Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting | Daño moral en una emergencia sanitaria mundial: Un estudio de validación de la versión italiana de la Escala de Eventos de Daño Moral ajustada al entorno sanitario | COVID-19全球健康紧急情况下的道德伤害：针对医护环境调整的意大利语版道德伤害事件量表的验证研究

背景：当接触到违反道德信仰的事件时，可能会产生大量负面后果，这些后果被道德伤害（MI）的概念所体现。尽管它与全球健康紧急情况下医护人员的经历相关，缺乏适用于医护环境的经过验证的 MI 工具。 目的：本研究旨在通过评估因素结构、内部一致性和结构效度，对适应医护环境的意大利语版道德伤害事件量表（MIES）进行验证。 方法：意大利 COVID-19 疫情期间在医院机构工作的 794 名医护人员（46% 是护士，51% 是女性）样本完成了 MI、PTSD、焦虑、抑郁、倦怠、生活意义和积极情感的测量。 结果：使用探索性结构方程模型 (ESEM)，我们评估了整个样本的标度因素结构，并分别评估了专业护士和女性医护人员群体的标度因素结构。调查结果支持三因素解决方案：因素 1‘他人认为有违规行为’； 因素2‘自我感知的违规行为’； 因素 3‘感知到他人的背叛’。研究结果还表明，与PTSD、焦虑、抑郁和倦怠的衡量标准有一定程度的收敛性。 结论：结果表明，MIES 可能有助于捕捉参与全球健康紧急情况的医护人员的独特道德伤害经历。与心理困扰测量值的低范围相关性可能表明，MI（捕捉认知价值判断而不是表现症状）可能唯一地解释一定量的方差。讨论了开发新的实证衍生和理论指导工具的含义，强调未来研究需要检验个体化和社会约束道德原则的作用，以更细致地了解不同社会文化背景的医护专业人员的道德伤害经历。

Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting. Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity. Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect. Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 'perceived transgressions by others'; Factor 2 'perceived transgressions by self'; and Factor 3 'perceived betrayals by others'. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout. Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.