Description of the Questionnaire

The MDS-27 (Moral Distress Survey – 27 items) is designed to assess moral distress experienced by healthcare professionals in clinical settings. Moral distress refers to feelings of anxiety or discomfort that arise when one knows the ethically appropriate action to take but is prevented from doing so by external or institutional constraints. The tool includes 27 situations that are likely to cause moral distress. For each situation, the respondent is asked to assess (a) how frequently they experience it (q#a) and (b) how intensely it causes moral distress (q#b).

Objective

The main objective of the MDS-27 is the quantitative assessment of moral distress in healthcare professionals, the identification of ethical dilemmas and barriers in the provision of care, and the strengthening of moral support and institutional policy within healthcare environments.

Data Analysis and Use

The final score is calculated as follows: Score = (q1a × q1b) + (q2a × q2b) + … + (q27a × q27b). The q#a component refers to the frequency of each situation, while q#b reflects the intensity of the moral distress it causes. Typically, a 0–4 scale is used, where 0 indicates “never” or “not at all” and 4 indicates “very frequently” or “very intense.” The total score ranges from 0 to 432. A higher total score indicates greater overall moral distress experienced by the healthcare professional.

Scoring

Although there are no universally fixed thresholds, scores between 0 and 100 generally indicate low moral distress, scores between 101 and 250 moderate moral distress, and scores between 251 and 432 high moral distress. Interpretation may be adjusted according to the needs of each study or the specific population being assessed.

References

Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics, 20(4), 330–342.
Hamric, A. B., Borchers, C. T., & Epstein, E. G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research, 3(2), 1–9.
Corley, M. C. (2002). Nurse moral distress: A proposed theory and research agenda. Nursing Ethics, 9(6), 636–650.