A Comparison of the Moral Distress Experienced by OTAs and OTs Working in Geriatrics Settings

Moral distress is defined as “the painful feelings and psychological disequilibrium that result from a moral conflict in which one knows the correct action to take, but constraints prevent implementation of the action” (Slater, 2016, p. 117). Nursing research suggests that moral distress impacts the personal and professional lives of practitioners leading to feelings of powerlessness, emotional exhaustion, thoughts of quitting jobs and even of leaving the profession (Oh & Gastmans, 2015). Slater & Brandt (2009) were the first to raise awareness of moral distress in occupational therapy. Penny, Ewing, Hamid, Shutt, and Walter (2014) found moderate levels of moral distress among occupational therapists working in geriatric and physical disability settings. However, there is a lack of research concerning the experience of moral distress of occupational therapy assistants (OTAs) compared to that of occupational therapists (OTs).

DESIGN: Quantitative mail survey.

PARTICIPANTS: The participants for this study were randomly selected to represent 20 percent of AOTA members working in geriatric settings. Survey packets were mailed to 334 OTAs and 1188 OTs. There were a total of 385 participants in this study (response rate = 25.3%); 66 OTAs and 319 OTs. The majority of the participants were female (93.8%), non-Hispanic (96.9%), and white (90.1%). The average age was 44.55, they had been working an average of 15.14 years and had held their current position an average of 5.90 years.

INSTRUMENTS: The Moral Distress Scale-Revised-Occupational Therapy (MDS-R-OT) was used to measure moral distress. Possible scores range from 0 to 368 (higher scores indicate more moral distress). An overall Cronbach’s alpha of .91 was obtained (OTAs α = .93 and OTs α = .91).

RESULTS: The mean score for all participants was 85.03 with a standard deviation of 57.00. Scores ranged from a low of 0 to a high of 292. The mean score for OTAs M = 94.92 was greater than for OTs M = 82.98; however, the difference was not statistically significant t = 1.38, p = .172. For those working in nursing homes the mean scores were almost identical; OTAs M = 101.27, OTs M = 99.41, t = 0.19, p = .846. A Spearman rank-order correlation (two-tailed) found a statistically significant correlation between the scoring of items by OTAs and OTs, r _s = .92, p = < .001. Finally, 195 of the 385 participants (50.6%) reported, that in the past, they had left a position where they had experienced high moral distress (35 OTAs, 53.0% and 160 OTs, 50.1%).

DISCUSSION: This study was distinctive in that it compared the experience of OTAs and OTs. The main finding was the similarity of the experience of moral distress. The situations ranked highest by participants in this study were consistent with those identified by Slater (2016) and related to constraints imposed by reimbursement, quality of care, productivity expectations, and directives from administration. Since the OTA works under the supervision of the OT, the findings suggest that the relationship between OTAs and OTs was not source or a contributor to moral distress. Rather that OTAs and OTs share a similar set of professional values that that can lead them to experience moral distress.

IMPACT AND IMPLICATIONS FOR PRACTICE: The experience of moral distress reported by OTAs and OTs was similar.

New OTAs and OTs need to be aware that they are likely to experience moral distress.

Educators need to prepare students for conflict in the workplace, including strategies to effectively address situations that are associated with moral distress.

Managers need to be aware that high levels of moral distress are associated with thoughts of leaving a position and should actively engage in strategies to reduce the experience of moral distress in their workforce.

References

Oh, Y., & Gastmans, C. (2015). Moral distress experienced by nurses: A quantitiatve literature review, Nursing Ethics, 22(1), 15-31. doi:10.1177/0969733013502803

Penny, N., Ewing, T., Hamid, R., Shutt, K., & Walter, A. (2014). An investigation of moral distress experienced by occupational therapists. Occupational Therapy in Health Care, 28(4), 382-393. doi: 10.3109/07380577.2014.933380

Slater, D. Y. (2016). Combating moral distress. In D.Y. Slater (Ed.). Reference guide to the occupational therapy code of ethics: 2015 edition (pp.117-123). Bethesda, MD: AOTA Press.

Slater, D., & Brandt, L. (2009, February). Combating moral distress. OT Practice, 14(2), 13-18.