ETHICAL DECISION-MAKING IN OCCUPATIONAL THERAPY PRACTICE IN CANADA

Abstract

Introduction: Ethical decision-making is an important component of occupational therapy practice in Canada. Research is needed to understand ethical decision-making and how to build occupational therapists’ competency to make ethical decisions. Purpose: The aim of this thesis was to study ethical decision-making in occupational therapy practice in order to contribute to epistemological development regarding ethics in occupational therapy and to support continuing competency in ethical decision-making. Method: Three studies comprise this thesis. A constructivist grounded theory study was conducted involving in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings to explore the process of ethical decision-making. An interpretive description study using secondary analysis of grounded theory data was conducted to explore gaps related to continuing competency in ethical decision-making from the participants’ perspective and to generate recommendations for future directions to support continuing competency. Finally, a non-randomized, single-group, pre- and post-test study (n=33) was conducted to evaluate an on-line education module developed to support competency for clinician-educators. Findings: The grounded theory study led to development of an ethical decision-making prism capturing three processes: Considering the Fundamental Checklist, Consulting Others, and Doing What’s Right. The interpretive description study highlighted two gaps related to continuing competency in ethical decision-making: lack of knowledge and lack of supports. Education, tool development, and ethics mentorship were identified directions for development. The third evaluation study found that an on-line education module led to improvements in ethics knowledge and intent to change practice but not to actual practice change. Implications: This thesis advances a theoretical understanding of ethical decision-making in occupational therapy practice and an applied understanding of occupational therapists’ needs related to competent ethical decision-making. Findings also provide preliminary data regarding on-line ethics education to advance knowledge and skills of clinician-educators who are involved in cultivating ethical decision-making among student occupational therapists.