Date Presented 04/02/2022

Investigators examined encounters with ethical issues in the first 5 years of practice by surveying 125 OT practitioners. Most common ethical issues included productivity and billing, compromised care as a result of cost containment, and therapeutic relationship issues. Those in practice longer than 1 year or practicing in adult or older adult settings experienced a greater number of ethical issues. Future studies to explore interventions for moral distress and ethical issues are indicated.

Primary Author and Speaker: Brenda S. Howard

Additional Authors and Speakers: Michele Govern, Morgan Haney, Haylee Jeanne Noelle Ottinger, Alyssa Earls, Alex Retter, Travis Rippe

PURPOSE: To examine OTRs’ and COTAs’ encounters with ethical problem solving within their first five years of practice. Secondary purposes include exploring types of ethical problems OT practitioners encountered; exploring practitioners’ education in entry-level didactic education, fieldwork experiences, and post-graduate continuing education for navigating ethical problems; exploring OT practitioners’ understanding of and confidence with ethical problem solving; and comparing these factors between groups by setting, OT/OTA, and years in practice.

DESIGN AND METHOD: This was a quasi-experimental design with descriptive and comparative statistics. Investigators surveyed OTRs and COTAs who were NBCOT-certified within the past five years. The survey included questions regarding types of ethical problems encountered in practice, how often ethical problems were encountered, and type of education received regarding ethics. Survey data were analyzed through descriptive statistics, Cronbach’s Alpha, Mann-Whitney U-Test, independent samples median test, and Kruskal-Wallis. For comparative analysis, practitioners were grouped into Adult/Older Adult, Pediatrics, and Other settings; OT and OTA comparison; and region of the country.

RESULTS: 125 OTRs and COTAs participated. The most common ethical issues included productivity and billing; compromised care due to cost containment; compromised care due to socioeconomic status; and moral distress in therapeutic relationships. Between-groups analyses indicated that OT practitioners working in Adult and Older Adults Settings experienced significantly more ethical issues than practitioners in other settings regarding productivity, billing, and clinical decision making. COTAs experienced more ethical issues related to compromised care due to costs, and OTRs experienced more ethical issues with client becoming too attached. OT practitioners who have been in practice for more than one year reported experiencing significantly more ethical issues related to employer/employee and colleague relationships, including experiencing incompetent, unsafe, or unnecessary practice by a colleague. Most common types of ethics education reported were lectures, readings, ethical problem-solving guides, discussion, and case studies. Participants reported the most helpful types of ethics education included case studies, role playing, and interprofessional education experiences, which occurred less commonly. Informal discussions with colleagues on Level II Fieldwork experiences were also helpful. Most practitioners had not participated in post-academic ethics continuing education. The majority of participants feel confident in their ability to find resources and solve ethical problems.

CONCLUSION: This study met its purpose to examine ethical problems encountered in the first five years of OT practice; report types of ethical problems experienced; and look at preparedness for managing ethical problems. The literature reported qualitative data that correlated with the ethical problems reported in this survey. Implications included the need for a better understanding of which types of ethics education are most effective, and mentoring and ethics continuing education for new practitioners. The onset of COVID-19 just prior to opening the survey may have impacted results. Further research regarding interventions for moral distress and which types of ethics education best prepare practitioners to manage ethical issues is warranted.

IMPACT STATEMENT: By examining what types of ethical problems new practitioners encounter, and which types of ethics education they found most helpful, OT researchers and educators can investigate interventions to improve ethical problem solving and decrease moral distress in OT practice.


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