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.

The experience and role of mentorship for paediatric occupational therapists

INTRODUCTION

Within Australia, the introduction of the National Disability Insurance Scheme has led to a growth in paediatric occupational therapists working in community settings. This growth has increased the demand for support from more senior paediatric occupational therapists to novice clinicians. Mentoring has long been valued by occupational therapists as a means to provide this support. Despite its apparent benefit, there is limited research on the contribution of mentoring as distinct from supervision, and its impact on mentees' skills and confidence in providing care. This study examined the contribution of mentorship to the development of professional capability in paediatric occupational therapy practice from the perspective of mentors and mentees.

METHODS

Interpretive description methodology was used. In-depth interviews were conducted with nine mentors and eight mentees from three Australian states. Data were analysed inductively and thematically.

FINDINGS

All participants reflected on the challenges presented by the complexity of practice, requiring a knowledge base that mentees perceived they did not possess. The essential nature of non-judgemental, emotional support allowed mentees to feel safe to discuss their concerns when they were often overwhelmed by practice. Mentorship was viewed as capacity building, building competence by scaffolding clinical reasoning and supporting theory to practice translation while developing resilience to cope with complexity.

CONCLUSION

Study participants reported that successful mentorship assisted novice practitioners to integrate knowledge and skills required for complex clinical and professional reasoning. The emotional support provided through the relationship supported novice therapists to build their confidence and resilience while promoting professional identity and socialisation into the profession. The study raised questions related to how the profession best supports novice paediatric therapists in the current employment contexts, and the need to review how bodies of knowledge relevant to paediatrics are brought together to be used by both novice clinicians and senior therapists, who support them, for translation to effective practice.

The use of the term ‘occupational profile’ in occupational therapy and occupational science literature: A scoping review

Introduction

The term ‘occupational profile’ is widely used within the occupational therapy profession; however, its use and application appear inconsistent in the literature. Understanding how occupational profile is described in existing literature can reduce ambiguity and strengthen consistent use of terminology across practice and research.

Methods

A scoping review was conducted to examine how occupational profile has been described in occupational therapy and occupational science literature.

Results

Seventy-six journal papers were included. A lack of consistent definitions, conceptualisation and measurements was identified. Key concepts relating to the conceptualisation of occupational profile included occupational history, motivation and performance. Only one measurement was used consistently with paediatric clients to identify individuals’ occupational profiles. Occupational profiles of populations and communities were not identified.

Conclusion

The lack of consistency in definitions, conceptualisation and measurement of the term ‘occupational profile’ presents significant issues for occupational therapy practice, including an inability to compare populations. Researchers should articulate their conceptualisation of occupational profile in the absence of a universally agreed-upon definition. More comprehensive measures seeking to explore the occupational profile of a variety of clients need to be developed. Occupational profiles of communities and populations should be explored to understand occupational patterns and identify potential occupational issues.

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.

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.

Transitioning to practice: a qualitative investigation of Australian graduate naturopath's experiences of being in practice

BACKGROUND

The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation.

METHODS

Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach.

RESULTS

A total of 19 new graduates (94.7% female; 57.9% aged 40-59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively.

CONCLUSIONS

Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.

The meaning of rehabilitation: a qualitative study exploring perspectives of occupational therapists and physiotherapists working with older people in acute care

OBJECTIVE

To explore how occupational therapists and physiotherapists constructed and interpreted the meaning of rehabilitation in relation to older people in acute care.

DESIGN

A focussed ethnographic study was undertaken, primarily using observation, interviewing and review of clinical records within one acute medical ward in a general hospital in the UK. Five patient participants gave consent for their episode of care to be studied, with observations and interviews primarily involving the identified patients and five occupational therapy and physiotherapy professionals.

RESULTS

Four themes were identified: rehabilitation as a process to facilitate physical improvement; rehabilitation as physiotherapy-led; rehabilitation as a place…but not here; and rehabilitation as a process which prioritises safety over function. Such conceptualisations of rehabilitation were recognised as rooted in social and historical perceptions and challenged the ideals of rehabilitation professionals.

