Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use. We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific outcomes measured by each scale. We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures ( = 3) or outcomes ( = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes. Results show how the terms MD and MI are applied in research. Several scales were identified as appropriate for research and clinical use. Recommendations for the application, development, and validation of MD and MI scales are provided.

中文翻译：

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衡量道德困扰和道德伤害：现有量表的系统回顾和内容分析

道德困扰（MD）和道德伤害（MI）是描述道德挑战压力源负面后果的相关概念。尽管越来越多的人支持这些结构的临床相关性，但测量质量方面持续存在的挑战限制了研究和临床进展。本研究总结了现有 MD 和 MI 量表的性质、质量和实用性，并为未来的使用提供了建议。我们确定了描述 MD 或 MI 量表的开发或验证的心理测量研究，并提取了有关方法和心理测量质量的信息。内容分析确定了每个量表衡量的具体结果。我们回顾了代表 42 个独特量表的 77 项研究。不同研究中心理测量方法的质量差异很大，而且大多数都未能检验收敛效度和发散效度。内容分析表明，大多数量表同时测量潜在道德压力源和结果的暴露，相对较少的量表仅测量暴露（= 3）或结果（= 7）。使用 MD 一词的量表通常评估一般痛苦。使用 MI 一词的量表通常评估几种具体结果。结果显示了术语 MD 和 MI 在研究中的应用。确定了几种适合研究和临床使用的量表。提供了 MD 和 MI 量表的应用、开发和验证的建议。