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Kirstin James, Derek Jones, Larissa Kempenaar, Jenny Preston and Susan Kerr, OCCUPATIONAL THERAPISTS IN EMERGENCY DEPARTMENTS: A QUALITATIVE STUDY. British Journal of Occupational Therapy (Pre-published 19th Dec. 2017). Copyright © [2017] (The Authors). Reprinted by permission of SAGE Publications. DOI: 10.1177/0308022616629168

Kirstin James, Derek Jones, Larissa Kempenaar, Jenny Preston and Susan Kerr, OCCUPATIONAL THERAPISTS IN EMERGENCY DEPARTMENTS: A QUALITATIVE STUDY. British Journal of Occupational Therapy (Pre-published 19 th Dec. 2017). Copyright ©

[2017] (The Authors). Reprinted by permission of SAGE Publications.DOI: 10.1177/0308022616629168

Introduction

Globally, occupational therapists are establishing their role in emergency care, especially in

Emergency Departments. This practice development merits investigation due to its

nascence and the challenges that face Emergency Department professionals. A qualitative

study examined the lived experience of occupational therapists in Emergency Departments

to contribute to knowledge and inform practice development.

Method

Interpretative Phenomenological Analysis framed the research methods. Nine occupational

therapists were purposively recruited with experience of Emergency Departments.

Individual, semi-structured interviews were audio-recorded and transcribed verbatim.

Interview transcripts were analysed line-by-line and interpreted using Interpretative

Phenomenological Analysis methods.

Findings

Theme one: 'On the Factory Floor' captured the experience of working in Emergency

Departments. They were perceived as ordered environments, but nonetheless could be

unpredictable, even chaotic. Theme two: 'A Stranger in a Strange Land' encapsulated what it

was like to enter and establish a new role in the Emergency Department. The Emergency

Department brings considerable personal and professional challenges, but it can offer

rewards, especially enjoyment, recognition and being valued. At the time of the study, the

participants were discovering how they might acculturate.

Conclusion

Occupational therapists are establishing their presence in the Emergency Department;

professional identity is forming and the practice paradigm requires further consideration.

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Key Words: Occupational Therapy; Emergency Department; Accident and Emergency;

Qualitative Research

Background

Globally, the role of occupational therapists within emergency care contributes a multi-

faceted, urgent, and time-critical response to people presenting with multiple and

increasingly complex needs, often at a time of personal crisis (College of Occupational

Therapists 2016). Emergency Departments (EDs) are one aspect of emergency care

provision. In the United Kingdom (UK) they provide 24-hour urgent and emergency care;

free at the point of delivery (Dolan and Holt 2008). However, ED attendances can also be

characterised, not by life-threatening medical emergencies, but by other situations including

relapses in chronic conditions, breakdowns in social care, or functional difficulties, for

example reduced mobility (Dolan and Holt 2008).

In addition, emergency care is becoming particularly challenging to deliver because of the

increasingly complex needs of populations (Department of Health 2001). These include

growing demands on services by an ageing demographic, and by the increasing numbers of

people living with long-term conditions (Department of Health 2012). In England alone,

over 3 million older people attend the ED each year, accounting for approximately 18% of all

attendances (Downing and Wilson 2004). As above, many individuals attend the ED with

complex social and functional needs, in addition to their medical symptoms. This

subsequently presents a challenge to the highly-technical model of emergency medicine,

founded to provide rapid and often life-saving medical interventions (Cameron et al 2009).

In response to these increasing demands on EDs, the UK Government introduced a four-

hour target from ED admission to discharge with the aim of improving efficiency

(Department of Health 2001). Nevertheless, this reformative measure has placed an

additional burden on the ED staff as penalties are incurred when the target time is

‘breached’ (Mortimore and Cooper 2007). Additional pressures are apparent within the ED

due to over-crowding because of a limited availability of ‘downstream’ beds, and the lack of

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provision of social care packages for those requiring additional support at home (Walker et

al 2016). The impact of both can result in a lack of ‘flow’ between the ED and other areas of

the hospital, with subsequent ‘blocking’ of emergency beds for those requiring further

assessment and intervention (Walker et al 2016).

