Running head: QUALITATIVE STUDY

Qualitative Study: Evidence Based Paper Chrys Quiroz Touro University Nevada

QUALITATIVE STUDY Introduction Research Question Would clients benefit more from occupational therapy if new therapists were provided a mentor after passing the NBCOT? Methodology APA Reference

Toal-Sullivan, D. (2006). New graduates experiences of learning to practise occupational therapy. British Journal of Occupational Therapy, 69(11), 513-524. Relation to Research Question The chosen article relates to my research question because it explores the experiences that new graduates had once they entered into the clinical work force. My research question involves the utilization of mentors for new graduates. This factor and its effectiveness were discussed in the study. In addition, the study relies solely on occupational therapists rather than taking into account other disciplines, such as physical therapy. Purpose of the Study The purpose of this study was to explore the transition of an occupational therapy student to a practicing occupational therapist. This study occurred within the participants first year of being a working professional. The study also sought to understand how therapists were able to bridge the gap between theory and skill once they entered into a clinical setting. Lastly, the study intends to discover strategies that would support new occupational therapists to be able to transition easily and efficiently into the work force.

QUALITATIVE STUDY Research Questions There were multiple research questions that this study explored. First, what is the experience of transition from student to practicing occupational therapist? Second, what are the challenges faced by occupational therapists in their entry to practice? Third, How do beginning occupational therapists learn in a practice context? Lastly, what is the role of mentoring in supporting beginning occupational therapists learning? (Toal-Sullivan, 2006). Study Design and Type of Qualitative Research The data was acquired through one hour, semi-structured interviews and journal entries. The participants were interviewed twice. Four of the participants were interviewed face to face and two were interviewed on the phone because of distance. This study used a phenomenological approach of qualitative research in order to understand the unique experiences of the participants. Phenomenology is focused on understanding a phenomenons essence relayed from the perspective of the individual who

experienced the phenomenon. The researcher must undergo a process of interpreting the data that is collected in order to understand the respective individual, population, or culture. For this study, it was essential for the researcher to gain insight from the participants regarding their transition into entry-level occupational therapists from a student role. The participants were able to relay, at their discretion, the personal experiences that they had so that the researcher could extrapolate themes and reduce any preconceptions or bias that may have been present involving the phenomenon.

QUALITATIVE STUDY Participants Participants Recruitment and Selection

The participants were recruited through a purposive sample and random selection. Of the 28 new occupational therapists that graduated from the respective undergraduate program, 18 invitations were sent via e-mail to the individuals. Six agreed to participate in the study. Number of Participants As stated above, six new occupational therapists agreed to participate in the study. They all signed a consent form regarding the study objectives and methodology. The researcher also ensured that what the participants shared would be confidential and that they would remain anonymous through pseudonyms. Participant Description All of the participants were female and ranged from 22 to 28 years old. The requirements of the Canadian university that the participants graduated from were general education classes, program specific classes, and a minimum of 1000 hours of fieldwork experience. In addition, they all were working full-time as occupational therapists while the study was being conducted. Relationship of Researcher to Participants The relationship of the researcher to the participants was not stated in the study. Data Collection and Findings Sources for Data As stated above, there were two interviews for each participant. The initial interview occurred between the third to fifth months of data collection. The interview consisted of questions revolving around the participants needs as an occupational therapist, their perceptions of disconnect between the theories they learned and their ability to apply it in practice, and their

QUALITATIVE STUDY thoughts on collaborative roles to assist in learning. Once the initial interview was complete, the participant would record their experiences in a journal for a month. The final interview occurred

between the eighth to tenth months of data collection. The interview questions were based on the initial interview and their journal entries. In addition, questions involved their increase of knowledge in practice, the challenges and rewards of the profession, and suggestions for new practitioners in securing a smooth transition from student to occupational therapist. During the interview, the researcher wrote self-reflections regarding his impressions about the interview. The interviews obtained were tape recorded. The interviews and journal entries were transcribed verbatim by the researcher. After listening to the interviews multiple times and re-reading the transcriptions, the researcher was able to highlight important statements made and developed themes and subthemes. The researcher decided to utilize separate files of the statements for each participant so that comparisons could be made, if necessary. From these statements, codes were made. Finally, the researcher was able to develop four categories from the data gathered. How Findings are Reported The researcher provided the findings through the four categories that were created based on the data collected. Under each of the categories, the researcher expands on the finding that is applicable to the respective category. There is also a table that is provided which summarizes the findings of the study. It is categorized into four main categories, the themes identified, the emergent themes, and the subthemes. Findings There were four categories developed by the researcher: occupational therapy knowledge and skills, professional identity, expectations of practice, and learning in clinical practice.

