RESEARCH METHODOLOGY Moral distress questionnaire for clinical nurses: instrument development Michal Mashiach Eizenberg, Helena Syna Desivilya & Miriam J. Hirschfeld Accepted for publication 28 November 2008 Correcpondence to M.M. Eizenberg: e-mail: michalm@yvc.ac.il Michal Mashiach Eizenberg PhD Lecturer Department of Health Systems Management, Yezreel Valley College, Emek Yezreel, Israel Helena Syna Desivilya PhD Associate Professor Department of Sociology and Anthropology, Yezreel Valley College, Emek Yezreel, Israel Miriam J. Hirschfeld DNSc MD.Hon RN Professor and Head of Department Department of Nursing, Yezreel Valley College, Emek Yezreel, Israel EIZENBERG M.M., DESIVILYA H.S., HIRSCHFELD M.J. (2009) EIZENBERG M.M., DESIVILYA H.S., HIRSCHFELD M.J. (2009) Moral distress questionnaire for clinical nurses: instrument development. Journal of Advanced Nursing 65(4), 885–892 doi: 10.1111/j.1365-2648.2008.04945.x Abstract Title. Moral distress questionnaire for clinical nurses: instrument development. Aim. This paper is a report of a study to develop and test the psychometric prop- erties of a culture-sensitive moral distress questionnaire among nurses employed in a variety of work settings. Background. In the course of the last decade, there has been increased interest in capturing healthcare professionals’ experiences of stress associated with ethical dilemmas. Ethical issues emerge in grey areas and are often blurred, and have thus received insufficient attention. Method. The study comprised two phases: a qualitative phase to elicit the culture- specific themes and a quantitative phase, comprising the design of a 15-item ques- tionnaire. The questionnaire was then completed by a convenience sample of 179 nurses from a variety of work settings. The data were collected in 2006. Results. Factor analysis resulted in three factors representing moral distress: (1) problems caused by work relationships among staff; (2) problems due to lack of resources; and (3) problems caused by time pressure. With regard to the con- struct validity of the questionnaire, differences between community and hospital nurses were tested, and a statistically significant difference was found between them in two among the three factors (relationships and time). The stability of the measures was examined by test-retest reliability and revealed statistically significant results. Conclusions. The instrument exhibits acceptable reliability and validity in the Israeli cultural context. Further research is needed to evaluate the measure in other cultural settings. Keywords: culture-sensitive instrument, ethics, instrument development, moral distress, nursing, questionnaire validation Ó 2009 The Authors. Journal compilation Ó 2009 Blackwell Publishing Ltd 885 JAN JOURNAL OF ADVANCED NURSING