Date Presented 03/28/20
Investigators compared moral reasoning between OT and physical therapy students and practitioners with the Defining Issues Test-2. Investigators found a significant difference in consolidated (set) versus transitional (forming) patterns of moral reasoning in practitioners versus students. The difference occurred between second-year students and practitioners, suggesting fieldwork experiences enhanced moral reasoning patterns. Implications include providing ethics education support during fieldwork experiences.
Primary Author and Speaker: Brenda Howard
Additional Authors and Speakers: Cheyenne Kern, Olivia Milliner, Lindsey Newhart, Sarah Burke
BACKGROUND: Moral distress has contributed to the unethical treatment of patients, high turnover rates, and overall increased costs of healthcare. Because the healthcare environment is fast-paced and ever changing, it is vital that academic programs prepare new professionals to handle complex ethical dilemmas. Research has compared moral reasoning of OT and PT students, OT and PT practitioners, and has explored practitioners’ experiences of moral distress. Kohlberg’s Theory of Moral Development has identified three levels of moral reasoning that distinguish how an individual resolves ethical dilemmas: Preconventional, conventional, and post-conventional. While preconventional reasoning focuses on self-interest, conventional reasoning focuses on avoiding deviation from societal norms. Postconventional reasoning focuses on universal moral principles such as justice, equality, and dignity. The development of moral reasoning in OT and PT students has been significantly under-researched.
PURPOSE: The purpose of this study was to analyze the differences in moral reasoning in OT and PT students between cohorts, and between students and OT and PT practitioners.
DESIGN AND METHOD: This was a cross-sectional study design utilizing a sample of convenience to recruit students from the University of Indianapolis OT and PT programs and licensed OT and PT practitioners. Participants completed the Defining Issues Test - 2 (DIT-2); after eliminating incomplete surveys, 154 surveys remained. Twenty-five first-year OT students, 10 first-year PT students, 32 second-year OT students, 24 second-year PT students, 46 occupational therapy practitioners, and 17 physical therapy practitioners participated in the study over a 4-week period.
RESULTS: Investigators answered the research purpose by comparing N2 scores (the DIT-2 measure of moral reasoning) using one-way ANOVA; results did not achieve significance (p=.850). A two-tailed t-test comparing means on N2 scores between all students and all practitioners was not significant (p=.968). When investigators grouped all first year students, all second year students, and all practitioners, results were not significant (p=.494 and p=.619, respectively). The DIT-2 “consolidation” and “transition” patterns of moral reasoning differentiate problem solving thought processes from a consistently synthesized and confident pattern of thinking (consolidated) to a varied or undecided pattern of thinking (transitional). A Pearson’s Chi-Square analysis comparing the Consolidation/Transition variable of all six groups did not reach significance (p= 0.064). However, a comparison of all students versus all practitioners for Consolidation/Transition was significant (p=.003). A significantly larger portion of OT and PT students (63.7%) were transitional in their approach to moral reasoning compared to all practitioners (39.7%), who demonstrated consolidated patterns of reasoning. A closer examination of all first year students, all second year students, and all practitioners indicated significant results (p=.013). A post hoc Bonferroni correction (p=.0167) indicated the significant difference was between second-year students and all practitioners (p=.007).
CONCLUSION: Literature indicated that ethics content within occupational therapy and physical therapy graduate programs may promote moral reasoning development. The current study suggested that increased clinical experiences throughout educational content provided students with real world opportunities necessary to move students from transitional thinking patterns to matured, consolidated thinking patterns. Implications include the need to support students in their moral reasoning development through continued ethics education during fieldwork experiences.
References
Evenson, M. E., Roberts, M., Kaldenberg, J., Barnes, M., & Ozelie, R. (2015). National survey of fieldwork educators: Implications for occupational therapy education. American Journal of Occupational Therapy,69, 6912350020p1-6912350020p5. doi:10.5014/ajot.2015.019265
Hudon, A., Laliberte, M., Hunt, M., Sonier, V., Williams-Jones, B., Mazer, B., . . . Ehrmann Feldman, D. (2013). What place for ethics? An overview of ethics teaching in occupational therapy and physiotherapy programs in Canada. Disability and Rehabilitation,36(9), 775-780. doi:10.3109/09638288.2013.813082
Koharchik, L., Vogelstein, E., Crider, M., Devido, J., & Evatt, M. (2017). Promoting nursing students’ ethical development in the clinical setting. American Journal of Nursing, 117(11), 57–60. https://doi.org/10.1097/01.NAJ.0000526750.07045.79
Penny, N. H., Bires, S. J., Bonn, E. A., Dockery, A. N., & Petit, N. L. (2016). Moral distress scale for occupational therapists: Part 1. Instrument development and content validity. The American Journal of Occupational Therapy, 70(4), 1-8.
