{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:48:08Z","timestamp":1782362888056,"version":"3.54.5"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"\n Introduction<\/jats:title>\n Moral distress impacts healthcare professionals\u2019 well-being, yet current measurement tools often rely on specific clinical scenarios, limiting their applicability. This study aimed to validate the Italian version of the Moral Distress-Appraisal Scale (MD-APPS), a context-independent instrument to assess the subjective appraisal of moral distress.<\/jats:p>\n <\/jats:sec>\n \n Materials and methods<\/jats:title>\n A cross-sectional validation study was conducted. 205 professionals caring for patients with oncological and chronic-degenerative diseases across different settings were enrolled. The sample was randomly split to perform Exploratory and Confirmatory Factor Analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Participants reported a mean MD-APPS total score of 1.85 (SD\u202f=\u202f0.76) (scale range 1\u20136). The analysis supported a robust two-factor structure consistent with the original framework: Support and Freedom (Factor 1), Hindrance and Coercion (Factor 2). The scale demonstrated satisfactory model fit indices [\n \n \n \n \u03c7<\/mml:mi>\n 2<\/mml:mn>\n <\/mml:msup>\n (<\/mml:mo>\n 15<\/mml:mn>\n )<\/mml:mo>\n =<\/mml:mo>\n 11.0<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ,\n \n \n p<\/mml:mi>\n =<\/mml:mo>\n 0.756<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ; SRMR\u202f=\u202f0.039; RMSEA\u202f=\u202f0.000 (90% CI: 0.000\u20130.067); CFI\u202f=\u202f1.000; and TLI\u202f=\u202f1.003] and adequate internal consistency (Factor 1,\n \u03b1<\/jats:italic>\n \u202f=\u202f0.82,\n \u03c9<\/jats:italic>\n \u202f=\u202f0.83; Factor 2\n \u03b1<\/jats:italic>\n \u202f=\u202f0.75,\n \u03c9<\/jats:italic>\n \u202f=\u202f0.80; Total scale:\n \u03b1<\/jats:italic>\n \u202f=\u202f0.84;\n \u03c9<\/jats:italic>\n \u202f=\u202f0.85). Convergent and divergent validity were substantiated through positive correlations with the Moral Distress Scale-Revised and the Burnout dimension of the Professional Quality of Life scale, and a negative correlation with Compassion Satisfaction dimension of the same scale.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n The Italian MD-APPS appears a valid, reliable, and rapid-to-administer tool. By focusing on clinicians\u2019 appraisals of moral distress, the MD-APPS is consistent with emerging definitions of moral distress (i.e., perceived violations of professional values or norms). Although further research is warranted, the MD-APPS holds promise as a suitable tool for diverse healthcare contexts and professional sectors.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1864410","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:21:33Z","timestamp":1782361293000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Moral distress among healthcare professionals: Italian validation of the Moral Distress-Appraisal Scale"],"prefix":"10.3389","volume":"17","author":[{"given":"Marina","family":"Maffoni","sequence":"first","affiliation":[{"name":"Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano Institute","place":["Montescano, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Borghi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Milan","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Lamiani","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Milan","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"4120","DOI":"10.1111\/jan.14923","article-title":"The moral distress-appraisal scale: scale development and validation study","volume":"77","author":"Baele","year":"2021","journal-title":"J. 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