Pearls of wisdom: using the single case study or 'gem' to identify strategies for mediating stress and work-life imbalance in healthcare staff

Background

The growing levels of stress and work-life imbalance reported in contemporary health and social care arenas in the UK can be linked to the neoliberal principles driving performance and intensification in the workforce. These pressures are an area of concern in terms of staff health and wellbeing and the impact of these on the care and compassion of patients/service users.

Aims

This paper reports on a single case study that was part of a wider interpretative phenomenological analysis (IPA) that aimed to explore the levels of stress and work-life imbalance experienced by occupational therapists working in health and social-care sectors in Wales in the UK.

Methods

Interpretative phenomenological analysis was used as both an approach and tool of analysis. The use of the single case study and gem as a tool in IPA to pique interest and promote further investigation is also explicated.

Results

Identified four key strategies that underpinned an approach to mediating stress and work-life balance for staff in the workplace. These were: a sense of choice and autonomy over workloads and decision-making; congruence with family values; supportive workplace attitudes and expectations of others; and finally, that the ability to reconcile conflicts i.e. integrate or harmonise them with personal values, as opposed to holding a sense of compromise marked by concession or loss, can address cognitive and emotional dissonance.

Conclusions

The existing constructs to support the health and wellbeing of staff in health and social-care settings are ineffective. These strategies offer tools to address this and successfully promote a sense of personal integrity and meaning in life. In turn, this can achieve and sustain a more resilient workforce providing the positive energy needed to be caring and compassionate in their practice.

Whose Occupational Balance is it Anyway? The Challenge of Neoliberal Capitalism and Work–Life Imbalance

Introduction:

Occupational therapists/scientists maintain that achieving occupational balance through participation in ‘doing’ and ‘being’ occupations enhances personal and social wellbeing. However, the influence of paid work on occupational balance is not well researched. The purpose of this study was to explore the influence of workplace cultures on the lived experience of occupational balance for occupational therapists.

Method:

Two representative workplaces were accessed: one health and one social services setting, both in Wales. Twenty-nine occupational therapists took part, 18 from healthcare and 11 from social services. The study was qualitative in design, using in-depth interviews and interpretative phenomenological analysis.

Findings:

The study identified a potent link between neoliberal capitalism and occupational imbalance for occupational therapists as a consequence of the pressures of paid work on the rest of life, the social hegemony of paid work, and a sense of individual responsibility for both performance in paid work and success or failure in personal occupational balance.

Conclusion:

Occupational therapists can live unbalanced lives as a consequence of the pressures of the neoliberal workplace on ‘doing’ and ‘being’ activities outside of paid work. Individuals can experience a sense of personal responsibility about success or failure in work–life balance that can affect their achievement of wellbeing through occupational balance.

The Professionalisation of Occupational Therapy: A Continuing Challenge

Professions are socially constructed phenomena. Accordingly, an understanding of what is meant by a profession, with its associated social positioning and how that is interpreted, is governed by historical, temporal, cultural and ideological influences. For occupational therapy, such an understanding can be a real challenge. This is because of a dichotomy between its ontological, person-centred approach and the medically dominated constructs prevalent in the professionalisation of all caring professions and still inherent in health care arenas today (Etzioni 1969, Fairhurst 1981, Rivett 1997, Freidson 2001).

As a consequence of this traditionally accepted dominance and the roles ascribed to or enabled by this positioning, the professional identity of occupational therapy can be limited by the politics of power at the organisational level. This can shape how occupational therapy is understood, not only by significant others but also by the profession itself. Professional consistency and cohesion, both inside and outside the profession, could therefore be challenged, unless individual actors, organisational attitudes and social constructs change. There is a need both to confront and to accept the ever-changing nature of professionalism and the meaning of occupation in the postmodern world.