The experiences of new graduates learning to make intervention decisions in diverse paediatric workplace settings: A cross-case analysis
DOI:
https://doi.org/10.11157/fohpe.v24i1.636Keywords:
occupational therapy, graduate, decision-making, paediatric, context, cross-case analysisAbstract
Introduction: New graduates commonly experience challenges making client-related decisions. Current occupational therapy literature has predominantly focused on new graduates’ general experiences of commencing practice and experienced clinicians’ perceptions of clinical decision making. This study aimed to explore new graduate occupational therapists’ experiences of learning to make intervention decisions in paediatric practice.
Methods: A case study approach enabled exploration of the experiences and reflections of 18 new graduate and eight experienced occupational therapists working in three paediatric service delivery contexts—private practice, acute hospital and non-government settings. Data were collected using semi-structured interviews, observations, informal discussions, review of documents and reflective journal entries. Similarities and differences across the three cases were examined.
Results: Contextual influences, including time pressure, clinical risk and self-expectations, shaped new graduates’ experiences of learning to make intervention decisions. These influences impacted new graduates’ access to common support mechanisms, such as informal discussions with colleagues, formal workplace supervision and shared workplace resources, and prompted them to draw on supports and resources external to the workplace.
Conclusions: Understanding the contextual influences that shape new graduate allied health practitioners’ experiences of learning to make intervention decisions assists professional bodies, workplaces and universities to better target the training and support provided to new graduates to ensure that their intervention decisions promote positive client outcomes. Furthermore, the research findings can increase new graduates’ understanding of both workplace and external support mechanisms that assist clinical decision making and the possible impact of high self-expectations on their decision-making experiences.
References
Ajjawi, R., & Higgs, J. (2008). Learning to reason: A journey of professional socialisation. Advances in Health Sciences Education, 13(2), 133–150. https://doi.org/10.1007/s10459-006-9032-4
Australian Government. (2020a). 2019: Occupational therapists. https://hwd.health.gov.au/resources/publications/factsheet-alld-occupational-therapists-2019.pdf
Australian Government. (2020b). 2019: Physiotherapists. https://hwd.health.gov.au/resources/publications/factsheet-alld-physiotherapists-2019.pdf
Babic, A. (2016). Ethical dilemmas experienced by occupational therapists working in private practice [Unpublished master’s thesis]. The University of Sydney. https://ses.library.usyd.edu.au/handle/2123/14209
Britton, L., Rosenwax, L., & McNamara, B. (2016). Occupational therapy in Australian acute hospitals: A modified practice. Australian Occupational Therapy Journal, 63(4), 257–265. https://doi.org/10.1111/1440-1630.12298
Brown, J. S., Collins, A., & Duguid, P. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32–42. https://doi.org/10.3102/0013189X018001032
Copley, J., Nelson, A., Turpin, M., Underwood, K., & Flanigan, K. (2008). Factors influencing therapists' interventions for children with learning difficulties. Canadian Journal of Occupational Therapy, 75(2), 105–113. https://doi.org/10.1177/000841740807500206
Copley, J. A., Turpin, M. J., & King, T. L. (2010). Information used by an expert paediatric occupational therapist when making clinical decisions. Canadian Journal of Occupational Therapy, 77(4), 249–256. https://doi.org/10.2182/cjot.2010.77.4.7
Cusick, A., McIntosh, D., & Satiago, L. (2004). New graduate therapists in acute care hospitals: Priorities, problems and strategies for departmental action. Australian Occupational Therapy Journal, 51(4), 174–184. https://doi.org/10.1111/j.1440-1630.2004.00380.x
Dreyfus, H. L., & Dreyfus, S. E. (1986). Mind over machine. Basil Blackwell.
Fay, P., & Adamson, L. (2017). Is there an occupational therapy employment crisis within Australia? An investigation into two consecutive cohorts of occupational therapy graduates from a single Victorian university identifying trends in employment. Australian Occupational Therapy Journal, 64(6), 466–476. https://doi.org/10.1111/1440-1630.12432
Fitzsimmons, C. (2019, July 21). Why children are waiting up to a year for occupational therapy? The Sydney Morning Herald. https://www.smh.com.au/lifestyle/health-and-wellness/why-children-are-waiting-up-to-a-year-for-occupational-therapy-20190718-p528me.html
Gilbert Hunt, S. (2017). Partnership, inclusion and innovation in occupational therapy: Essential or optional ingredients to flourish in a changing environment? Australian Occupational Therapy Journal, 64(6), 477–485. https://doi.org/10.1111/1440-1630.12439
Hines, M., & Lincoln, M. (2016). Boosting the recruitment and retention of new graduate speech-language pathologists for the disability workforce. Journal of Clinical Practice in Speech-Language Pathology, 18(2), 50–54.
