Background.Many researchers have expressed concerns about ethical tensions in occupational therapy practice; yet little research has considered this topic from the perspective of students. Purpose.The purpose of this study was to examine the nature of ethical tensions witnessed or experienced by occupational therapy students during practice education. Method.A phenomenological approach was used, and in-depth interviews were conducted at a Canadian university with 25 occupational therapy students. Findings.Four major themes emerged from analysis of the data. These include systemic constraints, conflicting values, witnessing questionable behaviour, and failure to speak up. Implications.The findings of this study raise awareness about ethical tensions in occupational therapy practice witnessed or experienced by students. Critical reflection on the findings highlights implications for professional practice and education and points to the need for further research, particularly in the area of policy and practice.
AtwalA., & CaldwellK. (2003). Ethics, occupational therapy and discharge planning: Four broken principles. Australian Occupational Therapy Journal, 50, 244–251.
2.
AveyardH., EdwardsS., & WestS. (2005). Core topics of health care ethics. The identification of core topics for interprofessional education. Journal of Interprofessional Care, 19, 63–69.
3.
BarnittR. (1998). Ethical dilemmas in occupational therapy and physical therapy: A survey of practitioners in the United Kingdom National Health Service. Journal of Medical Ethics, 24, 193–199.
4.
BarnittR., WarbeyJ., & RawlinsS. (1998). Two case discussions of ethics: Editing the truth and the right to resources. The British Journal of Occupational Therapy, 62, 52–56.
5.
BennerP. (1994). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: Sage.
6.
BrockettM., & DickR. (2006). The Canadian Framework for Ethical Occupational Therapy Practice. Ottawa, ON: CAOT Publications.
7.
BrookfieldS. (2000). The concept of critically reflective practice. In WilsonA. & HayesE. (Eds.), Handbook of adult and continuing education (pp. 33–49). San Francisco: Jossey-Bass.
8.
CaldicottC. V., & Faber-LangendoenK. (2005). Deception, discrimination, and fear of reprisal: Lessons in ethics from third-year medical students. Academic Medicine, 80, 866–873.
9.
CleverS. L., EdwardsK. A., FeudtnerC. & BraddockC. H.III. (2001). Ethics and communication: Does students' comfort addressing ethical issues vary by specialty team?Journal of General Internal Medicine, 16, 559–563
10.
DePoyE., & GitlinL. (2005). Introduction to research: Understanding and applying multiple strategies. St. Louis, MO: Elsevier Mosby.
11.
DierufK. (2003). Ethical decision-making by students in physical and occupational therapy. Journal of Allied Health, 33, 24–30.
12.
DwyerJ. (1994). Primum non tacere: An ethics of speaking up. Hastings Center Report, 24 (1), 13–18.
13.
FeudtnerC., & ChristakisD. A. (1994). Making the rounds: The ethical development of medical students in the context of clinical rotations. Hastings Center Report, 24 (1), 6–12.
14.
FinlayL. (1998) Reflexivity: An essential component for all research?British Journal of Occupational Therapy, 61, 453–456.
15.
FinlayL. (1999). Applying phenomenology in research: Problems, principles and practice. British Journal of Occupational Therapy, 62, 299–306.
16.
FlemingM. H., & MattinglyC. (1994). The underground practice. In MattinglyC. & FlemingM. H. (Eds.), Clinical reasoning: Forms of inquiry in a therapeutic practice (pp. 295–315). Philadelphia: F. A. Davis.
17.
FoyeS. J., KirschnerK. L., WagnerL. C. Brady, StockingC., & SieglerM. (2002). Ethical issues in rehabilitation: A qualitative analysis of dilemmas identified by occupational therapists. Topics in Stroke Rehabilitation, 9 (3), 89–101.
18.
GadamerH. G. (1996). Truth and method (2nd. ed.). (WeinsheimerJ. & MarshallD., Trans.). New York: Continuum.
19.
GiorgiA. P., & GiorgiB. M. (2003). The descriptive phenomenological psychological method. In RhodesP. & YardleyL. (Eds.), Qualitative research in psychology (pp. 243–259). Washington, DC: American Psychological Association.
20.
