Moral Distress and Resilience in the Occupational Therapy Workplace

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.

Pediatric Occupational Therapists and Occupational Stress: A Scoping Review

The purpose of this scoping review was to provide further insight into the stress and the stressors experienced by pediatric occupational therapists in the work environment. Using the Arksey and O'Malley framework, the search was conducted in eight databases, nine electronic journals, and eight gray literature sources to identify articles related to stress and stressors of pediatric occupational therapists. Review selection and characterization were performed by two independent reviewers. Twelve articles published from 2011 to 2020 were identified and varied in terms of purpose, population, and results although the articles all shared similar methodologies and outcome measures. Only 25% of the articles (3/12) addressed pediatric occupational therapy stress and stressors directly while the remaining addressed occupational stress, but with varying levels of attention to pediatric occupational therapists. Stress and stressors experienced by pediatric occupational therapists have been studied to a limited extent. Occupational stress is associated with increased burnout, decreased health, and decreased job satisfaction and performance. Several knowledge gaps have been identified, as well as priorities for future research into pediatric occupational therapists and occupational stress.

Moral Distress in the Time of COVID-19: Occupational Therapists' Perspectives

The conditions of COVID-19 have caused moral distress in healthcare workers. Occupational therapists have had to adapt to these unknown times to best treat their clients. The purpose of this study was to explore the experience of moral distress in occupational therapists during the time of COVID-19. Eighteen occupational therapists were included who worked in a variety of settings. Investigators conducted semi-structured interviews to explore experience with moral distress (distress felt when confronting an ethical problem) during the time of COVID-19. The data were analyzed using a hermeneutical phenomenological approach to generate themes regarding the experience of moral distress. Investigators identified themes of occupational therapists' experiences during the COVID-19 pandemic. These themes included: Experiences of moral distress, capturing participants' encounters with morally distressing issues; effects of moral distress, exploring the impact of COVID-19 experiences on participants' well-being and quality of life; and managing moral distress, addressing ways in which occupational therapists tried to mitigate moral distress throughout the pandemic. This study brings awareness to the experience of occupational therapists during the pandemic and explores implications for preparing occupational therapists for future occurrences of moral distress.

Stress among Pediatric Occupational Therapists: A Study of Prevalence, Work and Demographic Factors

This study aimed to evaluate the self-reported stress levels of pediatric occupational therapists, examine specific work factors and determine if demographic factors predict occupational stress. A cross-sectional survey design study, using voluntary response sampling, was conducted. The survey included demographics, the Workplace Stress Scale, and the Stress Index. The sample included 289 pediatric occupational therapists. Using descriptive analysis, a one-sample t-test, and multiple linear regressions, results indicated that pediatric occupational therapists had significantly higher stress levels than the validating sample of the Workplace Stress Scale. Self-reported work factors included too much work to do in a limited time and lack of time to plan or evaluate treatments. No demographic factors predicted work stress, while several work factors did. Occupational stress exists in pediatric occupational therapy work settings, especially in settings where high productivity is self-reported.

Let's Talk About Ethics: Addressing Ethical Tensions and Building Moral Resilience in the Occupational Therapy Profession

Health professionals across all care delivery settings, including occupational therapy practitioners, are experiencing high levels of moral distress. The mental, emotional, and physical consequences of unresolved moral distress are resulting in burnout, decreased quality of care, and poor patient outcomes. Moral resilience is a teachable and learnable skill that can nullify some of the adverse consequences of moral distress. To ensure quality care outcomes and improve the well-being of individual occupational therapy practitioners and the profession, it is essential that occupational therapy practitioners be provided with the education, training, resources, and strategies needed to address moral distress, foster moral resilience, and cultivate the skills necessary to cope with ethical tensions. In this column, we call the profession to action to address the phenomenon of moral distress as it relates to occupational therapy practitioner well-being. We also discuss resources and strategies for addressing ethical tensions and building moral resilience in occupational therapy practice.

Australian Health Professionals’ Attitudes toward Voluntary Assisted Dying: A Cross-Sectional Survey

Voluntary assisted dying (VAD) is when a terminally ill person with decision-making capacity consensually ends their life with assistance from an authorised professional. Many countries have legalised VAD, and health professionals’ roles within VAD frameworks are varied. Health professionals must be well informed of their legal obligations to ensure they practice within the legal boundaries, and those professionals with objections toward VAD should ensure that their eligible patients have equitable access. Given the current landscape of VAD, it is important to understand different health professionals’ attitudes toward VAD and what may underpin these attitudes. We explored (a) Australian health professionals’ attitudes toward VAD; (b) the psychological components that underpin those attitudes; (c) health professionals’ level of knowledge about VAD; (d) health professionals’ most common beliefs, emotions, and experiences related to VAD. A cross-sectional correlational survey design was used. A total of 182 Australian health professionals participated in the online survey based on a tripartite model of attitudes. We conducted a binomial logistic regression through a Generalised Linear Mixed Model and found polarised attitudes toward VAD between health professionals. Attitudes were accounted for by beliefs, emotions, education, and strength of religious beliefs. Knowledge of VAD was low, but not associated with overall attitude in our model. We highlight the importance of reflexive practice to help health professionals identify their values and feelings related to VAD, and to understand how these may affect their clinical practice. Low knowledge of VAD suggests that legislative and procedural training should be mandatory.

Les enjeux éthiques de l’enseignement en ergothérapie : des injustices au sein des départements universitaires

Si les enjeux éthiques de l’enseignement sont bien documentés dans les écrits, tel n’est pas le cas des enjeux éthiques que pose l’enseignement en ergothérapie. Aucune étude n’a été menée sur le sujet au Québec. Pour pallier cette lacune, une recherche a été réalisée. Cet article en présente les résultats. Puisque l’état des connaissances sur le sujet est limité, un devis qualitatif a été utilisé. Onze ergothérapeutes-enseignantes ont participé à un entretien individuel semi-dirigé pour discuter des enjeux éthiques que soulèvent leurs enseignements. Six unités de sens émergent des données : 1) l’équité entre les étudiants : un défi ; 2) la santé et le bien-être des étudiants et des enseignantes : un portrait troublant ; 3) des injustices au sein du corps enseignant : l’éléphant dans la pièce ; 4) l’identité professionnelle tiraillée par des conflits de rôles ; 5) la présence de conflits d’intérêts préoccupants et 6) l’équilibre occupationnel : un mythe plus qu’une réalité. Les résultats rejoignent en général ceux documentés dans les écrits. Cela dit, un élément peu documenté dans les écrits émerge, soit la présence d’une culture académique hiérarchisée où l’autorité épistémique est détenue par les professeurs-chercheurs au détriment des autres types d’enseignants et des milieux cliniques. Ainsi, bien que la profession ergothérapique valorise la justice occupationnelle, les départements universitaires sont dominés par une injustice épistémique qui, par ricochet, engendre une injustice occupationnelle, ce qui d’un point de vue ergothérapique est préoccupant. Aussi, le contexte universitaire est lié à une surcharge de travail peu propice à l’agir éthique et à la pratique réflexive.