Becoming the radiation therapist: Exploring the transition to practice experiences of Australian radiation therapist graduates

INTRODUCTION

The transition to qualified practice for health practitioner graduates can be a challenging experience. Supportive transition to practice programs for graduates are typical in nursing, however they are less common in allied health. Investigations into the transition to practice experience of radiation therapist (RT) graduates specifically have been limited. This study aimed to examine the transition to practice experiences of RT graduates in Australia during their first ten months of qualified practice, with the intention to inform the development of fit for purpose transition to practice programs.

METHODS

A longitudinal qualitative study was undertaken employing a constructivist grounded theory methodology. Data collection included an online focus group with RT graduates within their first three months of practice; recording of longitudinal audio diaries for six months; and an individual online interview at ten months of qualified practice.

RESULTS

Seven RT graduates participated in the study during 2022-2023. Central to the transitional process was 'Becoming the Radiation Therapist' where graduates worked towards assimilating their emerging professional identity. This process was influenced by 'Fitting in' to the team; 'Navigating expectations' of work and the workplace; 'Being supported by experienced others'; and 'Building confidence' through validating experiences.

CONCLUSION

The transitional experience of the RT graduate was influenced by their internal identity work, and by the social and structural mechanisms within their workplace. A transition to practice program should include supportive mentoring, intentional exposure to a breadth of experiences, and clear expectations to assist the RT graduate in navigating this challenging period.

IMPLICATIONS FOR PRACTICE

The transitional experience can be difficult, and supportive mechanisms throughout the first year of graduate practice would aid the emerging professional identity of the RT graduate and their role within the workplace.

Allied health work readiness capabilities: a qualitative comparison of graduates, supervisors, and managers' perspectives

Researchers have highlighted gaps in the work readiness (WR) of allied health (AH) graduates and the capabilities required to successfully work in an interprofessional collaborative practice healthcare environment. In the studies conducted, the focus has generally been on one AH discipline or on one participant group across disciplines, such as new graduates. We explored WR capability of new AH graduates across three participant groups (managers, supervisors, and graduates) and across several AH disciplines in the health sector. Focus groups using Critical Incident Technique (CIT) were conducted with 47 participants (14 new graduates, 13 supervisors, and 20 managers) from four public health organisations across Eastern Australia. CIT identified examples where new AH graduates had/did not have necessary WR capabilities to manage situations in the collaborative practice environment. Using thematic analysis, we found four main themes related to WR expectations of AH graduates (work skills and knowledge, working with others, personal attributes, and organisational knowledge), with several sub-themes. Some aspects of identified themes/sub-themes were unique to the AH interprofessional work context. Understanding of AH graduates' WR from multiple perspectives could support development of programs to enable graduate success in interprofessional working environments.

Exploration of mentor and mentee perspectives of a mentored clinical practice programme to improve patient outcomes in musculoskeletal physiotherapy

Background

A recent randomised controlled trial has demonstrated the impact on practice of an educational programme for clinicians. Mentored clinical practice in musculoskeletal physiotherapy resulted in clinically significant improvements in both physiotherapist performance and patient outcomes. The objectives of this study were to explore mentor and mentee perceptions of a mentored clinical practice programme, in order to identify key factors in the process to improve patient outcomes.

Methods

Employing a case study design of a mentoring programme that led to improved patient outcomes, mentored clinical practice was explored from multiple perspectives using a grounded theory strategy of enquiry to derive a theory of mentored clinical practice grounded in the views of the participants. Semi-structured interviews with a purposive sample of mentors and mentees were employed along with qualitative observations of mentored clinical practice. Data analysis and collection were concurrent, with analysis an iterative process deriving inductive analytical categories from the data through constant comparison.

Findings

Highly informative themes of how the complex interaction between mentor, mentee, patient and environment worked successfully were identified from the data. The mentors’ knowledge, additional perspectives, critical analysis and facilitatory style were enabling factors, as were mentees’ motivation, openness to criticism and commitment to reflect on practice. Themes around potential threats to the mentees’ development were also identified. Overloading or contradictory feedback and lack of relationship with mentees were barriers that mentors could bring; fear, defensiveness, routine working, people-pleasing and lack of experience were potential mentee barriers. A model emerges from the data demonstrating how these themes interact, providing guidance to mentors and mentees to optimise the effectiveness of mentored clinical practice.

Conclusion

This study provides a sound basis for future mentored clinical practice, producing a model from key themes from a case study where impact on clinician performance and patient outcomes are established.