HaffertyF. W., & FranksR. (1994). The hidden curriculum, ethical teaching, and the structure of medical education. Academic Medicine, 69, 861–871.
21.
HusserlE. (1970). The idea of phenomenology. The Hague, Netherlands: Martinus Nijhoff.
KemmisS. (2005). Knowing practice: Searching for saliences. Pedagogy, culture and society, 13, 391–426.
24.
Kumas-TanZ., & BeaganB. (2003). Ethical tensions in the caring professions: A summary report of interviews with occupational therapists in Nova Scotia. Unpublished manuscript, Dalhousie University at Halifax, Nova Scotia.
25.
KylerP. (1998). Putting everyday ethics into action. OT Practice, 3 (5), 36–40.
26.
LohmanH., GabrielL., & FurlongB. (2004). The bridge from ethics to public policy: Implications for occupational therapy practitioners. The American Journal of Occupational Therapy, 58, 109–112.
27.
Merleau-PontyM. (1962). Phenomenology of perception. (SmithC., Trans.). New York: Routledge & Kegan Paul.
28.
OpacichK. J. (1996). Ethical dimensions in occupational therapy. In McCormackG.L., JaffeE.G., & Goodman-LaveyM. (Eds.), The occupational therapy manager (pp. 627–649). Bethesda, MD: AOTA.
29.
PattonM.Q. (2002). Qualitative research and evaluation methods (3rd Ed.). Newbury Park, CA: Sage.
30.
PurtiloR. B. (2000). Moral courage in times of change. Visions for the future. Journal of Physical Therapy Education, 14 (3), 4–6.
31.
RitchieJ., LewisJ., & ElamG. (2003). Designing and selecting samples. In RitchieJ. & LewisJ. (Eds.), Qualitative research practice: A guide for social science students and researchers (pp. 77–108). Thousand Oaks, CA: Sage.
32.
SachsD., & LinnR. (1997). Client advocacy in action: Professional and environmental factors affecting Israeli occupational therapists behaviour. Canadian Journal of Occupational Therapy, 64, 207–215.
33.
SatterwhiteR. C., SatterwhiteW. M., & EnarsonC. (2000). An ethical paradox: The effect of unethical conduct on medical students' values. Journal of Medical Ethics, 26, 462–465.
34.
SeedhouseD. (1998). Ethics: The heart of health care. Chichester, United Kingdom: Wiley & Sons.
35.
SlaterD. Y. (2006). The ethics of productivity. OT Practice, 11 (19), 17–20.
36.
StrongS., BaptisteS., & SalvatoriP. (2003). Learning from today's clinician's in vocational practice to educate tomorrow's therapists. Canadian Journal of Occupational Therapy, 70, 11–20.
37.
TaylorC. (2006). Practising reflexivity: Narrative, reflection and the moral order. In WhiteS., FookJ., & GardnerF. (Eds.), Critical reflection in health and social care (pp. 73–88). Berkshire, United Kingdom: Open University Press.
38.
ThomasS., & PollioH. (2002). Listening to patients: A phenomenological approach to nursing research and practice. New York: Springer.
39.
TownsendE., & WilcockA. (2004). Occupational justice and client-centred practice: A dialogue. Canadian Journal of Occupational Therapy, 71, 75–87.
40.
van ManenM. (2001). Professional practice and ‘doing phenomenology’. In ToombsS. Kay (Ed.) Handbook of phenomenology and medicine (pp. 457–474). Dordrecht, South Holland: Kluwer Press.
41.
van ManenM. (1997). From meaning to method. Qualitative Health Research, 7, 345–369.
42.
van ManenM. (1990). Researching lived experience: Human science for an action sensitive pedagogy. London, ON: The Althouse Press.
43.
WildingC., & WhitefordG. (2005). Theoretical and philosophical underpinnings of phenomenological research. Occupational Therapy Journal of Research, 25 (3), 98–104.
44.
St. ClairV. Wright, & SeedhouseD. (2005). The moral context of practice and professional relationships. In WhitefordG. & Wright-St. ClairV. (Eds.), Occupation and practice in context (pp. 16–33). Sydney, Australia: Elsevier.
