Moral Distress (MD) and burnout in mental health nurses: a multicenter survey.

INTRODUCTION: Moral Distress (MD) is a common experience among nurses and if it is not recognised and treated, it may lead to serious consequences on nurses' health and quality of care. MD has been studied in several healthcare contexts. However, there are only few studies on MD in psychiatry and in Italy there are no data in this field.  Objective: To assess the presence of MD among mental health nurses in Italy and verify whether there is a relationship between MD and burnout. METHODS: We conducted a multicentre survey among nurses of Mental Health services of four hospitals in Milan. The MD Scale for Psychiatric NursesItalianrevised (MDS-PItarev) and the Maslach Burnout Inventory (MBI) were used for data collection. Factor analysis and calculation of content validity index (CVI) and Cronbach's alpha were performed on the Italian version of the MDS-PIta. Three items of the old version of the scale were removed, because judged not relevant in the Italian context. The revised scale maintained excellent CVI (0.89) and Cronbach's alpha (0.93). RESULTS: Of 285 questionnaires distributed, 228 (80%) were returned. The median of MD was 2 (scale range 0-6); MD is correlated with two burnout dimensions: emotional exhaustion (rho(ρ)=0.28, p<0,001) and depersonalization (ρ=0.20, p<0,001). CONCLUSIONS: This is the first study about MD among psychiatric nurses in Italy. We found a medium-low level of MD among nurses who participated in the survey. We also found a modest but significant correlation between MD and two dimensions of MBI. Further studies are needed to confirm these results.

[Translation and validation in italian of the Moral Distress Scale for psychiatric nurses (MDS-P)]. / Traduzione e validazione in italiano della Moral Distress Scale for Psychiatric Nurses (MDS-P).

AIM: Moral distress (MD) is a painful feeling and/or psychological disequilibrium, which may lead to negative consequences into the wellness of a nurse's working life. Nurses who work in psychiatry are more likely to experience a different type of MD compared with nurses of other contexts. In Italy a tool to evaluate MD in nurses who work in psychiatry doesn't exist. The aim of this study is to validate the Moral Distress Scale for Psychiatric Nurses (MDS-P) in Italian language. METHOD: For translation the forward and back-translation has been used; the effectiveness regarding content and face validity of the translated scale has been analyzed through a focus group with experts of the field. In order to check the reliability of the scale the test-retest method has been used, by means of the determination of Spearman's correlation coefficient, Intraclass Correlation Coefficient (ICC) and Cronbach's alpha. RESULTS: The forward and back-translation process was successful. During the focus group analysis, 8 items were added to the 15 items of the original scale, due to experts suggestions. 32 nurses took part in the test-retest phase. Spearman's correlation coefficient resulted to be 0,91, ICC > 0,9, Cronbach's alpha calculated on test and retest, was always >0,9. CONCLUSION: The Italian version of the MDS-P proves to be an effective, appropriate and reliable instrument to measure the MD phenomenon within the population of nurses who work in the psychia- tric field in Italy.