Analysis of Preferences and Struggles of Occupational Therapy 

Occupational therapy is known for being a low-stress job and for having high job satisfaction rankings. In fact, according to U.S. News, occupational therapy is ranked #17 in Best Healthcare Jobs and #28 in 100 Best Jobs. Of course there are benefits of occupational therapy, but in this essay we will mention not only them. Here we will understand how therapists help people restore their ability to execute everyday tasks and what struggles can be in occupational therapy. Depending on the patient’s needs, therapy can be mental, physical, emotional, or developmental. They treat people with pain, injury, illness, or a disability that makes it hard for them to do everyday tasks. After talking to a patient, the occupational therapist will articulate a complete plan that works toward helping the patient meet certain goals. Occupational therapists work with people of all ages, from infants to teenagers, adults, and seniors.

Although occupational therapy has amazing satisfactory ratings, workers in this field face a daily challenge of having bad news conversations with their patients. ‘Bad news conversations’ in healthcare are perceived as crucial clinical tasks, and one of the most difficult tasks that any type of healthcare worker may have to partake in. In 1847, the American Medical Association's first code of medical ethics stated, “The life of a sick person can be shortened not only by the acts but also by the words or the manner of a physician. It is, therefore, a sacred duty to guard himself carefully in this respect and to avoid all things which have a tendency to discourage the patient and to depress his spirits”. When a therapist is pushed to have so many of these ‘bad news conversations’, it can lead to burnout. The stress that these tough discussions cause can push a therapist to their breaking point. Although having these ‘bad news conversations’ is such a difficult task, there is very little concrete instruction on how clinicians should go about having these discussions with their patients.

Furthermore, many occupational therapists agree that they have very meager training in having ‘bad news conversations’. Many of them do not agree on how to address, however, when they are asked about how to address training and support needs. There was a general understanding that confidence in their ability to have these conversations comes with experience. Many believe that training would help but experience is the best way to learn how to manage these conversations. Four distinct training mechanisms that therapists find useful to help them when having ‘bad news conversations’ are role-play, supervision, and reflective practice and use of a staff support group.

There is no single definition for a ‘bad news conversation’. Although, it can be described as an interaction between an occupational therapist and a person with a disability where the discussion centers on expected limitations in function. In many instances, patients with physical or mental impairment ask direct questions about the probable long-term levels of disability and associated limitations in body function. For example, a stroke survivor, whom occupational therapists decided would be a lifelong wheelchair user may ask, “Why don’t you give me a time frame for when I should be able to walk again as you did for the patient in the bed next to me?” Another example: when an 18-year-old stroke survivor with a no longer functioning arm is asked about his current goals, he replies, “I just want to work on getting my arm functioning again”. After having these conversations with their patients, occupational therapists find it difficult to decide how they should further the discussion about their patient’s recovery.

The British Journal of Occupational Therapy conducted a study by interviewing occupational therapists to collect data about ‘bad news conversations’. Throughout the interviews, the researcher noticed that common themes and sub-themes arose. For example, under the theme ‘bad news conversations’, sub-themes such as ‘integral part of the work’, ‘functional focus’, and ‘discharge planning’ were determined. Every participant confirmed that ‘bad news conversations’ were essential to their field of work. They also stated that they were consistently having this type of conversation with their patients. According to the study, patient 003 stated, “ I think it is the nature of what we are doing here, you can not work with this client group without addressing some of these issues, you can not fob people off; it will not work”. Another strong reason for having these difficult conversations is when the patient is being discharged. Frequently, a person with a disability does not want to go home until they are back to being fully functioning again. Participant 007 described how some therapists think it is dreadful when they have to talk about discharge because if the patient is not back to normal, they often ask “how can you possibly send me home the way I am?”

There are many types of ‘bad news conversations’, such as one where treatment is complete but recovery is limited. Sometimes discharging the patient back to their home is not safe, therefore the patient and the therapist must have a conversation about another alternative. Many patients do not even want to think about going to a nursing residential home. Sometimes these difficult conversations can actually help a patient realize the reality of their situation. Participant 004 stated, “I have actually had good, positive experiences of breaking bad news as well. I have had people who did not actually realize their true situation and they were glad now that they understood the picture so that they could plan more about what they were going to do”.

The participants of the study commonly used five strategies to help them when having ‘bad news conversations’. The first common strategy is pre-discharge home visits. When the patients return home, they realize they will not be able to manage everyday tasks, making them aware that they need more therapy. Another strategy is goal setting. Setting goals with a short time frame, such as 2 to 4 weeks, keeps the patient on track and motivated. Using others is an effective strategy as well because therapists valued being able to lean on their co-workers for advice and opinions when configuring a plan for their patients. Maintaining an optimistic attitude while not giving the patient false hope is another very effective strategy when having ‘bad news conversations’. Communication is also an important aspect of these conversations. The therapist must select a communication style that corresponds to the patient. Active listening, taking the emotions of the patient into account, and using proper non-verbal cues are all proved to be effective communication skills.

I interviewed an occupational therapist named Kristie Liter on the stress level of her job. When asked, “What’s a problem you face every day at work?”, she responded, “Having to always be concerned with productivity. Sometimes patients are not ready to work or are involved in other activities. If they are not available, then you have downtime not billable”. I also asked her what she thought was the most difficult thing about her job. She answered, “Seeing someone who has the potential to overcome their deficits but not having the motivation and being okay with someone else caring for them. On the other hand, someone may have the drive to be independent, but due to safety reasons or the extent of their deficits will never be independent again”. I also asked her about her experiences with ‘bad news conversations’ and whether she was familiar with them. She stated, “Yes. During these types of conversations patients, family, and other team members are included in a case conference meeting to discuss realistic expectations for progress and family needs for the patient to return home”. This interview was beneficial because it further proved my research on the problems that occupational therapists face today.