QUALITATIVE STUDY Occupational therapy knowledge and skills discussed how participants felt like they had difficulty connecting theories learned in their coursework and applying it in a clinical setting. They often struggled with treatment priorities and therapeutic activities for their clients. In addition, the participants felt that they had a lack of knowledge in treatments that involved more specialized training such as hand therapy and splinting. The participants stated having to adjust to their work settings expectations. For example, coursework taught a client-centered approach. However, when they were to actually implement treatment, their work setting limited their

abilities to provide client-centeredness, due to reasons such as high caseloads or limited funding. Lastly, the participants stated that clinical reasoning was challenging. Still, if they managed to find support from proficient practitioners, they began improving with their clinical reasoning skills. Professional identity involved the participants perceived role within their work setting. Understanding how to collaborate with various disciplines was a difficulty. In addition, role expectations were not as clear-cut unless they were in a setting such as a hospital where departments and protocols are outlined. In regards to the transitional experience, the participants stated that a happy client is often their reward for service. They recalled memorable and positive interactions with their clients. The participants also noted that the transition from student to practitioner was more comfortable due to their fieldwork experiences. They were able to acclimate themselves to the work environment and were able to witness their classroom knowledge in the context of a clinical setting. Expectations of practice discussed how the participants felt like they were not equipped to manage the increased load of responsibilities, once they became a practitioner. They often had to make heavy decisions such as their clients readiness for discharge, as well as multitasking

QUALITATIVE STUDY

additional demands expected of them. Participants noted that they were often overwhelmed with their schedules and tackling other duties. Learning in clinical practice noted how new occupational therapists developed the strategy of utilizing mentors as a form of guidance, support, and supervision. The mentor relationship was informal and consisted of casual conversations in everyday practice. Participants stated that interacting with experienced health professionals allowed them to develop their work-related vocabulary and skills. In addition, specifically having an occupational therapist mentor allowed new practitioners to understand the culture of occupational therapy and were provided an avenue to link theory with practice. Lastly, it was mentioned how new occupational therapists working in hospitals had a mentor, whereas those working in a private practice were often on their own. The new practitioners who were employed in a private practice admitted to being more stressed and frustrated because they did not have a veteran therapist validating their practice decisions. Findings Relation to Previous Research Some findings were congruent with previous research. For example, previous research stated that the expectations of the new occupational therapist did not correlate with their actual experience in the clinical work force. In addition, regarding professional identity, past research and the current study found that elements that influenced a new practitioners identity were confidence in tying together theory and treatment, as well as recognition from the professionals and clients they interacted with.

QUALITATIVE STUDY Conclusions Implications The author does not state clinical implications involving the work force but they do state educational implications. These implications may indirectly influence occupational therapy practice in the clinical setting. It is noted that strategies that include proper transitioning from student to therapist and methods of support for new practitioners are needed. In addition, building relationships with varying perspectives, coming from occupational therapy educators, practitioners, and clients, can help the student bridge together and apply the classroom knowledge. Limitations Limitations identified were that the study consisted of only females from the same occupational therapy program in Canada. Due to this limitation, this study is not representative of males, various occupational therapy programs, and is not reflective of other regions. In

addition, the degree requirement was a Bachelors whereas in other areas of the world, a Masters is required for practice. This may influence the knowledge, experience, and professionalism of the participants of the study. For these reasons, the study may not be transferable to other populations. Also, the sample size was only six individuals. Though this may be small, it is typical because phenomenological qualitative studies often utilize between 5-10 participants. Lastly, the limited and regulated time frame for the data collection may not truly illustrate the experiences of the beginning therapists. Implications for Future Research Most of the suggestions and recommendations made by the authors of this study involve educational strategies. It is mentioned that future studies can explore various approaches,

