{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:02:08Z","timestamp":1790136128799,"version":"4.0.1"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing &amp; Health Sciences"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Traditional moral distress scales primarily measure sources rather than contextualized responses. This study developed and validated the Narrative Moral Distress Scale, a context\u2010based instrument for assessing multidimensional moral distress in nurses and nursing students. In Phase 1, narrative stories and items were generated from previous qualitative transcripts of 32 nurses, followed by expert validation and face validation. Phase 2 involved testing with 291 nurses and 52 nursing students in Taiwan using Exploratory Factor Analysis, Confirmatory Factor Analysis, and measurement invariance tests. The final 14\u2010story 29\u2010item scale comprises five factors. The second\u2010order model demonstrated acceptable fit, good internal consistency, and robust measurement equivalence, confirming the model's stability. Participants reported moderate moral distress, primarily in value conflict and emotional distress. In clinical practice, the scale could identify moral distress factors driving burnout, enabling managers to design targeted interventions to improve interprofessional communication. In nursing education, it provides a framework for quantifying the efficacy of ethics curricula, while supporting administrative policy efforts to enhance supportive ethical environments and improve professional retention.<\/jats:p>","DOI":"10.1111\/nhs.70421","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:20:52Z","timestamp":1789086052000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Context\u2010Based Narrative Moral Distress Scale for Nurses and Nursing Students"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8425-6059","authenticated-orcid":false,"given":"Hsun\u2010Kuei","family":"Ko","sequence":"first","affiliation":[{"name":"College of Nursing, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Medical Research Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Center for Medical Education and Humanizing Health Professional Education Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8824-2685","authenticated-orcid":false,"given":"Wei\u2010Ting","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Nursing Pingtung Christian Hospital  Pingtung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1736-0307","authenticated-orcid":false,"given":"Shu\u2010Li","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Nursing, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8926-8473","authenticated-orcid":false,"given":"Min\u2010Tao","family":"Hsu","sequence":"additional","affiliation":[{"name":"College of Nursing, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7508-9471","authenticated-orcid":false,"given":"Hsiu\u2010Yueh","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Nursing Kaohsiung Municipal Siaogang Hospital  Kaohsiung Taiwan"},{"name":"Graduate Institute of Adult Education National Kaohsiung Normal University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0184-9116","authenticated-orcid":false,"given":"Li\u2010Min","family":"Wu","sequence":"additional","affiliation":[{"name":"College of Nursing, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Medical Research Kaohsiung Medical University Hospital  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnss.2024.10.005"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733008097990"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.13803"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733014551595"},{"key":"e_1_2_12_6_1","volume-title":"Code of Ethics for Registered Nurses","author":"Canadian Nurses Association","year":"2017"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.2307\/249674"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102648.2001.01658.x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0040957"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020909523"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/23294515.2019.1586008"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.2307\/3151312"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1198\/tast.2009.0001"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/14777509211034142"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2020.103767"},{"key":"e_1_2_12_16_1","volume-title":"Multivariate Data Analysis","author":"Hair J. 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