New graduate occupational therapists' narratives of ethical tensions encountered in practice

Moral Distress in the Time of COVID-19: Occupational Therapists' Perspectives

The conditions of COVID-19 have caused moral distress in healthcare workers. Occupational therapists have had to adapt to these unknown times to best treat their clients. The purpose of this study was to explore the experience of moral distress in occupational therapists during the time of COVID-19. Eighteen occupational therapists were included who worked in a variety of settings. Investigators conducted semi-structured interviews to explore experience with moral distress (distress felt when confronting an ethical problem) during the time of COVID-19. The data were analyzed using a hermeneutical phenomenological approach to generate themes regarding the experience of moral distress. Investigators identified themes of occupational therapists' experiences during the COVID-19 pandemic. These themes included: Experiences of moral distress, capturing participants' encounters with morally distressing issues; effects of moral distress, exploring the impact of COVID-19 experiences on participants' well-being and quality of life; and managing moral distress, addressing ways in which occupational therapists tried to mitigate moral distress throughout the pandemic. This study brings awareness to the experience of occupational therapists during the pandemic and explores implications for preparing occupational therapists for future occurrences of moral distress.

Evaluative judgement in practice education: How does the ability to judge the quality of work impact placement performance?

INTRODUCTION

Occupational therapy students need to be ready to work autonomously in a range of environments as soon as they complete their degree. Practice education experiences are considered key to students developing the competencies that autonomous work requires. To function autonomously in practice environments, it is argued that practitioners need to be able to judge the quality of their own work and the work of others. This is referred to as evaluative judgement. However, there is limited empirical literature relating to evaluative judgement and even less exploring the concept within occupational therapy.

METHODS

This study used qualitative methods, seeking to understand the evaluative judgements of clinical practice made by third- and fourth-year occupational therapy students during practice education.

RESULTS

Twenty-one interviews were conducted with third- (n = 10) and fourth-year occupational therapy students (n = 1), university support staff supporting practice education (n = 4), and practice education supervisors (n = 5) at one Australian university. Practice education grades and documentation were also used as data. Data were analysed thematically, and two themes, each with three sub-themes, were identified: students coming to understand expected standards, with the following sub-themes: students attuning to cues, cues that inform supervisors about students' meeting the standards, and barriers and frustrations to understanding standards; and practising and developing evaluative judgement, with the following sub-themes: making comparisons, acting on feedback, and reflective practice.

CONCLUSIONS

Practice education experiences provide many context-specific opportunities for students to develop their evaluative judgement. Students may be supported to come to know what quality work looks like by offering scaffolded opportunities to develop evaluative judgement in university and practice education settings.

Occupation-centred practice and supervision: Exploring senior occupational therapists' perspectives

INTRODUCTION

Occupation-centred practice is core to contemporary occupational therapy; however, knowledge and implementation of occupation in practice vary. New graduate occupational therapists find implementing occupation-centred practice challenging, partly due to the influence of senior occupational therapists. However, little is known about senior therapists' views, knowledge, and use of occupation-centred practice and the impact this has on new graduates. The aims of this study were to explore senior occupational therapists' perspectives on and use of occupation-centred practice and the extent to which they influence the occupation-centred practice of the new graduates they supervise.

METHODS

Interpretative phenomenology was used as the research design. Ten senior occupational therapists in Australia were purposively recruited to participate in semi-structured interviews, which we transcribed. Interpretative Phenomenological Analysis (IPA) was used to analyse the data and develop themes.

FINDINGS

Five themes were discovered from the data: together, but apart; a link between knowledge and identity; navigating different cultures; making up for what is missing; and good supervisors. The themes revealed participants' varied knowledge and use of occupation-centred practice, the influence of practice context, and the way supervision impacted on the practice of new graduates.

CONCLUSION

Senior occupational therapists valued occupation-centred practice, but their understanding and implementation of it varied. Participants acknowledged that they held great power to influence new graduates' use of occupation-centred practice through supervision. Consequently, if occupation is not central to supervision, this could perpetuate the ongoing challenges of delivering contemporary practice.

Attrition and Retention of Rehabilitation Professionals: A Scoping Review

INTRODUCTION

Attrition is defined as a permanent departure from one's profession or the workforce. Existing literature on retention strategies, contributing factors to the attrition of rehabilitation professionals and how different environments influence professionals' decision-making to stay in/leave their profession, is limited in scope and specificity. The objective of our review was to map the depth and breadth of the literature on attrition and retention of rehabilitation professionals.

METHODS

We used Arksey and O'Malley's methodological framework. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, Scopus, and ProQuest Dissertations and Theses from 2010 to April 2021 for concepts of attrition and retention in occupational therapy, physical therapy, and speech-language pathology.

RESULTS

Of the 6031 retrieved records, 59 papers were selected for data extraction. Data were organized into three themes: (1) descriptions of attrition and retention, (2) experiences of being a professional, and (3) experiences in institutions where rehabilitation professionals work. Seven factors across three levels (individual, work, and environment) were found to influence attrition.

DISCUSSION

Our review showcases a vast, yet superficial array of literature on attrition and retention of rehabilitation professionals. Differences exist between occupational therapy, physical therapy, and speech-language pathology with respect to the focus of the literature. Push , pull , and stay factors would benefit from further empirical investigation to develop targeted retention strategies. These findings may help to inform health care institutions, professional regulatory bodies, and associations, as well as professional education programs, to develop resources to support retention of rehabilitation professionals.

Current Status and Challenges of Support Environments for New Graduate Occupational Therapists in Japanese Hospitals: A Mixed Method Study

Introduction

The number of occupational therapists in Japan continues to increase, which has led to an urgent need to improve the educational environment for new graduate occupational therapists. This study attempted to identify the current state and challenges of the educational environment for new graduate occupational therapists in Japan.