As such, The College of Emergency Medicine (2013) described UK EDs as being in ‘crisis’ and

raised concerns regarding retention and recruitment of staff, over-crowding, and optimal

methods of providing treatment to those without immediate, life-threatening needs. The

working conditions within the ED have been shown to have a negative impact on the well-

being of medical practitioners (The College of Emergency Medicine 2013) and nurses (Lavoie

et al 2011). This has led to poor staffing retention, high sickness absence and ‘burn-out’ (The

College of Emergency Medicine 2013). A study by Spang and Holmqvist (2015) also

highlighted that occupational therapists face many professional challenges in emergency

care due to the complexity of the environment. This ‘crisis’ is not unique to the UK, and

globally EDs face challenges in how best to deliver care (Hsla et al 2010).

In growing response to these challenges within emergency care, occupational therapists are

now prevalent within EDs in many countries, including the UK, Canada, and Australia (James

et al 2016). Emerging evidence suggests that occupational therapists have a key role to play

in facilitating optimal functional outcomes for those attending the ED, while contributing to

a reduction in the length of admission to hospital, and potential cost-savings as measured

through saved ‘bed days’ (Hill 2010). Moreover, The College of Occupational Therapists

recently claimed that 70% of people seen by an occupational therapist in the ED were

discharged directly home, with cost-savings to the health organisation implied (College of

Occupational Therapists 2016).

Despite this growing and valuable role, a critical review of the literature pertaining to

occupational therapy in the ED (James et al 2016) showed that there are limited research

studies and theoretically informed frameworks to underpin practice in this area. Therefore,

there is a lack of evidence to understand how occupational therapists experience the ED.

Developing an understanding of the strengths and challenges of the experience of working

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within the ED will inform ongoing professional development within this key area of practice.

This paper reflects on the findings from a qualitative study that aimed to explore and

understand the lived experience of occupational therapists working within the ED with the

research question:

What is the lived experience of occupational therapists working in Emergency Departments?

Method

The aim of the study was to develop an understanding of the everyday experiences of

occupational therapists working within the ED and to explore the meanings constructed by

the participants as they make sense of the phenomenon of being an occupational therapist

within emergency care. Phenomenological research seeks to investigate the everyday, or

lived, experience of the individual participants and as such supports a methodological

framework firmly rooted within the phenomenological paradigm (Smith et al 2009).

Recruitment

Purposive sampling (Finlay and Ballinger 2006) was applied to ensure the research

participants had experience of working within the ED. Recruitment began with the

chairperson of a relevant Special Interest Group agreeing to circulate information sheets

about the study at a meeting. Contact details of the lead author were included on the

information sheets, and interested parties were invited to contact her by e-mail. After this,

and with agreement, further study details were mailed out to potential participants.

Participants were invited to take part in a semi-structured research interview, at a time and

place convenient to them. All participants subsequently chose to be interviewed in their

workplace. Recruitment thereafter was by ‘snowball’ sampling (Finlay and Ballinger 2006). In

line with the underlying research methodology, nine participants from across Scotland, UK,

were recruited to the study (Smith et al 2009).

Inclusion/Exclusion Criteria

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The main criterion for participant inclusion in the study was that they had worked as an

occupational therapist within the ED within the last five years, to ensure a contemporary

perspective of their experience. To obtain as full and thorough accounts as possible it was

also deemed necessary that the participants worked within the ED as their substantive place

of work. Substantive place of work was defined within this study as more than 50% of their

role was to involve the delivery of clinical services within the ED. Two potential participants

did not consider the ED to be their substantive place of work. One of these participants

chose not to participate further in the study, while the other agreed to take part in a pilot

study and gave their written consent with this understanding.

