Moral comfort, an emerging concept in nursing, is defined as an individual’s feelings of ease with decisions and actions related to a moral dilemma. Moral comfort for nurses is the positive outcome of a moral situation or dilemma, while moral distress, a widely explored issue in nursing, is the negative outcome. However, nursing literature on the concept of moral comfort is limited. While several instruments to measure moral distress exist, an instrument to measure moral comfort was not found. The Moral Comfort Questionnaire (MCQ) was theoretically developed. The purpose of this study was psychometric evaluation of this new 35-item instrument.
Direct-care hospital-based registered nurses (n = 466) participated from February 2019 to September 2019 in this IRB-approved study. Participants completed demographic information, the MCQ, and the Moral Distress Scale revised (MDSR). Psychometric evaluation included a priori content validation and multiple statistical analyses: Cronbach’s alpha, Spearman’s correlation coefficient, weighted kappa, Bland-Altman analysis (B&A), discriminant validity, and confirmatory factor analysis (CFA).
Cronbach’s alpha was .951, suggesting internal consistency. Spearman’s correlation coefficient was .605 (p < .001) suggesting strong correlation between Time 1 and Time 2. Weighted kappa values for each item (range = .139 - .559) suggested slight to moderate agreement between responses over time. The B&A plot suggested agreement of responses over time. Discriminant validity results suggested no correlation between the MCQ and MDSR (r = -.219), which was expected. CFA results suggest poor model fit of the proposed five-factor model. A post hoc hierarchical cluster analysis showed the presence of two clusters. A subsequent two-factor exploratory factor analysis showed items loading onto one of the two factors (internal and external).
Moral comfort in nurses is essential to promoting positive outcomes for nurses. An instrument to measure moral comfort in nurses is needed to gain further understanding of the concept. The MCQ was theoretically developed and psychometrically evaluated. Results suggest further revision and testing of the MCQ with a two-factor model. Knowledge acquired from studies using the MCQ could potentially be used to develop strategies to promote moral comfort in nurses, thereby promoting positive outcomes for nurses, patients, and healthcare organizations.
|Advisor:||Tappen, Ruth M.|
|Commitee:||Longo, Joy, Freeman-Costin, Katherine|
|School:||Florida Atlantic University|
|School Location:||United States -- Florida|
|Source:||DAI-B 81/12(E), Dissertation Abstracts International|
|Keywords:||Instrument development, Instrument testing, Moral comfort, Moral courage, Moral distress, Psychometric evaluation|
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