Burnout and job satisfaction in occupational therapy have been studied internationally for the past 30 years. Burnout is defined as “A state of chronic stress that leads to physical and emotional exhaustion, cynicism and detachment, and feelings of ineffectiveness and lack of accomplishment” (Lyon). I have had a personal experience with a burnout in the athletic world. I played volleyball for about 11 years of my life. I have a passion for the game, but I played the sport for so long that I got burnt out, which is why I decided not to play in college. ‘Bad news conversations’ causes high-stress levels among healthcare professionals, which leads to job dissatisfaction. Burnout among occupational therapists is a very convoluted issue, but a common cause of it is proven to be ‘bad news conversations’. Occupational therapists are more susceptible to burnout because they often have a feeling of personal failure. Many of these clinicians feel a loss of meaning and purpose in their work. A lack of dramatic improvement in their patient’s recovery can make a therapist question their own ability and expertise in their field.

The physical and emotional demands of rehab are physically exhausting. Not only occupational therapists, but many healthcare workers put their all into their work. Workers in this field laugh with their patients, as well as cry with them. This type of work takes a toll on their bodies and minds. Although, clinicians found certain coping strategies to help decrease their chances of burnout, such as maintaining work-home boundaries, staying in touch with coworkers and friends, having self-awareness, and concentrating on satisfying aspects of the job. Health care environments that encourage worker engagement and resiliency are crucial to preventing worker burnout. Although burnout is a problem throughout the healthcare field, the importance of it tends to get neglected. Burnout can negatively affect the person receiving rehabilitation, the person administering rehabilitation and his or her family, and the employer. It has also been linked to alcoholism, drug use, illness, and depression.

On the other hand, if a therapist is able to make breaking bad news to a patient easier and less stressful, their likeliness of getting burnt out is less likely. When interviewing Kristie Liter, I asked, “Are there ever situations where patients do not want to listen to what they are being told to do? If so, how do you deal with this?” She replied, “Definitely! There are times patients do not want to follow recommendations for completing tasks safely. I always encourage safety but if the patient is adamant to do things their way I have them show me they can safely without my help. Typically, they are not able to and will eventually do what I am asking in order to get home faster. When I first became a therapist, I wanted every patient to be successful. When I would come across someone like this, I tried everything possible to get the patient to participate and follow recommendations. Now, I just explain that it is their choice if they follow or not. I can not make them do what they need to in order to get home, it is up to them. I then have to explain that insurance will not cover for them not to participate”. Out of the entire interview, this statement stood out to me the most because I never thought about this aspect of the job. Personally, I am not the best at standing up to others. I am a very non-confrontational person. However, to be successful in this field, I am going to have to stand my ground with my patients. My patients are not always going to get good news and they are not always going to want to listen to me. In order to avoid creating more stress for myself, I will need to be confident in my decisions and my ability to assess their situation. I will be the trained professional and hopefully, I will be able to help them fully recover. My patients will not always want to listen to me and sometimes I will just have to explain to them that it is their choice if they want to get better or not.

I have always dreamed of being an occupational therapist. I have known that this is what I wanted to be ‘when I grew up’ ever since I was a freshman in high school. I do believe that this is the perfect job for me because of my nurturing and compassionate personality. Being in a work field where I am able to better the lives of patients in need every single day will fulfill my passion for helping others. I love that I will be able to make a difference in people’s lives. In my personal life, I strive to please everybody; which can be a good and bad thing. This trait of mine can make being an occupational therapist harder because I will not always be able to please everybody in this job. There will be times when I will have to sit down with a patient and tell them things that they will not want to hear. This will definitely be the hardest thing about the job for me. It will break my heart if I have to tell a patient that they will never fully recover. However, I know I will be able to overcome this with experience and support from my co-workers. I believe that the positive aspects of this job overcome the negative ones.

When asked “What are the best things about being an occupational therapist?”, Kristie Liter responded, “Being able to help people overcome deficits incurred from illnesses/accidents to restore their independence. It is a great feeling when someone enters your care needing max assistance to take care of themselves and is able to leave being independent because of the instruction and treatment provided.” This made me feel a lot better because although having difficult conversations with patients will be hard, the reward of helping people in need surmounts that. I know this job will be great for me because I love meeting new people. This job will help me create personal bonds and lifelong connections with each of my patients. Yes, I will have to have tough discussions with them, but the bonds I will create will be worth it. There are various fields in occupational therapy such as geriatrics, pediatrics, hand therapy, vision therapy, etc. Therapists can choose the one that seems the most interesting to them. They also have the option to work on a part-time or full-time basis. Therefore, I believe the positives of this job outweigh the negatives.

There is a massive demand for occupational therapists in the U.S. today. This field of work is always going to need people to step up and help the patients that need rehabilitation to live a normal life. ‘Bad news conversations’ in healthcare are perceived as crucial clinical tasks, and one of the most difficult tasks that any type of healthcare worker may have to partake in. Having many of these stressful conversations can lead to burnout among many therapists. Although having these ‘bad news conversations’ is such a difficult task, there is very little detailed direction on how clinicians should go about having these discussions with their patients. Overall, I know that having these conversations will be difficult but the rewards of this job are well worth it and I can not wait to have a career in this field.