Psychological Consequences of the COVID-19 Disease among Physicians and Medical Students: A Survey in Kerman Province, Iran, in 2020

Is nurses' clinical competence associated with their moral identity and injury?

BACKGROUND

The enhancement of nursing care quality is closely related to the clinical competence of nurses, making it a crucial component within health systems.

OBJECTIVE

The present study investigated the relationship between nurses' clinical competence, moral identity, and moral injury during the COVID-19 outbreak.

RESEARCH DESIGN

This cross-sectional study was carried out among frontline nurses, using the Moral Identity Questionnaire (MIQ), the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP), and the Competency Inventory for Registered Nurse (CIRN) as data collection tools.

PARTICIPANTS

and research context: The research population for this study consisted of all frontline nurses (n = 251) employed in a hospital in southern Iran. Sampling was conducted between May 1, 2021 and September 30, 2021, during the COVID-19 outbreak.

ETHICAL CONSIDERATIONS

The present study received approval from the research ethics committee of Rafsanjan University of Medical Sciences, with project No. 99267 and code of ethics ID No. IR. RUMS.REC.1399.262, dated 15.02.2021.

RESULTS

According to the study findings, 42.2% of the nurses demonstrated high clinical competence, while 51.4% exhibited moderate clinical competence. The results indicated a positive correlation between moral identity and clinical competence but a negative correlation between moral injury and clinical competence. Furthermore, the variables of moral identity and moral injury were found to predict 10% of the variance in clinical competence.

CONCLUSION

According to the results, moral identity and moral injury had an impact on the clinical competence of nurses. Therefore, implementing a program aimed at enhancing moral identity and providing training strategies to address moral injury during crises like the COVID-19 pandemic can lead to improvements in nurses' clinical competence and the overall quality of care they provide.

The psychometric properties of the Persian version of the moral injury symptoms scale-health care professionals version

Background

Health care professionals face a number of problems during crises, such as the COVID-19. Studies addressed the prevalence of moral injury among healthcare professionals during the COVID-19 outbreak. Lack of a valid standard of moral injury among health care professionals is one of the factors that has made it difficult to identify and treat this complication. This study aimed to evaluate the psychometric properties of the Moral Injury Symptoms Scale-Health Care Professionals (MISS-HP) among health care professionals in Iran.

Methods

This study was conducted to evaluate the validity and reliability of the MISS-HP. The sample included 455 healthcare professionals working in four teaching hospitals in Kerman, who were in direct contact with patients. In this study, face validity, content validity, construct validity (structural and convergent), and internal reliability of the MISS-HP were evaluated. Demographic information questionnaire, the Moral Injury Symptoms Scale-HealthCare Professionals (MISS-HP), General Health Questionnaire (GHQ), and Impact of Event Scale (IES) were administered to study participants.

Results

The MISS-HP was evaluated using translation-back translation technique. The content validity index of the items (I-CVI) and the scale (S-CVI) were 0.9 and 0.99, respectively. Exploratory factor analysis showed a three-factor structure in the MISS-HP that explained 57.49% of the variance. Confirmatory factor analysis indices were acceptable. The cut-off point of the questionnaire was 36.5. There was a positive and moderate correlation between the Persian version of MISS-HP, GHQ (r = 0.34), and IES-R (r = 0.40). The Cronbach’s alpha coefficient of the Persian version of MISS-HP was 0.70.

Conclusion

This study found that the MISS-HP is a concise, comprehensive, valid and reliable scale for assessing moral injury among health care professionals in clinical or research settings. This scale will be helpful for managers and researchers to identify and plan health policies and improve the psychological state of health care professionals.