Conflicting Priorities and Moral Distress
Often physiotherapists feel like there are too many patients to see with too little time. And there’s so much charting to do, therapists can’t get their charting done and see all their patients. What is a therapist to do – not chart, not see patients, not go home at the end of the day? For most physiotherapists this situation is all too common and causes significant moral distress.
It’s 11:30 on a Thursday night. You are tossing and turning and can’t seem to get the work day out of your mind.
Your thoughts go to 2:45 pm when the manager of the busy orthopedic unit tells you the patient you had prepared for discharge earlier has changed his mind and now wants to follow your recommendation to rent a 2 wheeled walker. His daughters have just arrived from out-of-town and they have some questions.
Your heart sinks as you had worked through most of your lunch break to ensure you had left some time to see the 2 patients on your list who are not discharge priorities but still have potential to improve their mobility. You haven’t been able to work with them for the past 2 days and they won’t meet the criteria for the limited weekend physio coverage.
You know that each one of these folks will require 25-30 minutes of contact time and that’s only if they do not need to use the commode as soon as they stand up. You also have a good 30 minutes of charting to do before you leave.
After providing education to the daughters and measuring the walker, you head to your paperwork. When you look up you see some of your colleagues heading back to the department to complete their workload measurement tasks and prepare patient lists for the next day. It is 3:30 and your work day is supposed to end at 4:00. They give you a look that is a mix of compassion, understanding and resignation.
You realize that even without seeing even one of those two unseen patients, you will be leaving at least 45 minutes late. You have been told clearly by your manager that there will not be any approval for overtime. You do what you feel you need to on the unit and then head down to an empty physio department to finalize your day.
As you now see that it is past midnight, you comfort yourself by acknowledging that you provided excellent care and completed quality documentation for the patients that you did see. You tell yourself that at least you have tomorrow to try to get to those patients who are really struggling. That’s when you start to feel your heart racing again.
What is Moral Distress?
Moral distress describes “the negative feelings that occur when one knows the right thing to do, but is prevented from doing it through some barrier or constraint. This leads to the sense that one has compromised their integrity, and can cause significant personal emotional reactions.” (http://www.wrha.mb.ca/about/ethics/files/PCEthicsGuide.pdf, 2015 WRHA Ethics Services, page 34).
Physiotherapists frequently face difficult situations that arise out of their control. We urge you to reflect on similar scenarios that you have faced in your work. What causes you moral distress and what strategies do you use to try to address this? Feedback to the committee is welcome and can be sent to firstname.lastname@example.org.
This case study was published in CPM’s In-Touch newsletter December 2019