New graduates learning to make intervention decisions in acute paediatric hospital settings: Support and influences

Introduction

New graduate occupational therapists’ experiences of learning to make paediatric intervention decisions within hospital settings are unexplored. New graduates commonly find clinical decision-making challenging. Previous research has predominantly evaluated support programs designed to assist their transition to practice. Exploring new graduates’ experiences working in hospital settings is important because they are common employers of new graduates and typically provide substantial support.

Method

A case study approach enabled exploration of the experiences of four new graduate and perspectives of four experienced occupational therapists working in an Australian paediatric hospital. Data were collected through semi-structured interviews, informal discussions, observations and review of documents. Inductive analysis was used to identify codes and themes within the data.

Findings

New graduates reported substantial access to workplace supports and resources to inform their intervention decisions. However, the immediacy with which occupational therapists needed to respond to referrals impacted new graduates’ ability to consistently access available supports. They were acutely aware of needing to manage clinical risk and actively sought informal support for making intervention decisions.

Conclusion

Providing opportunities to seek informal support on an ‘as-needs’ basis was most important for assisting new graduates to obtain reassurance that they were making safe, high-quality 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.

Occupational therapy fieldwork educators: Examining professional quality of life

BACKGROUND

Occupational therapy practitioners with the simultaneous working role of fieldwork educator support the growth of the profession by supervising students, but little is known about their reported burnout, compassion fatigue, and compassion satisfaction levels, and if specific work characteristics predict those levels.

OBJECTIVE

The purpose of this research was to: 1) assess the current levels of compassion fatigue, compassion satisfaction, and burnout in occupational therapy fieldwork educators through The Professional Quality of Life Scale (ProQOL), and 2) to explore how professional characteristic variables correlate and predict the measured constructs of compassion fatigue, burnout, and compassion satisfaction.

METHODS

A cross-sectional design was used, and participants were recruited from a convenience sample to complete the ProQOL and a work characteristic questionnaire.

RESULTS

On the average, 117 fieldwork educators scored higher on the subscale of compassion satisfaction when compared to those of the normed group. Linear regression analyses revealed that a higher number of roles and greater years working predicted higher compassion satisfaction.

CONCLUSIONS

This study contributes to understanding the experiences of fieldwork educators in multiple roles, their reported levels of compassion fatigue, compassion satisfaction, and burnout, and the potential for development of personal, educational and organizational resources to support professional quality of life indicators within the role of fieldwork educator.

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.

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.

Novice therapists in a developing context: Extending the reach of hand rehabilitation

Introduction

Hand rehabilitation needs in some parts of the world extend beyond the impact of specialised hand therapists. This study aimed to establish what hand rehabilitation services novice occupational therapists in South Africa were providing; the supports and barriers for such services; and, therapists’ perceptions of being equipped for hand rehabilitation.

Methods

A descriptive cross-sectional study was conducted, and an online questionnaire was sent to all occupational therapists in their first year of practice (n = 240). Data were analysed with Stata 12 and IBM SPSS Statistics, version 21.0. Responses to open ended questions were post-coded.

Results

A 43.3% response rate was obtained. Participants (n = 104) treated an average of 20 clients requiring hand rehabilitation per month often without adequate equipment (73%). Central nervous system (91.3%), bone and joint (72.8%) and arthritic conditions (72.4%) were treated most frequently. Most participants felt confident (64%) and competent (79%) in hand rehabilitation.

Conclusion

Participants were undertaking hand rehabilitation that in other contexts is considered to require specialised skills. To ensure quality rehabilitation, supervision and mentoring of novice therapists and appropriate professional development opportunities are required.

A qualitative meta-synthesis about challenges experienced in occupational therapy practice

Introduction

Information about challenges for occupational therapists is typically provided in small-scale studies from different perspectives. The purpose of this meta-synthesis was to synthesise and report about challenges in occupational therapy practice that appear to penetrate across the profession.

Method

Databases searched were Ovid Medline, EMBASE, AMED and CINAHL. Search terms were selected after gaining understanding of the topic: occupational therap* AND Exp burnout / OR Exp morals / OR retention OR clinical reasoning OR new graduate OR novice OR transition-to-practice. Studies were critically appraised using the criteria of credibility, transferability, confirmability and dependability. Findings, along with direct quotes, were extracted and data compared and contrasted through first, second and third order analysis.

Findings

Twenty-four studies were included in the meta-synthesis and three constructs were identified: ‘challenges in context’; ‘personal challenges’ and ‘social and cultural challenges’. These findings inform knowledge about constraining factors on clinical reasoning and the alignment of practice with the occupational therapy philosophy, and give insight into satisfaction with practice, ethical and professional behaviours.

