Edinburgh Napier University

  Background
Moral distress is a phenomena that occurs following a compromise to moral beliefs. Moral distress has been reported across health professions, including midwifery. Although there are validated tools to assess for moral distress, none have been identified that suit the Australian healthcare system or midwifery.

Aim
The aim of this study was to pilot the Barometer of Moral Distress in Midwifery.

Methods
This study was the fourth stage of a mixed method project. Using a cross-sectional approach, a survey tool including demographic questions, the Barometer of Moral Distress in Midwifery, and the Copenhagen Burnout Inventory assessed tool stability, reliability, and validity.

Findings
A total of 103 surveys were completed. A test-retest demonstrated tool reliability and stability (=.97). Factor analysis confirmed internal consistency; Factor 1 - Professional Identity (=.91), Factor 2 - Inadequate Resources (=.85), and Factor 3 - Unethical Cultures (=.88). Concurrent validity was demonstrated through positive correlations between self-reported types of moral distress with mean scores for each Factor. Strong correlations were identified between work-related burnout and mean scores, while only weak correlations were noted between client-related burnout and mean scores. Only Factor 1 demonstrated a correlation between leaving the profession and mean scores.

Discussion/conclusion
This was the first moral distress tool that assessed both frequency of exposure and psychological outcomes to score moral distress. Findings indicate that moral distress in midwifery is not associated with caring work but with occupational environments. Further research is required to assess self-sacrifice in moral distress.