Cultural Adaptation, Validity, and Reliability of the Moral Distress Scale for Prehospital Emergency Health Services Employees: The Case of Türkiye.

Prehospital emergency healthcare professionals, who frequently face situations requiring rapid decision-making, interventions with limited resources, and ethical dilemmas related to patient care, are at high risk of experiencing moral distress. This study aimed to conduct the Turkish cultural adaptation, validity, and reliability testing of the Moral Distress Scale in order to evaluate the moral distress experienced by prehospital emergency healthcare workers. Within the scope of the study, the 20-item, five-factor Moral Distress Scale was translated and culturally adapted into Turkish. The construct validity of the scale was evaluated using exploratory factor analysis and confirmatory factor analysis. Data were collected from 215 prehospital emergency healthcare professionals. Factor loadings ranged from 0.442 to 0.801, and item-total correlations were above 0.30. In the exploratory factor analysis, items 4 and 5 from the "Providing Care" subdimension were loaded onto the "Conflict" subdimension, while item 6 was loaded onto the "Communication" subdimension. The confirmatory factor analysis results confirmed the five-factor, the 20-item structure of the scale, and the model fit indices were found to be acceptable (χ2/df = 2.27, p ≤ 0.001; RMSEA = 0.07; GFI = 0.86; CFI = 0.89; IFI = 0.89; PNFI = 0.70; SRMR = 0.06). The scale demonstrated high internal consistency (α = 0.90). Our results indicate that the Turkish version of the Moral Distress Scale is a reliable and valid instrument for assessing moral distress experienced by prehospital emergency healthcare professionals in their work settings.