Adaptation and validation of the moral distress instrument (MDI) for social workers in spain

Abstract

Moral distress (MD) occurs when professionals encounter obstacles that prevent them from acting in accordance with their ethical principles, resulting in psychological distress. This phenomenon, introduced by Jameton in 1984, has been documented in different professions, including social workers, where it is associated with burnout syndrome and post-traumatic stress. The present study adapts and validates the Moral Distress Instrument (MDI), an instrument recently developed by Mänttäri-van der Kuip et al. to assess the frequency and emotional impact of moral distress. The adaptation process included cultural translation, acceptability assessment, and psychometric analysis in a sample of 1,123 social workers in Spain. Confirmatory factor analyses confirmed the 2D structure of the MDI, representing the dimensions of frequency of restricted moral agency and emotional distress, with high internal consistency indices (α > 0.87). The findings highlight the importance of identifying and mitigating organizational barriers that contribute to moral distress in social work. The MDI is validated as an effective tool for understanding and addressing moral distress, facilitating the design of interventions that promote professional well-being and improve working conditions in ethically challenging environments.