Physiotherapists' moral distress: Mixed-method study reveals new insights

Area of Science:

• Healthcare Ethics
• Professional Psychology
• Rehabilitation Sciences

Background:

• Moral distress, characterized by emotional, cognitive, and physical reactions to conflicts between obligations and constraints, is under-researched in physiotherapy.
• Limited research exists on the specific factors contributing to moral distress among physiotherapists.

Purpose of the Study:

• To develop and test a multifaceted model of moral distress in physiotherapists.
• To gain an in-depth understanding of the phenomena of moral distress within this professional group.

Main Methods:

• A mixed-methods study (2017-2022) involving a quantitative survey of 407 physiotherapists and qualitative semi-structured interviews with 21 physiotherapists.
• Quantitative analysis explored relationships between moral distress, moral sensitivity, locus of control, self-efficacy, and ethical climate using structural equation modeling.
• Qualitative analysis employed phenomenological methods to examine lived experiences of moral distress.

Main Results:

• Moderately high average moral distress was reported, with significantly higher levels among women and pediatric physiotherapists.
• Moral distress positively correlated with moral sensitivity. Qualitative data revealed intense emotions, inner conflicts, and coping strategies like reflective skills.
• Despite higher self-efficacy and moral sensitivity, senior therapists reported persistent high distress.

Conclusions:

• Moral distress in physiotherapy is complex, linked to moral sensitivity, self-efficacy, professional autonomy, and organizational support.
• A new framework elucidates the interplay of personal, professional, and organizational factors in moral distress.
• Findings can inform the development of targeted ethics training programs and enhance professional competencies for physiotherapists.