Psychometric testing of the Moral Neutralization Scale-Nurse Version (MNS-NV): An exploratory and confirmatory factor analyses

Abstract

Aim

To psychometrically validate the 15-item Moral Neutralization Scale-Nurse Version (MNS-NV).

Background

Nurses' moral neutralization techniques may adversely impact patient safety and healthcare outcomes. However, studies about moral neutralization in nursing remain a blank spot. More than ever, a valid and reliable scale is needed to measure nurses' moral neutralization.

Methods

A descriptive cross-sectional design. Participant nurses from three nursing colleges and five hospitals in Saudi Arabia were consecutively recruited and accomplished the 15-item MNS-NV. Polychoric correlations, exploratory factor analysis (EFA), Spearman's rank-order correlation, Kaiser-Meyer-Olkin test, and confirmatory factor analysis (CFA) were used for data analyses.

Results

Four items from the MNS-NV were omitted after EFA and CFA due to low inter-item correlations and low-factor loading difference. The MNS-NV was condensed to 11 items containing the three-factor structure: Negative Cognitive Reconstruction, Bullying Normalization, and Retribution Rationalization. Accordingly, results exhibited the scale's revised three-factor structure yielded good overall reliability and sub-scale consistencies while demonstrating acceptable construct validity following the CFA.

Conclusion

The 11-item MNS-NV is a practical scale with established construct validity and reliability. Healthcare institutions that employ nurses and their nurse managers may use this scale to evaluate nurses' moral neutralization techniques to provide evidence for creating and sustaining ethically and morally relevant nursing policies and practice.