Italian validation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP): A multicenter cross-sectional study

Background: Moral distress occurs when ethically appropriate actions cannot be implemented, resulting in cognitive and emotional strain linked to outcomes like burnout and staff turnover. Despite extensive cross-cultural validation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP), no Italian adaptation currently exists, limiting research in Italian contexts. Aim: To culturally adapt and validate the Italian version of the Measure of Moral Distress for Healthcare Professionals (MMD-HP-ITA) within two major Italian healthcare settings. Methods: An observational multicenter cross-sectional study was conducted from December 2022 to September 2023. The original questionnaire underwent forward-backward translation. Confirmatory and exploratory factor analyses evaluated structural validity, and Cronbach’s alpha assessed internal consistency. Construct validity was tested by correlating scores with the Ethical Leadership Scale. Participants: A sample of 567 healthcare professionals (median age 43 years; 74% female; 74% nurses) was recruited and completed the Italian version of the questionnaire online. Ethical consideration: The study was approved by the Ethics Committees of the two healthcare institutions involved. Informed consent was obtained from all participants. Results: The Italian version demonstrated strong internal consistency (Cronbach’s α = 0.96). Exploratory factor analysis supported a three-factor model explaining 58.6% of the variance, with dimensions reflecting: (1) System-level constraints, (2) Team-level dynamics, and (3) Patient/family-level conflicts. Convergent validity was confirmed via significant associations with related constructs: moral distress scores were higher among nurses, younger professionals, and those considering job departure, and negatively correlated with ethical leadership ratings (r = −0.375, p < 0.001). Conclusion: The Italian version of the Measure of Moral Distress for Healthcare Professionals is a reliable and valid instrument for assessing moral distress among Italian healthcare professionals, effectively capturing the multidimensionality of the construct in a culturally relevant way.