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The Rushton Moral Resilience Scale ™ (RMRS) can be self-administered to interprofessional clinicians, and is designed to measure levels of moral resilience.

You are free to reproduce and use the Rushton Moral Resilience Scale without modification, for research or clinical practice. The Rushton Moral Resilience Scale ™ may be reproduced on forms with hospital or clinical unit letterhead or logo or used in electronic record systems.

The scales are available for use at no cost; the scales are free.

Moral Resilience

It is inevitable that healthcare inter-professionals will face ethical challenges as they conduct their work. As healthcare technology advances, diversity increases among healthcare inter-professionals and patient populations, and new challenges surface, disagreement about the “right thing to do” is inevitable. Daily, clinicians must balance competing obligations and commitments to patients, families, healthcare institutions, and themselves. These questions have intensified in the recent COVID-19 pandemic.

When values clash and there is not consensus on the appropriate action to take, or competing obligations cannot be reconciled, healthcare inter-professionals may feel as though their integrity is threatened. These sources of moral adversity lead to various forms of moral suffering, including moral distress and injury, moral residue, and contribute to burnout.

In light of these challenges there is a critical need to identify and cultivate the capacities for clinicians to meet these ethical challenges in the healthcare setting with less personal and professional damage. Recently, the concept of moral resilience has emerged as an alternate path to respond to moral adversity and mitigate burnout. Moral resilience, or “the capacity of an individual to sustain or restore their integrity in response to moral adversity,” has the potential to guide healthcare inter-professionals who seek to maintain integrity in the face of everyday ethical challenges (Rushton, 2018).

For more information about moral resilience:

The current and most comprehensive scholarship:

Rushton, C. H. (Author & Ed) (2018) Moral Resilience: Transforming Moral Suffering in Healthcare. New York: Oxford University Press. (American Journal of Nursing/Elsevier Book of the Year First Place Award in the category of professional issues 2020)

https://www.amazon.com/Moral-Resilience-Transforming-Suffering-Healthcare/dp/0190619260

Publications:

Holtz, H., Heinze, K. Rushton, C. (2017) Inter-professionals’ definitions of moral resilience. Journal of Clinical Nursing Aug 3. doi: 10.1111/jocn.13989.

Young, P. Rushton, C. (2017) Concept analysis Moral Resilience, Nursing Outlook 65(5), 579-587. http://dx.doi.org/10.1016/j.outlook.2017.03.009.

Rushton CH, Schoonover-Shoffner K, Kennedy MS. (2017) "A Collaborative State of the Science Initiative: Transforming Moral Distress into Moral Resilience in Nursing." The American Journal of Nursing 117(S2): S2-S6.

Rushton CH. "Cultivating Moral Resilience." (2017) American Journal of Nursing 117(2-S1): S11-S15.

Rushton, C. (2016) Building moral resilience to neutralize moral distress, American Nurse Today, 11(10), 27-33.

Rushton, C. (2016) Moral resilience: A capacity for navigating ethical challenges in critical care. AACN Advanced Critical Care, 27(1), 111-119

The Original Scale

Validity of the Scale

The Rushton Moral Resilience Scale ™ contains 17 items that represent four sub-scales: responses to moral adversity, personal integrity, moral efficacy, and relational integrity. The response format is a Likert-type scale with four response options (1=Disagree, 2=Somewhat Disagree, 3=Somewhat Agree, and 4=Agree).

The RMRS has been validated and has an internal reliability for each subscale as follows:  responses to moral adversity (alpha = .78), personal integrity (alpha = .50), moral efficacy (alpha = .69), relational integrity (alpha = .78).

All items should be coded so that higher scores indicate more resiliency; this will require recoding negatively worded items indicated with a (R) in the list of scale items. Obtain each subscale score by computing the mean for scores on the items associated with that subscale. An overall score can be computed by combining the means of each subscale.

Utility of the Scale

Differences by professional role (chaplain, nurse, physician, social worker) were found in Responses to Moral Adversity (F=5.82, p=.001) and Moral Efficacy (F=5.81, p=.001), but not in Personal Integrity or Relational Integrity. Specifically, chaplains scored higher in Responses to Moral Adversity than both nurses and physicians (see Table 4). Nurses had lower Moral Efficacy than both chaplains and physicians. Differences by primary practice setting were found only in Personal Integrity (F=3.14, p=.008); outpatient/ambulatory employees rated their personal integrity as higher than employees in inpatient-critical care.

You are free to reproduce and use the Rushton Moral Resilience Scale ™ without modification, for research or clinical practice. The Rushton Moral Resilience Scale ™ may be reproduced on forms with hospital or clinical unit letterhead or logo or used in electronic record systems.


Rushton Moral Resilience Scale, © 2021, Johns Hopkins University, Dr. Cynda Rushton, use with permission only.