Military Moral Distress in Nurses: Instrument Development

Three interrelated phases of tool development for a scale to measure military nursing moral distress (MNMD), were guided by conceptual models of the moral distress phenomenon, previous research, literature review, and interviews of crisis-deployed military nurses. Interviews were conducted to identify the experience and dimensions of moral distress in military nurses. Data analysis was completed on 959 anonymous survey packets from Army Nurse Corps officers who had (n = 529) or had not (n = 430) been crisis-deployed. The majority were female (76.8%), had completed an average of 16.2 years of military service as well as an average of 15 years of non-military nursing service and over 47% held a master's or higher degree. The 25-item Military Nursing Moral Distress Scale (MNMD) was found to be reliable by internal consistency (Cronbach's alpha = .92) with three factors: Effects and Consequences (11 items), Initial Distress (8 items), and Reactive Distress (6 items), which explained 49.8% of the variance and had alpha coefficients of .90, .82, and .80 respectively. Contrasted groups examination of MNMD scores by deployed (n = 529, M = 26.2, SD = 21.2) versus non-deployed (n = 430, M = 17.8, SD = 19) revealed higher scores (t = 6.4, p = .000) in the deployed group, supporting MNMDS validity since the military moral distress phenomenon was developed from interview data of crisis-deployed military nurses. Scores of deployed and non-deployed groups on the Corley Moral Distress Scale (MDS), developed for civilian critical care settings, did not differ. Since the Corley MDS measures moral distress not related to deployment, the similar scores found in both groups support the construct validity of the MNMDS. Previous research has demonstrated that moral distress is associated with nurse stress, burnout, and the decision to leave nursing practice. The MNMDS will allow for examination of interventions designed to decrease the presence of moral distress among military nurses. Moral distress may be one factor that can affect the ability of the military nurse to effectively do his or her job and thus requires the development of appropriate interventions to ameliorate its occurrence and effects.