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

Abstract

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.

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

“…An ability to manage conflict and having a strong professional identity are qualities that will assist new graduates to manage within a workplace culture that disparages clients (Newton, Henderson, Jolly & Greaves, 2015). In a qualitative meta-synthesis by Murray et al (2015), it was found that the nature and culture of workplaces had a strong influence on the occupational therapy role. The issue of workplace culture is certainly an issue for new graduates in nursing and is an area for further exploration in occupational therapy (Hazelwood, Murray, Baker & Stanley, 2017).…”

“…The findings from the theme ‘working in a business model’ resonate with previous occupational therapy studies on resource issues and systemic constraints that challenge health care providers’ ability to meet personal and professional standards of care (Atwal & Caldwell, ; Bushby et al ., ; Foye et al ., ; Kassberg & Skar, ; Kinsella et al ., ; Murray, Turpin, Edwards & Jones, ). Healthcare reforms such as the National Disability Insurance Scheme (NDIS) are creating more opportunities for occupational therapists to work privately or in non‐government sectors.…”

Using Technology Enhanced Learning to Promote the Acquisition of Practical Skills in Occupational Therapy

“…Recent focus appears to be limited to the use of online assessment tools, such as e-portfolios (Cordier et al, 2016) and the use of video media, such as digital story-telling (Frost, Isbel, Kellett, & Lawlis, 2017;Smeda, Dakich, & Sharda, 2014). However, it is useful to note that colleagues in associated health professions such as nursing have begun to explore the use of virtual teaching tools (Frost et al, 2017;Hardy, Mushore, & Goddard, 2016) and the occupational therapy profession is moving forward in embracing technology with a rising popularity of social media based content (Manca & Ranieri, 2017;Murray & Ward, 2017;Rolls, Hansen, Jackson, & Elliott, 2016).…”

“…Like all practical skills, it takes time and repetition to learn adaptive equipment use, which may not be available in the clinical setting. While many students are exposed to this essential skill during their practice placements, the increasing diversity of placement opportunities means that there is less conformity in what all students can expect to experience on placement (Glenn & Gilbert-Hunt, 2012;Murray, Turpin, Edwards, & Jones, 2015). It can no longer be guaranteed that students will Published by Encompass, 2019 experience the opportunity to become proficient in equipment fitting before national registration.…”

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

“…Professional identity in occupational therapy has received a great deal of attention (Turner & Knight, 2015). Lack of respect or awareness of occupational therapy has been identified as a key stressor in a range of settings (Ashby, Ryan, Gray & James, 2013;Gupta, Paterson, Lysaght & von Zweck, 2012;Moore, Cruickshank & Haas, 2006;Murray, Turpin, Edwards & Jones, 2015). Maintaining a strong sense of professional identity (e.g.…”