Neil H. Penny, Samantha J. Bires, Elizabeth A. Bonn, Alisha N. Dockery, Nicole L. Pettit; Moral Distress Scale for Occupational Therapists: Part 1. Instrument Development and Content Validity. Am J Occup Ther 2016;70(4):7004300020. https://doi.org/10.5014/ajot.2015.018358
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© 2021 American Occupational Therapy Association
OBJECTIVE. We describe the development of an instrument to measure moral distress experienced by occupational therapists and show how its content validity was established.
METHOD. Written comments (n = 78) from a previous survey using the Moral Distress Scale–Revised–Other Health Provider Adult were used to modify that instrument and create the Moral Distress Scale–Revised–Occupational Therapy–Adult Settings (MDS–R–OT[A]). The MDS–R–OT[A] was distributed to a nationwide random sample of 400 occupational therapists who rated the relevance of each item to their clinical practice.
RESULTS. A scale content validity index of 81.8% was found (geriatric = 81.5%, physical disability = 80.8%, combination of the two = 85.7%).
CONCLUSION. The MDS–R–OT[A] possesses acceptable content validity and is appropriate for use with occupational therapists working in geriatric or physical disability settings.
Item 3, “Follow the family’s wishes to continue life support even though I believe it is not in the best interest of the patient”
Item 4, “Initiate extensive life-saving actions when I think they only prolong death”
Item 7, “Continue to participate in care for a hopelessly ill person who is being sustained on a ventilator, when no one will make a decision to withdraw support”
Item 12, “Participate in care that does not relieve the patient’s suffering because the physician fears that increasing the dose of pain medication will cause death”
Item 13, “Follow the physician’s request not to discuss the patient’s prognosis with the patient or family.”
Modifying an instrument from another discipline is a viable approach for researchers seeking to measure emerging constructs in occupational therapy.
Establishing instrument content validity does not need to be limited to expert opinion but can, and perhaps should, include the opinion of representatives from the intended population.
The MDS–R–OT[A] possesses content validity and is ready for further investigation of its psychometric properties.
That high I–CVIs were found for most items on the MDS–R–OT[A] suggests that moral distress has relevance to practicing occupational therapists.
When practitioners encounter an ethical conflict, they need both cognitive problem-solving skills and emotional coping skills to resolve the conflict. Occupational therapy educators can provide opportunities for students to acquire both types of skills.
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