Moral distress among healthcare professionals: Italian validation of the Moral Distress-Appraisal Scale

IntroductionMoral distress impacts healthcare professionals’ well-being, yet current measurement tools often rely on specific clinical scenarios, limiting their applicability. This study aimed to validate the Italian version of the Moral Distress-Appraisal Scale (MD-APPS), a context-independent instrument to assess the subjective appraisal of moral distress.Materials and methodsA cross-sectional validation study was conducted. 205 professionals caring for patients with oncological and chronic-degenerative diseases across different settings were enrolled. The sample was randomly split to perform Exploratory and Confirmatory Factor Analyses.ResultsParticipants reported a mean MD-APPS total score of 1.85 (SD = 0.76) (scale range 1, 6). The analysis supported a robust two-factor structure consistent with the original framework: Support and Freedom (Factor 1), Hindrance and Coercion (Factor 2). The scale demonstrated satisfactory model fit indices [χ2(15)=11.0, p=0.756; SRMR = 0.039; RMSEA = 0.000 (90% CI: 0.000, 0.067); CFI = 1.000; and TLI = 1.003] and adequate internal consistency (Factor 1, α = 0.82, ω = 0.83; Factor 2 α = 0.75, ω = 0.80; Total scale: α = 0.84; ω = 0.85). Convergent and divergent validity were substantiated through positive correlations with the Moral Distress Scale-Revised and the Burnout dimension of the Professional Quality of Life scale, and a negative correlation with Compassion Satisfaction dimension of the same scale.DiscussionThe Italian MD-APPS appears a valid, reliable, and rapid-to-administer tool. By focusing on clinicians’ appraisals of moral distress, the MD-APPS is consistent with emerging definitions of moral distress (i.e., perceived violations of professional values or norms). Although further research is warranted, the MD-APPS holds promise as a suitable tool for diverse healthcare contexts and professional sectors.