Comparative analysis of moral distress and values of the work organization between American and Spanish podiatric physicians

M E Losa Iglesias, R Becerro de Bengoa Vallejo, P Salvadores Fuentes

Journal of the American Podiatric Medical Association
Journal of the American Podiatric Medical Association

Abstract
Background: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress.

Methods: A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N = 186) presented statements about different ethical dilemmas, values, and goals in the workplace.

Results: Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients’ treatment and economic constraints, overload of paperwork, and acting against one’s conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results.


Iglesias MEL, de Bengoa Vallejo RB, Fuentes PS. Comparative analysis of moral distress and values of the work organization between American and Spanish podiatric physicians. J Am Podiatr Med Assoc. 2012 Jan;102(1):57-63.

Moral distress related to ethical dilemmas among Spanish podiatrists

Marta Losa Iglesias, Ricardo Becerro de Bengoa Vallejo, Paloma Salvadores Fuentes

Journal of Medical Ethics
Journal of Medical Ethics

Abstract
Objectives: To describe the distress experienced by Spanish podiatrists related to ethical dilemmas, organisational matters, and lack of resources.

Design: A 2008 email survey of a representative sample of 485 Spanish podiatrists presenting statements about different ethical dilemmas, values and goals at the workplace.

Results: The response rate was 44.8%. Of all the respondents, 57% described sometimes having to act against their own conscience as distressing. Time constraints is the main cause of moral distress (67%) and 58% of respondents said that they found it distressing that patients have long waits for treatment. Distress related to inadequate treatment due to economical constraints or ineffectiveness was described by 60% of the podiatrists. Another 51% reported that time spent on administration and documentation is distressing. Female doctors experienced more distress than their male colleagues. Last, 36% of respondents reported that their workplace lacked strategies for dealing with ethical dilemmas.

Conclusion: These study results identify moral distress among Spanish podiatrists mainly related to time constraints, patient demands and lack of resources. Moral distress varies with sex and age. Organisational strategies such as moral deliberation and responsive evaluation offer the potential to address moral distress.


Iglesias ML, de Bengoa Vallejo RB, Fuentes PS. Moral distress related to ethical dilemmas among Spanish podiatrists. J Med Ethics. 2010 May 6;36(5):310-314.