Adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version to Italian language

Main Article Content

Loris Bonetti https://orcid.org/0000-0003-0694-0880
Stefano Terzoni https://orcid.org/0000-0002-0716-5663
Paolo Ferrara
Anne Destrebecq https://orcid.org/0000-0003-4250-7881
Esperanza Zuriguel-Pérez https://orcid.org/0000-0002-0622-8423
Anna Falcó-Pegueroles https://orcid.org/0000-0002-3702-3009

Keywords

ethical conflict, moral distress, questionnaire, reliability, validity, critical care

Abstract

Background and aim of the work


Ethical conflict in Intensive Care Unit (ICU) can lead to poor quality health care and attention. Knowing the level of exposure to ethical conflict in health professionals allows to design strategies for improve the ethical environments and making decisions process. To study ethical conflict in health professionals it is necessary to have valid and reliable instruments that can be applied to different health and cultural contexts. No tool existed in Italian context still now. Therefore, the aim of this study was to adapt and validate the Ethical Conflict Nursing Questionnaire-Critical Care Version to the Italian sociocultural context.


Methods


This is a two-phase psychometric study, including one translation-back-translation phase, and an analysis phase for determining the content and construct validity, by means respectively Content Validity Index, Principal Component Analysis (PCA) and Confirmatory Factor Analysis(CFA), and reliability of the instrument, by means Cronbach's α calculation.


Results


The sample included 286 nurses from critical care units of four hospitals in (deleted for review) (Italy). Translation-back-translation phase was successful. A Content Validity Index of 95.39 was obtained. The overall Cronbach's α value was 0.866. When an item was eliminated, this value oscillated between 0.871 and 0.881. As the original tool, Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA) confirmed a single factor capable of explaining more than 30% of the variance.


Conclusions


The ECNQ-CCV Italian version is a valid and reliable instrument for measuring the exposure of ICU nursing professionals to ethical conflict.


 

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References

1. Falcó Pegueroles AM. Análisis de la conflictividad ética en los profesionales de enfermería de las unidades de cuidados intensivos. Universitat de Barcelona; 2012.
2. Azoulay E, Timsit J-F, Sprung CL, Soares M, Rusinová K, Lafabrie A, et al. Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med. 2009 Nov;180(9):853–60.
3. Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med. 2007 Feb;35(2):422–9.
4. Kim SH, Kjervik D. Deferred decision making: patients’ reliance on family and physicians for CPR decisions in critical care. Nurs Ethics. 2005 Sep;12(5):493–506.
5. Falcó-Pegueroles A, Lluch-Canut T, Roldan-Merino J, Goberna-Tricas J, Guàrdia-Olmos J. Ethical conflict in critical care nursing: Correlation between exposure and types. Nurs Ethics. 2015 Aug;22(5):594–607.
6. Chen Y-Y, Chu T-S, Kao Y-H, Tsai P-R, Huang T-S, Ko W-J. To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization. BMC Med Ethics. 2014 Jan;15:1.
7. Lusignani M, Giannì ML, Re LG, Buffon ML. Moral distress among nurses in medical, surgical and intensive-care units. J Nurs Manag. 2017 Sep;25(6):477–85.
8. Papathanassoglou EDE, Karanikola MNK, Kalafati M, Giannakopoulou M, Lemonidou C, Albarran JW. Professional autonomy, collaboration with physicians, and moral distress among European intensive care nurses. Am J Crit care an Off Publ Am Assoc Crit Nurses. 2012 Mar;21(2):e41-52.
9. Pavlish CL, Hellyer JH, Brown-Saltzman K, Miers AG, Squire K. Screening situations for risk of ethical conflicts: a pilot study. Am J Crit care an Off Publ Am Assoc Crit Nurses. 2015 May;24(3):248–56.
10. Pishgooie A-H, Barkhordari-Sharifabad M, Atashzadeh-Shoorideh F, Falcó-Pegueroles A. Ethical conflict among nurses working in the intensive care units. Nurs Ethics. 2019;26(7–8):2225–38.
11. Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics. 2005 Jul;12(4):381–90.
12. Eizenberg MM, Desivilya HS, Hirschfeld MJ. Moral distress questionnaire for clinical nurses: instrument development. J Adv Nurs. 2009 Apr;65(4):885–92.
13. Cavaliere TA, Daly B, Dowling D, Montgomery K. Moral distress in neonatal intensive care unit RNs. Adv neonatal care Off J Natl Assoc Neonatal Nurses. 2010 Jun;10(3):145–56.
14. Sporrong SK, Höglund AT, Arnetz B. Measuring moral distress in pharmacy and clinical practice. Nurs Ethics. 2006 Jul;13(4):416–27.
15. Dahlqvist V, Eriksson S, Glasberg A-L, Lindahl E, Lützén K, Strandberg G, et al. Development of the perceptions of conscience questionnaire. Nurs Ethics. 2007 Mar;14(2):181–93.
16. Glasberg A-L, Eriksson S, Dahlqvist V, Lindahl E, Strandberg G, Söderberg A, et al. Development and initial validation of the Stress of Conscience Questionnaire. Nurs Ethics. 2006 Nov;13(6):633–48.
17. Falcó-Pegueroles A, Lluch-Canut T, Guàrdia-Olmos J. Development process and initial validation of the Ethical Conflict in Nursing Questionnaire-Critical Care Version. BMC Med Ethics. 2013 Jun;14:22.
18. Lluch-Canut T, Sequeira C, Falcó-Pegueroles A, Pinho JA, Rodrigues-Ferreira A, Olmos JG, et al. Ethical conflicts and their characteristics among critical care nurses. Nurs Ethics. 2020 Mar;27(2):537–53.
19. Motaharifar F, Atashzadeh-Shoorideh F, Pishgooie AH, Falcó-Pegueroles A. Translation and psychometric properties of the “ethical conflict in nursing questionnaire: critical care version” in Iran. Electron physician. 2017 Feb;9(2):3776–85.
20. McAndrew NS, Schiffman R, Leske J. Relationships among Climate of Care, Nursing Family Care and Family Well-being in ICUs. Nurs Ethics. 2019;26(7–8):2494–510.
21. Polit DF, Tatano Beck C. Nursing research: Generating and assessing evidence for nursing practice. 11th ed. Wolters Kluwer, editor. 2020.
22. Nunnally JC. Psychometric theory. 3rd ed. McGraw-Hill, editor. New York; 1994.
23. American Educational Research Association, American Psychological Association & NC on M in E. Standards for educational and psychological testing. American Educational Research Association, editor. Washington DC: American Educational Research Association American Psychological Association …; 2014.
24. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. 2006 Oct;29(5):489–97.
25. Jameton A. Nursing practice: The ethical issues. Englewood Cliffs, editor. New Jersey: Prentice-Hall; 1984.
26. Corley MC. Moral distress of critical care nurses. Am J Crit care an Off Publ Am Assoc Crit Nurses. 1995 Jul;4(4):280–5.
27. Wilkinson JM. Moral distress in nursing practice: experience and effect. Nurs Forum. 23(1):16–29.
28. Fry ST, Duffy ME. The development and psychometric evaluation of the Ethical Issues Scale. J Nurs Scholarsh an Off Publ Sigma Theta Tau Int Honor Soc Nurs. 2001;33(3):273–7.
29. Nordman T, Santavirta N, Eriksson K. Developing an instrument to evaluate suffering related to care. Scand J Caring Sci. 2008 Dec;22(4):608–15.