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

Noit Inbar, Israel Issi Doron, Yocheved Laufer

Research output: Contribution to journalArticlepeer-review


Background: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. Research Question: What factors contribute to Moral distress among physiotherapists and how do they cope? Objectives: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. Research Design: A 2017–2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. Participants and Context: Israeli physiotherapists from various occupational settings recruited via professional networks. Ethical Considerations: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. Findings: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. Discussion: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. Conclusions: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies.

Original languageEnglish
JournalNursing Ethics
Early online date9 Feb 2024
StateE-pub ahead of print - 9 Feb 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.


  • ethical dilemmas
  • mixed-methods study
  • model
  • moral distress
  • physiotherapy

ASJC Scopus subject areas

  • Issues, ethics and legal aspects


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