Conclusion

These findings could inform provision of professional support, education for students and enhance agency to reform practice. More research is needed about professional socialisation, clinical reasoning and ethical issues.

What Actually Informs Practice: Occupational Therapists' Views of Evidence

Introduction:

This research aims to explore what New Zealand occupational therapists consider ‘evidence’ to be and how the search for evidence is accomplished in their practice.

Method:

Semi-structured interviews were conducted with 14 therapists who had shown variations in comfort levels with locating and implementing evidence.

Findings:

Four themes emerged from the data: (1) finding evidence to support practice: informal quick methods were favoured; (2) the nature of available evidence: evidence was considered to be of limited value in practice as the context of the research was often very different to the context of local practice; (3) the organisational influences: the culture of the work environment played a key role in the dissemination of knowledge and (4) the importance of evidence: the need to use evidence to support practice was appreciated by most therapists. In general, using reliable resources was regarded as key to evidence-based practice with availability of resources, therefore, deemed essential.

Conclusion:

Therapists value trustworthy research information that is pre-digested and can be readily used in practice. Where there is limited research evidence, the focus should be on the generation and dissemination of information from critical reflections on practice.

The Influence of Environment on Clinical Practice: Unspoken Rules

Purpose:

The purpose of this study was to explore organisational social processes as an environmental contributor to the professional culture of practice. Occupational therapy practitioners are expected to be adaptable, responding to ever-changing demands of health care organisations. Occupational therapy students are expected to integrate into multiple settings during their practice education; however, the distinctive culture of organisations is often unspoken, making acculturation difficult.

Method:

This study examined four representative practice settings in the United States through institutional ethnography.

Findings:

Analysis revealed complex, interlaced, poorly documented social processes at immediate, local and external organisational levels. Occupational therapy practitioners revealed that these social processes influenced the ways in which they provide health services, perceive change and respond to change. They also revealed that newcomers, including practitioners and students, must learn to fit in by the sink-or-swim method.

Conclusion:

The findings of the study suggest possible changes in didactic, practical and continuing education to facilitate adaptation to increasingly complex health care systems. Further research is recommended to determine practitioner and student perceptions of hierarchical social processes, commonalities and differences of practice environments, the influence of different environments on practice, and strategies of adaptation.

The Relationship between Adult Attachment Styles and Work-Related Self-Perceptions for Australian Paediatric Occupational Therapists

Introduction:

An attachment framework has been increasingly employed to inform our understanding of the ways in which early childhood relationships have an impact upon people's adaptation to the workplace. Evidence supports the presence of four attachment-related work orientations in adulthood (secure, cautious, support-seeking and self-reliant), which correspond to a secure and three insecure attachment patterns in early childhood. Although these work orientations have been investigated in several working populations, they have not yet been considered within a sample of occupational therapists.

Method:

The present exploratory study considered the results of a nationwide survey of 486 paediatric occupational therapists, and investigated the associations between attachment styles and a range of demographic variables and work-related self-perceptions.

Results:

Consistent with hypotheses, those with a secure attachment style reported a high investment of skill and energy in their job and low levels of over commitment. Conversely, cautious attachment and, to a lesser extent, support-seeking attachment were linked with feeling overcommitted and perceiving low returns in terms of recognition and prestige from their work.

Conclusion:

Understanding how practitioners' predominant attachment style is associated with work-related self-perceptions may offer insights into their behaviours and needs. This, in turn, can inform the provision of appropriate supports, with potential benefits for staff satisfaction, retention, health, wellbeing and, ultimately, client care.

Developing an Observed Practice Programme for Occupational Therapists and Physiotherapists: Reporting the First Phase of an Action Research Study

Occupational therapists working in higher education have acknowledged the benefits of peer observation to their professional development and there has been discussion of its potential benefits in clinical settings. However, there is limited literature and no practical guidance on the implementation of observed practice within clinical practice.

This action research study sought to develop a work-based observed practice programme for occupational therapists and physiotherapists in a United Kingdom mental health trust. Action research was chosen to enable the positive engagement of practitioners in order to co-create knowledge and to improve practice. Occupational therapists and physiotherapists with expertise of local practice and personal experience of staff development and clinical supervision formed a working group to develop and implement the programme.

The group considered examples of similar programmes from higher education and addressed issues relating to the purpose, status and process of the programme. It also explored its relationship to existing preceptorship programmes and clinical supervision. This paper summarises the key steps of the observed practice process and the development of supporting documentation created by the working group. The observed practice programme was implemented at workshops in the autumn of 2009 to be followed by a formal evaluation.