CONCLUSIONS

The meaning of rehabilitation in acute care is shaped by a range of cultural, contextual and systemic influences. Recognising these influences, and subsequent challenges to rehabilitation ideals, can encourage professionals to work towards meaningful change.Implications for RehabilitationA reductionist version of rehabilitation was evident within this context which placed value on physical improvement, achieving optimum safety and led by physiotherapy.This version of rehabilitation was unsatisfactory to occupational therapists and physiotherapists in this setting and different to their ideals.Where rehabilitation may be associated with another place, practitioners should reflect on whether this is influencing patients becoming a lower priority for interventions whilst waiting and address this, if required, within their own reasoning, prioritisation and delegation.Those who recognise similarities with their own practice context could individually, and within teams, revisit definitions of rehabilitation to notice, document and have conversations about the ideals of their professions versus the reality of practice.Occupational therapists and physiotherapists can be champions for organisational and cultural change to promote rehabilitation as a multi-disciplinary phase of care working towards optimising improvements in wellbeing, function and safety, irrespective of location.

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.

Student perspectives on factors that influence the implementation of evidence-based practice in occupational therapy

AIM

Evidence-based practice (EBP) is perceived as an integral component of contemporary allied health practice. While allied health clinicians (such as occupational therapists) have generally positive attitudes towards EBP, research suggests that they find its implementation consistently challenging. The professional literature increasingly suggests that more effective EBP learning takes place when social constructivist approaches to learning are adopted. The authors of this study sought to use the pre-existing knowledge and perceptions of occupational therapy students to inform a curriculum review of an EBP unit. Therefore, the aim of this content analysis study was to investigate how occupational therapy students perceive and critically analyse factors that influence the implementation of EBP, specifically strengths, weaknesses, opportunities and threats (SWOT).

METHODS

The study sampled students in the third year of a 4-year, Bachelor level Australian Occupational Therapy Program. The students were undertaking the first of two EBP units, and data were collected from the first assignment they submitted for these units. The assignment required the students to complete a SWOT analysis of EBP in occupational therapy, and response to a statement around whether it should be mandatory. Data were collected over 2 consecutive years from a total of 64 occupational therapy students. All data collected were subjected to content analysis, with themes identified by at least 25% of students in each cohort retained for analysis and formation into overall themes.

RESULTS

Participating occupational therapy students identified five strengths, four weaknesses, six threats but only one opportunity for EBP. Three key themes were identified within the data: first, the role and purpose of EBP; second, the resources it requires and third, factors that influence its success. The students perceived the main purpose of EBP as supporting positive practice change, and highlighted its roles in building clinician capacity and professional credibility. They also characterized EBP as a separate and specialist practice that requires specific training and resourcing to achieve, and questioned its feasibility as an integrated part of daily practice. Along with previously identified challenges around time and resourcing, the students also highlighted negative attitudes and beliefs from senior colleagues as an important negative influence on the success of EBP.

CONCLUSION

The current study consolidates a growing body of international literature about the value of social constructive approaches to EBP in undergraduate education. Vertical constructive alignment that embeds EBP through undergraduate education, rather than the provision of 'EBP'-specific units, should now be considered best practice. However, this embedded approach requires the explicit and repeated communication of the presence of EBP in all learning opportunities, to enable students to recognize opportunities to deploy their existing knowledge and skills.

Workplace Aggression: Exploring Experiences of Occupational Therapy Practitioners in Healthcare Settings

Workplace aggression (WPA) among healthcare workers is a pervasive and serious problem in the healthcare industry, yet there is a poor understanding of WPA in the profession of occupational therapy (OT). The authors employed a mixed method design using a Likert scale survey and focus groups from two different settings and locations to explore WPA experiences of OT practitioners working in healthcare settings. Participants for the focus groups totaled 14 and 109 surveys were returned. The findings revealed that 100% of the focus group participants and 67% of the survey respondents report exposure to specific types of WPA. Key underlying causes relate to the challenges occupational therapy practitioner's face in advocating their professional role and values in a predominant biomedical setting. These findings are important not only to increase awareness among practitioners, leaders, and educators but to further examine how occupational therapy's unique role in healthcare can be fully recognized.

Experiences of and support for the transition to practice of newly graduated occupational therapists undertaking a hospital graduate Program

INTRODUCTION

Newly graduated occupational therapists face well-documented difficulties as they embark on professional practice. Occupational therapy departments need to ensure that new graduates conduct their roles appropriately while developing experience and building clinical and professional skills. This study aimed to explore the experiences of new graduates at a major Australian metropolitan hospital occupational therapy department, the support provided to them and their perceptions of this support.

