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Measure of Moral Distress for Healthcare Professionals (MMD-HP)

Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. This survey lists situations that occur in clinical practice.  If you have experienced these situations they may or may not have been morally distressing to you.  Please indicate how frequently you have experienced each item.  Also, rank how distressing these situations are for you.  If you have never experienced a particular situation, select “0” (never) for frequency. 
    Even if you have not experienced a situation, please indicate how distressed you would be if it occurred in your practice. Note that you will respond to each item by checking the appropriate rows for two dimensions:  Frequency and Level of distress.
1. Witness healthcare providers giving “false hope” to a patient or family.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #1(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
2. Follow the family’s insistence to continue aggressive treatment even though I believe it is not in the best interest of the patient.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #2(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
3. Feel pressured to order or carry out orders for what I consider to be unnecessary or inappropriate tests and treatments.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #3(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
4. Be unable to provide optimal care due to pressures from administrators or insurers to reduce costs.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #4(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
5. Continue to provide aggressive treatment for a person who is most likely to die regardless of this treatment when no one will make a decision to withdraw it.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #5(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
6. Be pressured to avoid taking action when I learn that a physician, nurse, or other team colleague has made a medical error and does not report it.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #6(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
7. Be required to care for patients whom I do not feel qualified to care for.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #7(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
8. Participate in care that causes unnecessary suffering or does not adequately relieve pain or symptoms.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #8(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
9. Watch patient care suffer because of a lack of provider continuity.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #9(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
10. Follow a physician’s or family member’s request not to discuss the patient’s prognosis with the patient/family.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #10(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
11. Witness a violation of a standard of practice or a code of ethics and not feel sufficiently supported to report the violation.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #11(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
12. Participate in care that I do not agree with, but do so because of fears of litigation.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #12(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
13. Be required to work with other healthcare team members who are not as competent as patient care requires.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #13(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
14. Witness low quality of patient care due to poor team communication.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #14(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
15. Feel pressured to ignore situations in which patients have not been given adequate information to ensure informed consent.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #15(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
16. Be required to care for more patients than I can safely care for.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #16(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
17. Experience compromised patient care due to lack of resources/equipment/bed capacity.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #17(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
18. Experience lack of administrative action or support for a problem that is compromising patient care.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #18(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
19. Have excessive documentation requirements that compromise patient care.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #19(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
20. Fear retribution if I speak up.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #20(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
21. Feel unsafe/bullied amongst my own colleagues.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #21(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
22. Be required to work with abusive patients/family members who are compromising quality of care.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #22(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
23. Feel required to overemphasize tasks and productivity or quality measures at the expense of patient care.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #23(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
24. Be required to care for patients who have unclear or inconsistent treatment plans or who lack goals of care.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #24(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
25. Work within power hierarchies in teams, units, and my institution that compromise patient care.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #25(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
26. Participate on a team that gives inconsistent messages to a patient/family.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #26(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
27. Work with team members who do not treat vulnerable or stigmatized patients with dignity and respect.(Required.)
Never
0
 1
 2
 3
Very frequently
4
Frequency
Level of distress you would feel or have felt as a result of #27(Required.)
None
0
 1
 2
 3
Very distressed
4
Level of distress
28. Other situation
     How frequently have you experienced this?
Never
0
 1
 2
 3
Very frequently
4
Frequency
     Level of distress you would feel or have felt
None
0
 1
 2
 3
Very distressed
4
Level of distress
29. Other situation
     How frequently have you experienced this?
Never
0
 1
 2
 3
Very frequently
4
Frequency
     Level of distress you would feel or have felt
None
0
 1
 2
 3
Very distressed
4
Level of distress
Have you ever considered leaving your position because of moral distress?