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

Abstract

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.

The Clinical Challenges Experienced by New Graduate Occupational Therapists: A Matrix Review

“…In the current review, it was reported that having access to more experienced colleagues allows new graduates to receive confirmation and validation of their decision-making, have their questions answered, and receive assistance to apply theory to practice (Robertson & Griffiths, 2009). This is supported by other literature which highlights that contact with other clinicians may provide the opportunity for new graduates to discuss and develop their clinical reasoning (Tryssenaar & Perkins, 2001) and gain advice and feedback (Lee & Mackenzie, 2003), in order to enhance client services (Hazelwood et al, 2018). Formal supervision sessions can provide the opportunity for new graduates to discuss specific clients with their supervisor Turpin et al, 2021.…”

“…New graduates found it challenging to engage in their clinical role when faced with aspects of the practice environment such as limited time (Allen & Cruickshank, 1977) and resources (Nordholm & Westbrook, 1981; van Stormbroek & Buchanan, 2019). Recent research suggests that working within funding constraints is now a key resource issue for new graduates (Hazelwood et al, 2018; van Stormbroek & Buchanan, 2019). They also struggled with clients being quickly discharged from the service (Leonard & Corr, 1998) and working within political or challenging workplace cultures (Lloyd et al, 2007; Murray et al, 2020).…”

“…This included: liaising with relatives (Atkinson & Steward, 1997; Leonard & Corr, 1998); assisting families to understand the value of the intervention and helping parents of pediatric clients accept responsibility for continuing therapy at home (Allen & Cruickshank, 1977); and experiencing language barriers and challenges with cultural competence (van Stormbroek & Buchanan, 2019). New graduates also found it challenging to facilitate group interventions (Allen & Cruickshank, 1977; Gray et al, 2012), manage client behaviour and work with “atypical” clients or those with unusual needs (Hazelwood et al, 2018; Lloyd et al, 2007; Rosa & Hasselkus, 2005).…”

“…Any relevant numerical results were converted to qualitative statements, such as 94% of participants found decision-making stressful. Challenges were extracted if they were associated with new graduates' work with clients, such as "difficulty deviating from accepted standards of practice" (Di Tommaso et al, 2019a) and "providing therapy within funding constraints" (Hazelwood et al, 2018).…”

“…For example, under the National Disability Insurance Scheme (NDIS) in Australia, previously government-funded disability services are being privatized (Department of Communities, Disability Services, & Seniors, 2018). This has resulted in more opportunities for occupational therapists to work outside of the public sector, such as in private practice or non-government organizations (Hazelwood et al, 2018). Canada has also seen a rise in the number of occupational therapists who are self-employed or working in community settings (Canadian Institute for Health Information, 2018).…”