Methods

We employed a mixed method using quantitative and qualitative data from a questionnaire survey of 1055 chief occupational therapists in Japanese hospitals. The questionnaire consisted of (1) basic information about the respondent and their hospital, (2) educational environment for new graduate occupational therapists at the respondent's hospital, (3) time spent on in-hospital lectures and on-the-job training, and (4) challenges in the clinical education of new graduate occupational therapists. Text data was analysed qualitatively using text mining to create cooccurrence networks.

Results

A total of 385 responses were obtained with a response rate of 36.5%. All hospitals had recruited new graduate occupational therapists in the last five years, but more than half of them did not have a philosophy and policy on education and had not prepared guidelines for the completion of occupational therapy education. The cooccurring network of issues in the educational environment for new graduate occupational therapists indicates the need to create standard guidelines, train supervisors, and develop a hospital education system.

Conclusion

In the future, the needs of the educational environment for newly graduated occupational therapists should be investigated, and standardised educational guidelines should be developed.

New Graduates' Experiences in Paediatric Private Practice: Learning to Make Intervention Decisions

Background. Challenges with clinical decision-making are common among new graduate occupational therapists. There is limited research exploring their experiences of learning to make intervention decisions. Purpose. To explore new graduates' experiences of learning to make intervention decisions in pediatric private practice. Method. A case study approach, involving a range of data sources, explored the experiences of 11 new graduates and three experienced occupational therapists working in Australian private practices. Data were analyzed using inductive thematic analysis. Findings. Themes pervading new graduates' decision-making experiences were: "being seen as capable and competent," "similar and familiar," and "specialist versus generalist positions." Contextual influences contributed to new graduates utilizing their support networks and personal experiences in addition to workplace supports. Implications. It is vital to balance private practice business demands with opportunities for new graduates to engage with experienced occupational therapists and professional communities of practice to assist their learning to make intervention decisions.

Novice Occupational Therapy Practitioners’ Use of Occupation in Practice: A Scoping Review

An occupation-centered perspective is a foundational component defining occupational therapy practice. A scoping review was conducted of research studies from 2002 - 2020 describing novice occupational therapy practitioners and occupation. Ten articles met the inclusion criteria. Novices acknowledged that using occupation was a source of professional tension, describing a mismatch between their education and workplace expectations. The cognitive load of occupation-centered practice influenced novices' avoidance of occupation. Few articles address novices' experiences using occupation in their practice. Existing research primarily addresses barriers limiting novices' use of occupation such as lack of supervision and confidence.

Assessing Older Adults’ Decision-Making Capacity for Independent Living: Practice Tensions and Complexities

Decision-making capacity (DMC) is a salient issue due to increasing ageing populations and associated dementia-related diseases. Legislative and policy developments emphasise older adults’ rights to participate in decision-making. Fifty-two occupational therapists working with older adults from a range of practice settings in Ireland participated in focus groups to discuss their contribution to multidisciplinary assessments of older adult’s DMC for independent living. Findings indicate lack of shared understanding of DMC and conflicting philosophies of practice and highlight the need for a comprehensive and multidisciplinary approach. Findings also highlight that older people are often excluded from care-planning, and independent living options are determined by availability of community services rather than their preferences. Future research will attempt to inform practice in assessing and supporting older adults’ DMC for independent living.

Early career programs for mental health occupational therapists: A survey of current practice

INTRODUCTION

Early in their career, occupational therapists may require a range of additional development for a successful transition to the profession. However, both the definition of 'early career' and the relevant development for this career stage vary between sources. In regard to occupational therapists transitioning to mental health professional practice, there is very little evidence to draw upon when designing the structure and content of development programs. This study aimed to review current practices in early career programs for mental health occupational therapists within the Australian state of Victoria.

METHODS

Tertiary mental health services in Victoria were purposefully recruited, supplemented by snowball recruitment. The participants responded to a bespoke survey including open and closed questions, designed to benchmark practices against previous research and explore current practices with early career mental health occupational therapists. Thirteen services participated, with respondents including senior clinicians, allied health chiefs, allied health clinical educators and early career development program coordinators.

RESULTS

The participants confirmed the perceived value of development programs for early career mental health occupational therapists; however, limited resources were available to develop, implement and sustain these supports. Program content, structure and terminology varied significantly, as did the identified competencies for participants to achieve. Some of this variability was related to program eligibility criteria and early career workforce structure within organisations.

CONCLUSION

Early career mental health occupational therapist development should be responsive to their local service environments. A better understanding of the outcomes of these programs for early career occupational therapists, from both an individual and service perspective, could also provide a firmer rationale and foundation for sustained resourcing of this valuable approach to workforce development.

The clinical challenges experienced by new graduate occupational therapists: A matrix review

BACKGROUND.

The transition from student to new graduate occupational therapist is recognized as stressful. Current literature has not specifically drawn together the challenges new graduates face when learning to work with clients.

PURPOSE.

This review aimed to synthesize common challenges that new graduate occupational therapists face when working with clients.

METHODS.

Searches of online scholarly databases located research articles. Content related to working with clients in practice was charted using the Matrix Method.

FINDINGS.

From 21 articles, four categories of challenges were identified: "reasoning and decision-making," "using knowledge and skills in practice with clients," "the context of service provision," and "managing caseload and priorities." "Having self-doubt" was a theme that pervaded the data.

IMPLICATIONS.

New graduates often do not feel fully prepared for all aspects of occupational therapy practice. As they may not have access to substantial workplace support, exploring personal resources and professional support may assist this challenging transition.