Development of the Japanese Version of Rushton Moral Resilience Scale (RMRS) for Healthcare Professionals: Assessing Reliability and Validity

Aim: To translate the Rushton Moral Resilience Scale (RMRS) into Japanese and validate its applicability among Japanese healthcare professionals.

Background: To overcome daily challenges in the field of healthcare, in which moral difficulties are routinely encountered, the development of intervention methods to address moral suffering and moral distress is crucial.

Methods: We conducted a cross-sectional survey using a web-based questionnaire. The RMRS-16 was translated into Japanese and confirmed through back-translation. Reliability analyses (Cronbach’s alpha and intraclass correlation coefficient [ICC]), confirmatory factor analyses (CFAs), correlation analyses, t-tests, and analysis of variance (ANOVA) were used to assess the validity of the scale.

Results: Participants comprised 1295 healthcare professionals, including 498 nurses. All subscales and the total scale had acceptable reliability values (α ≥ 0.70). CFA supported the original four-factor structure (response to moral adversity, personal integrity, relational integrity, and moral efficacy), with acceptable fit indices. The ANOVA results suggested that, among Japanese healthcare professionals, nurses and individuals from other professions showed lower average moral resilience scores compared to physicians, consistent with previous research on mental health and moral distress. In addition, women scored lower for moral resilience than men. However, the ICC values for the subscales of the RMRS were below acceptable levels, and the results of the standardized residual covariances also suggested a model misfit.

Conclusion and Implications: The reliability, validity, and utility of the Japanese version of the RMRS were generally supported. However, there were areas at the item level that required structural examination. The current findings suggest that there are cultural differences in the concept of moral resilience. Therefore, for future cultural comparisons, the original four-factor structure was maintained in the Japanese version without modifications. Further conceptual development of moral resilience is needed in Japanese healthcare.