Ethical Approval and Consent

Ethics Approval was obtained from Research Ethics Committee of Glasgow Caledonian

University on 30 June 2010. NHS Ethical Approval was requested but considered not

necessary and a letter was received to this effect from South East Scotland Research Ethics

Committee on 04 February 2010.

Every participant gave Informed, written consent prior to their interview. The lead author

took this. As an ethical consideration, all participants were identified thereafter as female.

This was to protect the identity of any male participants who might be easily identifiable due

to the gender imbalance identified during the recruitment process.

Data Collection

Data were not naturally occurring and a generated data collection method was required

which would be congruent with the underlying research methodology (Preston et al 2014).

Therefore, semi-structured interviews, lasting between 50 and 80 minutes were conducted

by the lead author. The interview schedule, outlined in Figure 1 was developed and

intended as a series of prompts. Active reflection and critical listening was applied within

the interview to facilitate, as much as possible, the interviewee to tell ‘their own story’. All

interviews were audio-recorded and transcribed verbatim by the lead author. Any

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participant identifiable information was anonymised using pseudonyms at the time of

transcription.

Data Analysis

Interpretative phenomenological analysis (IPA) is an accepted method of analysis for

research emergent from the tradition of phenomenological inquiry and with a record of

application to occupational therapy research (Clarke 2009). IPA aims to understand by

interpretation how participants make sense of their experiences and, as such, embraces the

researcher’s perspective to enrich the sense-making process (Smith et al 2009). As with any

qualitative methodology the researcher is required to evaluate and declare underlying

assumptions and potential bias. In this case, the lead author was working as an

occupational therapist within the ED while undertaking the research study. While IPA values

the researcher’s own experience within the interpretative process (Smith et al, 2009),

challenges to the rigor and trustworthiness of the research can occur when the researcher

has direct experience of the phenomenon which is under investigation.

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Interview Prompt Sheet

Biographical information (gender, age, how long qualified as an occupational therapist, how long working in ED?)

Tell me about how you came to work in the ED?

What is it like being an occupational therapist working in an ED?

What do you do as an occupational therapist in this environment?

Can you describe some of your experiences? What has been good/bad?

What does your job mean to you?

What does being valued mean to you?

How do you know what you are doing is the right thing to do?

What does occupational therapist identity mean in this environment?

Figure 1 Interview Schedule

Therefore, to deal with any potential bias several processes were implemented, These

included: conducting a pilot study to ensure the interview schedule had sufficient sensitivity

to capture experience; sense-checking throughout the data analysis process by regular

supervision with the research team’ ensuring rigour through questioning and further

exploration of the interpretation; the lead author kept a reflective research journal

throughout the study, including after each interview; and early findings were disseminated

at a national occupational therapy conference to further test the interpretations for

authenticity and relevance.

Within IPA there is recognition that the meanings generated within the interview may not

represent a direct reflection of previously existing understandings as the participants will

themselves utilise both the interview and the time after the interview to reflect on and

review their understanding of their experiences (Mason 2002). It may not therefore be

possible, given the process of reflexivity which has occurred, for the participants to ensure

that accurate repeatability can be obtained (Guba and Lincoln 1989). Thus, and in line with

the underlying methodology, respondent validation did not take place within this study.

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However, the epistemological critical realist stance of IPA gives credibility to the study

through acknowledgement that the ‘truth’ of the findings is somewhere between the

narrative of the interviewee and the interpretation of the researcher (Madill et al 2000). To

further ensure transparency, participants were offered a copy of their interview transcript

for their own records.

The data were analysed using an IPA framework, and by closely following the structure for

this outlined by Smith et al (2009), including close engagement and immersion with the

transcripts. The following process was used to inform the analysis and the subsequent

identification of emergent themes. First, each transcript was taken individually and read

multiple times, in greater depth each time. At the same time, written comments were made

in the paper margins of transcripts and colour-coded as shown in Table 1. The colour-coded

comments were the method by which textual analysis took place and themes began to

emerge.