QUALITATIVE STUDY functions, and school-community partnerships as opportunities for new therapists to learn in a clinical context. This would be beneficial to future occupational therapists because the study

proposes that the current trend is autonomous practice. Therefore, strategies that are found would be of great value to beginning therapists. Study Analysis Sources of Bias and Methods for Avoiding Bias Due to the fact that the relationship of the researcher to the participants was not stated, it is difficult to determine if there were potential sources of bias on behalf of the researcher. It can be assumed that the researcher may have previous difficult experiences entering the occupational therapy workforce. Also, one may assume that the researcher is an advocate for education or a faculty member of a school attempting to revise program curriculum and standards. If these descriptions were true, the researcher may pose bias to the study. The researcher did not mention that he sent his data and findings to colleagues experienced with the process of phenomenology and qualitative research. Therefore, he did not take precautionary measures to ensure that the findings were reflective of the stated experiences. Also, there was only one researcher which would decrease the likelihood that the findings were checked for validity by knowledgeable professionals. In addition, it may have been helpful to show educated colleagues with various backgrounds to ensure validity, since they would not have emotional ties to the study, unlike the participants. Lastly, the researcher did not state that he recorded self-reflections before the start of the study. This would have assisted in the data analysis portion because the researcher would be cognizant of any biases he may have which may affect how he reads and interprets the data.

QUALITATIVE STUDY Rationale for Participant Selection and Credibility

10

The only rationale for the participant selection was the educational and field requirements stated above. However, the researcher did not discuss his rationale for choosing the respective university. As a result, the participants credibility is concerning because the reader would not be able to understand the expectations of the university, in regards to grades and extracurricular activities that the then-students were engaged in. It would be helpful to see if the occupational therapy students were well-rounded and how successful they were in their coursework because this may influence their clinical performance and essentially, the outcome of the study. Trustworthiness The researcher did address his attempt to attain trustworthiness in the study. It was stated that a summary of the first interview and the journal entries were provided to the participants. They were encouraged to review and ensure that it was an accurate depiction of their interview. The participants also filled out a form of verification as a means to strengthen the trustworthiness of the study. However, it was not mentioned that the third interview was provided or if the researcher would exclude information that the participants requested. Therefore, the trustworthiness of this study can be doubted. Themes A copy of the entire verbatim transcriptions from the interviews and the journal entries were not provided in the study. Because of this, it is difficult to state whether the themes presented were consistent with the data presented. There were little excerpts that were included in the findings for each of the categories. These quotes were congruent with the respective category. Table 3 was an effective means in presenting the themes and categories for the study. The conclusions made sense because they addressed the initial research questions and the

QUALITATIVE STUDY

11

categories that were developed appeared to be extrapolated from the data and not stretched from reality. In addition, it did not appear that the author had a motive for reading into the findings, though this cannot be confirmed since the study did not state the authors relationship to the participants. Flexibility The researcher was flexible in the data collection process. As stated above, the second interview was guided from the first interview, as well as the journal entries that were submitted by the participants. In addition, the months that the participants were interviewed varied and if they were not able to meet face to face, the researcher allowed telephone interviews. This shows that the researcher took the participants convenience into consideration. Therefore, the researcher did not follow a strict protocol to gather the data and allowed the data to guide the process. Application I would be able to use this article as a seasoned therapist because it would make me more sensitive to new occupational therapists entering the field. This study would make me more proactive in attempting to mentor a new therapist and would remind me of the difficulties that are often faced as a beginning therapist. In addition, I could navigate through this article and find specific areas that most beginning therapists struggle with and support them through their experiences. Support This article supports the field of occupational therapy because it brings awareness to the struggles that new therapists face. It also advocates for additional educational strategies that would efficiently transition students to become competent therapists in the work force. During my Level 1 Fieldwork, I often challenged myself to come up with activities and interventions for

QUALITATIVE STUDY

12

the specific client I would observe. Because it is only second semester, I understand that I have so much more to learn but I feel like it would be beneficial to have more practice in applying the theories to hypothetical clinical case studies, such as the current 520 case study. Lastly, this article did not support participation in occupation because it mostly dealt with students who transitioned into new occupational therapists, rather than clients being seen for occupational therapy.