METHODS

The research design was Interpretive Description. Semi-structured interviews of approximately 60 min were undertaken with seven occupational therapists, their team leader and the Departmental Head. The two research questions were as follows: What were the graduates' experiences of their first year in practice? What support was provided to graduates and what were their perceptions of this?

RESULTS

New graduates perceived the transition to practice as overwhelming, particularly regarding their caseload responsibility. During the first few months, work tasks took them longer and they felt stressed and anxious. They received a range of support and education, both inter-professional and discipline specific. Their occupational therapy team leader and clinical senior provided tailored support, guidance and reassurance. Guided questioning facilitated development of new graduates' clinical reasoning and professional skills. Reflection helped them to identify and address learning goals relating to occupational therapy professional competencies. New graduates valued having a consistent caseload and a supportive workplace was highly valued.

CONCLUSION

New graduates initially feel overwhelmed by being responsible for their decisions. However, they can benefit from tailored supervision and guided questioning to help develop clinical reasoning and professional skills, formal and informal support from experienced occupational therapists and their inter-professional teams and time to increase skill with their caseload. Engagement in a professional community of practice is important.

Occupational Therapists as Street-Level Bureaucrats: Leveraging the Political Nature of Everyday Practice

Background.

As front-line service providers who often work in systems regulated by governmental bodies, occupational therapists can be conceptualized as “street-level bureaucrats” ( Lipsky, 1980/2010 ) who effect and are affected by policy.

Purpose.

Drawing on understandings from a study of long-term unemployment, this article proposes that occupational therapists, as street-level bureaucrats, respond to inter-related policies and systems in ways that can perpetuate, resist, or transform opportunities for doing and being.

Key Issues.

By highlighting practitioners’ everyday negotiation of governmental, organizational, and professional power relations, the notion of street-level bureaucracy illuminates the political nature of practice as well as the possibilities and boundaries that policy can place on ideal forms and outcomes of practice.

Implications.

Framing occupational therapists as street-level bureaucrats reinforces practitioners’ situatedness as political actors. Mobilizing this framing can enhance awareness of occupational therapists’ exercise of discretion, which can be investigated as a basis for occupation-focused and emancipatory forms of practice.

Learning thresholds for early career occupational therapists: A grounded theory of learning-to-practise

Introduction

Early career occupational therapists experience considerable learning. This research sought to develop a theory of how they learn once practising.

Method

The research employed a constructivist grounded theory methodology. Interviews were conducted with 20 participants who were either experienced ( n = 8), early career occupational therapists ( n = 10) or in supporting roles for early career occupational therapists ( n = 2). Participants were asked their views about what early career occupational therapists find troublesome and how they respond. Data were collected and analysed concurrently. Open, focused and theoretical coding were used to develop a theory.

Findings

The theory of learning-to-practise occupational therapy included four learning thresholds: consolidating professional reasoning; navigating into the workplace; building competence and confidence; and developing a personal theory and practise style. There were 11 strategies identified that early career occupational therapists use to cross the learning thresholds. Early career occupational therapists’ understanding and value of knowledge shifted, which culminated in them ‘realising’ their personal theory and practice style. They refined their values and beliefs and learned to be more deliberate and reflective in their thinking and actions.

Conclusion

Early career occupational therapists were challenged, which promoted learning. This research extends understanding of the learning needs, thinking and actions taken by early career occupational therapists to cross learning thresholds and to develop their personal theory and practice style.

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

BACKGROUND/AIM

Professionals in health and social care have high workloads and are working with diverse populations in hierarchical and complicated service delivery systems. There is increasing pressure on new graduates because they are expected to be immediately work ready and may not receive adequate support or supervision. It is well known that there can be issues with satisfaction and retention rates of new graduates due to the challenges they experience. Ethical tensions are an unavoidable part of occupational therapy practice and may contribute to unique challenges for new graduates who may not yet have the personal resources to make sense of these independently. New graduate occupational therapy perceptions of ethical tensions have not yet been explored and this study sought to fill this gap. Exploring the ethical tensions experienced by new graduates can inform appropriate policies, procedures, preparedness and standards.