Exploratory Comments

Ink Colour Nature of Comment Analysis

Blue Descriptive comment Content and subject of language

Green Linguistic comment Specific use of language Exploration of the meaning and use of a word in its context

Red

Black

Pink

Conceptual comment

Potential theme emerging

Researcher reflectivecomment

Potentially unconscious meaning of the language used

For interpretation in great depth

Researcher reflection

Table 1 Textual Analysis Method

Exploratory comments were made in the right-hand margins first, with emergent themes

noted in the left-hand margins later. Emergent themes were then interpretatively

conceptualised within the research team in greater depth, and considered within the

context of each transcript, before eventually considering the themes in relation to the wider

group of participants. Re-consideration of themes took place until a coherence emerged

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across the four researchers that encapsulated the experiences for the group of participants.

The team eventually arrived at two over-arching themes which illuminated the experiences

of the participants and these two themes became the main findings. The most explicative

aspects of each theme are illustrated using direct quotations from the data.

Findings

In alphabetical order the nine participants were: Corin, Jo, Katie, Keeley, Lucy, Mandy,

Rachel, Renee, and Sadie. All names are pseudonyms. Jo and Rachel had experience working

in the ED, but at the time of interview, were working within other clinical areas. All

participants were the only Allied Health Professional (AHP) in the ED, except for Sadie who

worked alongside a physiotherapist. Colleagues in the ED were doctors and nurses, and it

was unusual for the participants to have an occupational therapy colleague. Their details are

further summarised in Table 2.

Two main themes emerged from the data. The first theme entitled “On the Factory Floor”

encapsulates the environmental aspects of the participants’ experiences focussing

particularly on the structure, processes and mechanics of working in the ED. The second

theme “A Stranger in a Strange Land” offers insights into the cultural aspects of the ED,

reflecting language, values, and behaviours experienced by the participants. How these

impacted on the co-construction of meanings of their experiences was also evident.

Theme One: ‘On the Factory Floor’.

All participants spoke about their experiences of what it was like to ‘be’ in an ED. One

striking aspect of this was their perception of how it operated. At times, the participants

described it akin to a ‘factory-floor’ rather than a hospital department. They offered insights

into a very controlled environment with many systems and processes in place, lending a

reductive and automated feel to the ED.

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Participant Age group Experience in years

Work location Previous clinical roles

Corin 25-29 8 Based in the ED Older persons’ health

Jo 45-49 20 Previous role in the ED

Acute medical wards

Katie 40-44 16 Based in the ED Older persons’ health, acute medicine, surgical, orthopaedic and oncology wards, stroke rehabilitation and adult mental health

Keeley 35-39 12 Covers other ward areas and the ED

Acute medicine, older persons’ health

Lucy 40-44 13 Covers other ward areas and the ED Visits patients in the community

Mental health

Mandy 40-44 20 Covers other ward areas and the ED Visits patients in the community

Continuing care wards

Rachel 35-39 12 Previous role in the ED

Older persons’ health, acute medicine

Renee 30-35 8 Based in the ED Older persons’ health, acute medicine, surgical, orthopaedic and oncology wards, stroke rehabilitation and adult mental health, community occupational therapy

Sadie 40-44 19 Based in the ED Visits patients in the community.

Older persons’ mental health, mental health, older persons’ health, orthopaedic rehabilitation, acute medical, community rehabilitation team

Table 2 Participant Details

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This is reflected within Renee’s comments:

“And because of the escalation policy, beds are just booked and people are admitted

(em). And it's just about, really, a conveyor-belt of, of through-put of people.”

