。利用试验数据进行探索性因子分析(EFA)。使用验证数据在验证性因子分析(CFA)中测试EFA结果。验证样本包括美国107家医院的5042名护士。通过CFA和已知组比较评估结构效度。可靠性通过CFA和Cronbachα的omega系数进行评估。双因子CFA模型具有良好的模型拟合和较强的载荷，提供COVID-19特定维度的道德困扰的证据。一般和COVID-19特定的道德痛苦分量表的可靠性令人满意。已知组比较确定了统计学上的显着相关性。COVID-MDS是衡量护士道德困扰的有效和可靠的简短工具，包括广泛的系统来源和COVID-19特定来源。