METHODS

A qualitative study using narrative enquiry was undertaken in which stories were gathered from eight new graduate occupational therapists who had been working for 6-24 months. Semi-structured in-depth interviews were used to gather data. Transcripts were analysed following narrative analysis guidelines. Member checking, reflexivity and keeping an audit trail of methodological and analytical decisions were employed to strengthen the rigour of the study.

RESULTS

Analysis revealed six predominant themes: working in a business model, respecting client choice, dealing with aggression and death, mandatory reporting is hard to do, differing team values, and feeling devalued and unsupported.

CONCLUSION

The findings highlight the importance of understanding the ethical tensions faced by new graduates and of exploring ways to assist new graduates to respond constructively to ethical dilemmas, distress and uncertainties. To address the risk of attrition, graduates need systems in place for accessing support to increase preparedness to respond to ethical tensions when they do arise.

Evaluation of the construct and internal validity of the Professional Identity Questionnaire: A Rasch analysis

BACKGROUND/AIM

It has been suggested that occupational therapy practitioners with a poor sense of professional identity experience more difficulties in the workplace and may be less likely to implement evidence-based, occupation-focused interventions. Poor sense of professional identity has also been linked to increased risk of burnout. Although professional identity is considered important, few measures are available and none have been rigorously evaluated. The project was established to evaluate the construct and internal validity of one such measure, the Professional Identity Questionnaire (PIQ).

METHODS

The PIQ includes 10 questions, each rated on a 5-point Likert scale. Rasch analysis was used to evaluate several aspects of construct and internal validity of the PIQ. These included rating scale validity, unidimensionality, statistical validity, differential item functioning, overall construct validity and person response validity. Correlations were also calculated to explore the relationship between the Professional Identity Questionnaire and a commonly used measure of burnout, the Oldenburg Burnout Inventory (OLBI).

RESULTS

A total of 118 occupational therapists working in mental health completed the PIQ and OLBI. Initial analyses suggested that the rating scale validity and targeting of item difficulties to person abilities were not optimal. Revision of the rating scale structure improved the overall rating scale validity and item targeting. Analyses using the revised scale structure showed generally good alignment with quality control criteria established for this study. Fit statistics for one item were less than optimal and some differential item functioning was present. Correlations between PIQ and OLBI total scores were -0.53 for the original PIQ rating scale structure and -0.46 for the revised rating scale structure.

CONCLUSIONS

Results from this study provide preliminary evidence for the construct and internal validity of the PIQ, especially when using the revised scale structure. However, further research is required before the PIQ can be recommended for widespread use.

Ethical tensions: A qualitative systematic review of new graduate perceptions

Background:

New graduate transition into the workforce is challenging and can involve managing ethical tensions. Ethical tensions cause new graduates to doubt their capabilities due to their lack of experience. To support new graduates, we need to know what these ethical tensions are.

Objectives:

To explore the ethical tensions perceived to occur in practice for new graduate health professionals.

Research design:

This qualitative systematic review involved a search of five databases (Medline, EMBASE, AMED, CINAHL and Scopus) which resulted in the retrieval of 3554 papers. After the two-phased screening process, eight studies were identified that met the inclusion criteria and had rich data on the review question. Articles were read several times, critically appraised and analysed through thematic analysis.

Ethical considerations:

No ethical approval was required for the systematic review. The review was conducted following well-established reporting guidelines enabling transparency and rigour.

Findings:

Studies originated from Australia, United States, Iran and China. One study included speech pathologists and seven were with nurses. Four themes included the following: (1) enduring an unknown workplace culture that generates uncertainty without support for new graduates; (2) being vulnerable because of distress from bullying, exclusion and being a scapegoat; (3) constraining systems and institutional restrictions that cause dilemmas; and (4) experiencing disillusionment from lost ideals about ethical practice.

Discussion:

This review has brought to light the vulnerability of new graduates to negative workplace culture and collegial incivility. In addition, new graduates are subjected to ethical tensions created by institutional constraints which can create dilemmas and uncertainties through practice that does not align with what they anticipated.

Conclusion:

Understanding ethical tensions experienced by new graduates enables provision of informed support. There needs to be considerable cultural change for orientation and socialisation of new graduates to enable them to learn and manage ethical tensions.