The sense of the individuality of the attendees could then become lost as the focus of the

ED appeared more concerned about getting people ‘through’ the system as quickly as

possible. Furthermore, the four-hour admission to discharge target seemed to drive what

happened, not always to the advantage of patients, as Sadie described:

“I think it might have reduced our referrals because there’s like, ‘Right, they’re sitting

at three hours; if we get the OT [occupational therapist] or the physio[therapist] up,

we’re going to breach’, not, I mean, they’re patients, we’re not going to rush them

because of a time, you know, if they need more, they’ll get more.”

Both Renee and Corin offer similar reflections of this perceived time pressure:

“(Um) Well, originally, the government essentially, decided that patients shouldn't

wait any longer than four hours in any department before a decision is made about

admitting, transferring or discharging. Unless their care needs are best met in that

department (em). So, from our perspective, the minute a patient turns up at the

front-door, they're clerked in onto the system, the ‘Trak’ [electronic patient record]

system, the clock starts to tick. Or they attend (em) via ambulance, they're clerked in,

the clock starts to tick (sigh) (em).” (Renee)

Corin described how quickly she was required to respond:

“I thought the fact that it was very fast-paced. That, you know, you only have a

couple of hours to...do what you have to do and get somebody out the door. So that

would be different from working in, sort of, elderly rehab[ilitation], where you have

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weeks if not months with a patient. So you know, it would be very kind of quick, in

and out.”

Yet regardless of the apparent orderliness, the sheer numbers of people attending could

lend a sense of chaos to the environment. According to Mandy:

“It depends on what kind of day it is. The past wee while it's been walk in and you're

met by trolleys everywhere with ill patients on them you know, maybe twenty people

lying on trolleys that there's no rooms for or they're waiting on beds, or they're

waiting on further tests. So sometimes it can be extremely chaotic.”

For the participants, however the diversity of the workload and the individual patient stories

contributed to a sense of variety and interest as articulated by Katie:

“And I kind of, when it is really busy, I just get this kind of, get this feeling, that I like, that all

of life is here (laughs).…A&E [Accident and Emergency Department] is a really good place…a

good place to be.”

Although EDs might be perceived as rigid in their operations and therefore potentially

challenge the professional values of those that work within, the participants acknowledged

that benefits and professional rewards were to be found. As such and despite the

challenges, the participants continued to feel that they were able to apply their holistic

world-view:

“I think ‘cause you’re looking at the person as a whole and not just looking at the

injury which obviously, doctors and nurses do, that medical model, that we think,

right, lower limb problem, that’s going to affect every part of your li [life], …so we

just, I think it’s just how we’re trained and what, what we look at because of, one

injury can cause problems in any task (erm).”

Theme Two: ‘A Stranger in a Strange Land.’

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Theme Two captured the experiences of the participants as they became established within

their ED. This theme reflects initial fear and trepidation as the participants enter a ‘new

world’. However, their early misgivings are balanced by the recognition that the ED creates

opportunities at both an individual personal level and a professional level. This was

indicated by Rachel:

“I do recognise that I probably felt initially quite fearful, but it was an area that I

wanted to feel more comfortable in because (erm) it was new…and I suppose at that

time it was relatively uncharted territory for OTs and I was aware that it was an

amazing opportunity to, as an OT, to be in that environment and be exposed to all of

that (erm).”

In anticipation of their new roles the participants offered insights into their experiences of

how they believed they might be perceived by the wider team within the ED:

“I suppose they were really curious about, you know, this person in green trousers

coming through, what difference are they gonna [going to] make to our patients (er)

and you will, you know, you want your, your service to…to come across as being

worthwhile for, for them otherwise you won't get the referrals, you want it to be

perceived as something that's actually going to help people, not be a negative, you

want it to be something positive (erm).”(Rachel)

The participants’ anticipation of the ED as a formidable environment was borne out in their

experiences, and as they established themselves some felt unprepared for their new roles:

“And I think sometimes, it's a big leap of faith, in having faith in your assessment,

you know, there and then, which I think now I've overcome that, you know, it's…you

do have to have confidence in what you decide and, and sometimes you do hold your

breath and think ‘Oh, is this the right thing to do’?” (Mandy)