Hodgetts, S., Hollis, V., Triska, O., Dennis, S., Madill, H., & Taylor, E. (2007). Occupational therapy students' and graduates' satisfaction with professional education and preparedness for practice. Canadian Journal of Occupational Therapy, 74(3), 148–160. https://doi.org/10.1177/000841740707400303
Jeffery, H., Robertson, L., & Reay, K. L. (2021). Sources of evidence for professional decision-making in novice occupational therapy practitioners: Clinicians’ perspectives. British Journal of Occupational Therapy, 84(6), 346–354. https://doi.org/10.1177/0308022620941390
Kenny, B. J., Lincoln, M., Blyth, K., & Balandin, S. (2009). Ethical perspective on quality of care: The nature of ethical dilemmas identified by new graduate and experienced speech pathologists. International Journal of Language & Communication Disorders, 44(4), 421–439. https://doi.org/10.1080/13682820902928711
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge University Press. https://doi.org/10.1017/CBO9780511815355
Leonard, C., & Corr, S. (1998). Sources of stress and coping strategies in basic grade occupational therapists. British Journal of Occupational Therapy, 61(6), 257–262. https://doi.org/10.1177/030802269806100605
Mattingly, C. (1991). What is clinical reasoning? The American Journal of Occupational Therapy, 45(11), 979–986. https://doi.org/10.5014/ajot.45.11.979
Moats, G. (2006). Discharge decision‐making with older people: The influence of the institutional environment. Australian Occupational Therapy Journal, 53(2), 107–116. https://doi.org/10.1111/j.1440-1630.2006.00568.x
Moir, E. M. A., Turpin, M. J., & Copley, J. A. (2021). The clinical challenges experienced by new graduate occupational therapists: A matrix review. Canadian Journal of Occupational Therapy, 88(3), 200–213. https://doi.org/10.1177/00084174211022880
Morrison, T., & Robertson, L. (2011). The influences on new graduates’ ability to implement evidence-based practice: A review of the literature. New Zealand Journal of Occupational Therapy, 58(2), 37–40. https://go.gale.com/ps/i.do?id=GALE%7CA269531519&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=11710462&p=HRCA&sw=w&userGroupName=anon%7Ec140c05
Murray, C. M., Edwards, I., Jones, M., & Turpin, M. (2020). Learning thresholds for early career occupational therapists: A grounded theory of learning-to-practise. British Journal of Occupational Therapy, 83(7), 469–482. https://doi.org/10.1177/0308022619876842
Murray, C., Turpin, M., Edwards, I., & Jones, M. (2015). A qualitative meta-synthesis about challenges experienced in occupational therapy practice. British Journal of Occupational Therapy, 78(9), 534–546. https://doi.org/10.1177/0308022615586786
Occupational Therapy Australia. (2019). Professional supervision framework. https://otaus.com.au/publicassets/2e35a9f6-b890-e911-a2c3-9b7af2531dd2/ProfessionalSupervisionFramework2019.pdf
Occupational Therapy Australia. (2021). Membership. Retrieved January 24, 2021, from https://www.otaus.com.au/membership
Occupational Therapy Board of Australia (AHPRA). (2019). Occupational therapy regulation at work: Protecting the public in 2017/18. https://www.occupationaltherapyboard.gov.au/News/2019-02-14-profession-specific-report-published.aspx
Occupational Therapy Board of New Zealand. (2020). Guidelines: Recertification programme. https://otbnz.in1touch.org/document/5678/Recertification%20programme%20inducation%20and%20orientation.pdf
Patton, M. Q. (2015). Qualitative research & evaluation methods (4th ed.). SAGE Publications.
Psychology Board of Australia. (2022). General registration. Retrieved August 28, 2022, from https://www.psychologyboard.gov.au/Registration/General.aspx
Robertson, L. (2012). The novice therapist. In L. Robertson (Ed.), Clinical reasoning in occupational therapy: Controversies in practice (pp. 77–92). Wiley-Blackwell.
Robertson, L. J., & Griffiths, S. (2009). Graduates’ reflections on their preparation for practice. British Journal of Occupational Therapy, 72(3), 125–132. https://doi.org/10.1177/030802260907200307
Sellar, B., Murray, C. M., Stanley, M., Stewart, H., Hipp, H., & Gilbert‐Hunt, S. (2018). Mapping an Australian occupational therapy curriculum: Linking intended learning outcomes with entry‐level competency standards. Australian Occupational Therapy Journal, 65(1), 35–44. https://doi.org/10.1111/1440-1630.12430
Speech Pathology Australia. (2022). Professional support, supervision and mentoring. https://www.speechpathologyaustralia.org.au/SPAweb/Members/Position_Statements/SPAweb/Members/Position_Statements/Position_Statements.aspx?hkey=b1a46941-246c-4609-bacc-1c1b5c52d19d#super
Toal-Sullivan, D. (2006). New graduates’ experiences of learning to practise occupational therapy. British Journal of Occupational Therapy, 69(11), 513–524. https://doi.org/10.1177/030802260606901105
Turpin, M. J., & Hanson, D. J. (2018). Learning professional reasoning in practice through fieldwork. In B. A. B. Schell & J. W. Schell (Eds.), Clinical and professional reasoning in occupational therapy (2nd ed., pp. 439–460). Wolters Kluwer.
Wells, C., Olson, R., Bialocerkowski, A., Carroll, S., Chipchase, L., Reubenson, A., Scarvell, J. M., & Kent, F. (2021). Work readiness of new graduate physical therapists for private practice in Australia: Academic faculty, employer, and graduate perspectives. Physical Therapy, 101(6), 1–12. https://doi.org/10.1093/ptj/pzab078
Yin, R. K. (2018). Case study research and applications: Design and methods (6th ed.). SAGE Publications.
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