In Korea, intensive care nurses frequently experience various ethical conflicts, such as human dignity versus unnecessary medical treatments, the compulsory application of restraints for treatment, suffering resulting from a lack of moral sensitivity, dilemmas resulting from nurses’ limited autonomy in treatments, and conflicts with physicians or institutional policy (Choe et al., 2015). In these circumstances, the nurse is obligated to act morally. Aquino & Reed developed a moral identity tool that measures when and why people act on human welfare to understand the motives of moral behavior (Aquino, & Reed, 2002). According to Aquino & Reed, the higher the moral identity, the higher the likelihood of engaging in moral acts (e.g., donation behavior) (Aquino, & Reed, 2002). Therefore, this study aims to evaluate the validity and reliability of the Korean version of MIS (K-MIS) in order to identify the elements of moral identity that promote work ethics.
There may be cultural differences in understanding the moral identity of Western and Korean nurses. Therefore, it was important to first evaluate how Korean ICU nurses respond to the MIS. Second, it was necessary to investigate the pattern to see if a new subscale should be created. Therefore, EFA was first conducted to confirm the factor structure of K-MIS, which showed that the factor loadings of each item representing moral identity were all over.40. The item 6 had cross factor loading, when item 6 was put in factor 2, the Cronbach's α was higher at.645, so it was finally incorporated into factor 2 (indirectness).
In this study, as in the original MIS tool, it consisted of two factors, but the items that constitute these factors were different. The reason for this difference appears to be the difference in the EFA methods. At the time of development of the tool, EFA principal-components analysis with varimax rotation was performed. Principal-components analysis is a method mainly dealt with in the natural sciences because it does not include an error term. However, this study is in the field of social science. Since common factor analysis includes error terms as appropriate, common factor analysis with direct oblimin was performed in this study. This difference in analysis methods may have engendered the different results of the items constituting each factor.
Based on these results, a CFA was performed with a sample different from the one subjected to EFA. Models for latent variables and items were established to verify the fit of the model, but the criteria were not met. In addition, the standardized estimates of items 4 and 8 were.01 and.17, respectively, which did not satisfy the standard value of.40. This difference is believed to be due to cultural differences between Korea and the West. Item 4 is “I would be ashamed to be a person who had these characteristics.” Confucianism is one of the most influential social cultures in Korea and has more influence on the lifestyle of the people than any other religion (Ha, 2018). Confucianism teaches that human destiny can be improved by exercising moral principles (Ha, 2018). In particular, in the Confucian culture of Korea, regards morality as important enough to employ moral education as part of educational activities in official subjects or school environments (Han et al., 2018). Therefore, there is no shame in having moral characteristics in the Korean culture. Rather, Korean society expects people to act morally. Therefore, due to such cultural differences, item 4 was deleted because it was thought to have a relatively low impact compared to other questions. Item 8, which stated “The fact that I have these characteristics is communicated to others by my membership in certain organizations,” also revealed low standardized estimates. The original tool targeted college students who are members of specific organizations that perform various activities. However, in the case of this study, it was thought that it had a relatively low effect because it was targeted at Korean nurses who are already affiliated with an organization called the ICU, so it was deleted. Therefore, K-MIS was constructed with the final 2 factors, a total of 8 items.
Accordingly, CFA was performed with 8 items, and as a result of calculating and analyzing the AVE, the convergent and discrimination validity of the items were also secured. As a result, it was confirmed that 6 items of factor 1, and 2 questions of factor 2, were appropriate to measure each corresponding factor and were clearly distinguished from the questions included in other factors. In conclusion, it was judged that the construct validity of the eight items comprising the two factors constituting moral identity was secured.
To verify the convergent validity of the tool, the relationship with MIS was analyzed by setting authentic leadership, a variable correlated with MIS in previous studies, as the golden standard (Olsen & Espevik, 2017). Authentic leadership is a concept that values morality as a leader (Neider & Schriesheim, 2011). As a result of analyzing the correlation between the two variables, K-MIS had a significant positive correlation with “authentic leadership.” This result can be said to mean that the convergence validity of this tool has been secured.
Finally, as a result of measuring the internal consistency of the tool, the reliability of K-MIS was .67, and the reliability of factors was .54~.73. The overall reliability of the original tool MIS is unknown because it was not reported, but the factor was .76~.77, and the reliability of K-MIS was slightly lower than that of the original tool. In general, when the number of items is small, Cronbach's α value tends to be low. In this study, as two questions were deleted, reliability was measured with the only eight questions. Therefore, it is thought that the reliability may be reduced because the number of items is small, but the overall reliability of the tool was high.
K-MIS is a useful tool to measure the moral identity of nurses in ICU in Korea. It has educational significance in that it is a measurement tool that has secured validity and reliability for developing moral improvement training program for nurses in the Korean intensive care unit and evaluating its effectiveness. In addition, this tool can be effectively used by ICU nurses to recognize their own moral identity, which is thought to contribute to nursing practice.