At the time of the study, the participants were still establishing themselves within the ED

and offered some very practical insights regarding their sense of belonging. They reflected

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on an interesting tension between their desire to fit within the ED while acknowledging a

sense of betrayed loyalty to their own occupational therapy departments;

“(Um.) And…(um)…I mean, they, you don't use the sort of staff room of the A&E,

members of staff, we tend to go back to the [place name] home, back to our little OT

team, otherwise we'd never see them again (um)…So we are a bit …I suppose we are

a sort of member of the A&E team, but we don't go to their staff meetings etcetera,

so we're slightly…slightly added on.” (Katie)

However, this sense of belonging was co-constructed as being more than just a sense of

physical belonging within the environment as some of the participants revealed a more

personal meaning of belonging and the need to feel part of a team. Although acknowledging

themselves as part of the ED Team there was still a sense of attachment to their former

roles and relationships:

“I think to work in the A&E environment, you have to be quite…..well…kind of

independent in some respects, because there's nobody there to rely on, that's

not...Although it's a team, you are the only AHP person there.” (Corin)

Feeling valued was critical to their sense of belonging and the participants felt valued when

they were thanked for their contribution. The ED was perceived to offer the opportunity for

recognition and thanks more than previous work experiences had done.

“Having said all that…taking all that aside...and that for granted, so this is, I have to

be here…but what I am doing within those parameters is actually quite rewarding. I

wouldn't really want to be anywhere else. I'm getting much more reward out of my

job than I was. As I said before I was getting really quite disillusioned with things

when I was down in [place]. (Um) So I get quite a good…..(um) good sense of (um)

achievement out, out of my job, you know. You know, I go into A&E, (um) people are

kind of, are thankful, (er) get people home, and I, and I get a sense of reward from

that.” (Lucy)

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In an attempt to explain these findings, they will be discussed below in the context of the

wider literature, especially philosophies and theories of occupational therapy practice.

Discussion and Implications

The participants in the study perceived and experienced the ED as a demanding

environment lending substantial, but not insurmountable, challenges to both their day-to-

day experience of being in the ED and to their core-values. Their experiences showed that

the ED could be mechanistic, reductive, and target-driven and that the numbers of people

attending must be managed in some way to ensure equity and sustainability of services.

The participants also perceived that they themselves might be thought of as contributing to

further delays in getting someone ‘through’ the ED, resulting in non-referral of patients to

them; patients who might benefit from occupational therapy intervention. This finding may

have significant implications for patient safety, as people might be discharged without

thorough identification of their needs. Moreover, if patients were admitted into hospital

without the relevant assessments being completed this may lead to missed opportunities to

offer alternative care pathways to support people out with the hospital environment.

Further work is undoubtedly required to demonstrate the impact on patient outcomes and

services through early assessment and intervention with an occupational focus.

The experience of the participants also supports the work of Dewar and Nolan (2013) and

Lopez et al (2008) in that person-centred care can be particularly compromised in acute care

systems, and exceptionally challenging to the professional values of compassionate care and

holism. However, this research study departed from others in that the participants

experienced an ability to maintain a compassionate and holistic world view, despite the

challenges of the environment. The reasons for this apparent departure from other

paradigms of acute care delivery would merit further exploration in future studies to

determine whether other occupational therapists working in the ED are similarly able to

maintain a holistic identity.

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Furthermore, despite the challenges within the environment, the participants experienced

professional rewards from working in the ED, specifically enjoyment, recognition and feeling

valued. These are important findings when related to the experiences of other professional

groups with a longer history of working in the ED. This is because work-related stress,

retention, and ‘burn-out’ have been found to be more common in ED professionals,

including nurses (Lavoie et al 2011) and medics (College of Emergency Medicine 2013) than

those working in other areas of practice. These issues may therefore also present as

concerns for occupational therapists as they extend their tenure in the ED. The longitudinal

impact of working within the ED was beyond the scope of this study, however further

research to understand the impact, if any, of working in the ED on occupational therapists in

the longer term should be considered.

