Development and validation of moral distress scale in pre-hospital emergency service providers

PurposeThe uniqueness of the pre-hospital setting and the need for quick decision-making confronts pre-hospital emergency personnel with various moral conflicts that can lead to moral distress (MD) in them. This study aimed to design a valid scale for the assessment of MD in emergency medical service (EMS) staff.Design/methodology/approachThis exploratory mixed-method study was conducted among the EMS provider's community. In the qualitative section, data were gathered and analyzed with semi-structured interviews and conventional content analysis, respectively. The initial pool of items was formed and the primary scale was designed. In the quantitative section, a methodological study was carried out to determine the psychometric properties of the scale including qualitative-quantitative face validity, qualitative-quantitative content validity with content validity ratio and index (CVR/CVI), construct validity by exploratory factor analysis (EFA), and convergent validity, internal consistency (Cronbach's alpha/ Omega McDonald's/ floor and ceiling effect) and stability with intra-class correlation (ICC).FindingsAfter interviews with 14 emergency technicians, the initial scale was designed with 60 items. Of the total items, 17 poor items were dropped during face and qualitative content validity. In the content validity phase, the items with CVR > 0.62, modified Kappa > 0.74 were retained, which eliminated 23 items. EFA was conducted with 20 items and lead to the 5 factors. The floor and ceiling effect for the whole scale was zero. Finally, the reliability of the scale was confirmed (a = 0.83, O = 0.86, ICC = 0.95).Originality/valueThe developed 20-item scale is a valid and reliable scale for the assessment of the MD in EMS providers.