The participants found that their role as occupational therapists within emergency medicine

was still emerging and this is the first study to investigate the meanings constructed by

occupational therapy participants within this clinical speciality. Yet there is a lack of

understanding at this point as to how the experience of the ED compares to other emergent

areas of practice. It is therefore important to look at how emerging and establishing

professionals begin to cement their identity. One way to do this is to consider the findings

within the framework proposed by MacIntosh and MacLean’s in their model of conditioned

emergence (2001). Per MacIntosh and MacLean, emergence follows three stages:

1. Conditioning: identification and re-framing of rules

2. Creating far from equilibrium conditions: a crisis takes place as unfamiliar territory is

entered and new structures emerge including the formation of roles and

responsibilities

3. Managing the feedback process: feedback shapes the cementing of the new

structure (MacIntosh and MacLean 2001)

4. Applying this model to the experience of the participants in this study, would suggest

the emergence of occupational therapy within the ED appears to be at Stage 2. The

potential structures for occupational therapy practice within the ED are still forming

and the influence of feedback is key to the eventual shape of the occupational

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therapists’ identity (MacIntosh and MacLean 2001). Specifically, for this study, the

experience of the participants was that they worked as lone practitioners within

their teams, and therefore shaped their identity alongside nursing and medical

colleagues from whom they would be receiving feedback. It is therefore crucial to

now consider the mechanisms by which occupational therapists are becoming fully

established in emergency medicine to understand how fundamental constructs can

be understood in the ED context. The experience of the participants in this study

suggests there is a need for more evidence in this field to inform the future role and

contribution of occupational therapists within the ED.

Limitations

The participants were all a similar grade occupational therapy banding. This may limit

transferability of the findings to other settings. However, Smith et al (2009) argue that,

primarily, rather than claiming generalisation, how illuminating the study was for the

particular participants is of most import. For this study, the in-depth and detailed analysis

and interpretation, with context from the transcripts, may assist the reader in assessing the

relevance of the findings to their own situation.

Conclusion

The findings demonstrated that the occupational therapist participants within this study

experienced the ED through two key lenses of structure and culture. The perception of the

highly structured time-pressed environment was viewed as both supportive and chaotic.

Aspects of culture reflected the experiences in relation to both the physical environment

and the sense of belonging. This sense of belonging appeared to divide loyalties between

familiar occupational therapy and allied health relationships as the participants sought to

establish themselves within their new teams. Of need now is strong occupational therapy

leadership within emergency medicine and reliable research evidence to under-pin

occupational therapists’ practice and cement their professional identities.

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Further research is required to consider the longer-term impacts of the environment and

the culture of the ED on the longevity of the role occupational therapists. Within the

international community there is an inconsistency regarding the level of establishment of

occupational therapy within the ED. Further evidence is required to truly understand how

occupational therapists construct professional identity and how they experience the impact

of developing roles. The occupational therapy profession should seek to develop the

evidence base to support the theoretical frameworks of this emergent area of practice.

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Key Messages

Occupational therapy is still establishing its professional identity in the Emergency

Department context and models of practice are not yet fully developed

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I Key Findings

The participants experienced the ED as personally and professionally challenging, though it

also offered rewards.

At the time of the study, the participants were still discovering how they might acculturate.

2 What the Study has Added

This study has illuminated ‘what it is like’ to be an occupational therapist in the ED

demonstrating that occupational therapy is still establishing within the ED, and professional

identity is forming.

Conflicts of Interest

The authors confirm there is no conflict of interest.

Funding

Partial funding for this research was received from an NHS Education Scotland Allied Health

Professions Scholarship.

Acknowledgements

Special thanks to the research participants who graciously gave up their time to take part.

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