An interpretative phenomenological analysis of school-based occupational therapists' experiences with moral distress

Workplace stress in healthcare can impact patient safety and staff well-being. Moral distress, which refers to the suffering experienced by healthcare professionals when external pressures prevent them from acting, has gained public recognition due to the COVID-19 pandemic. Healthcare professionals who experience moral distress are more vulnerable to developing burnout and leaving their positions, making it a critical challenge for healthcare providers. Using a qualitative research approach and interpretative phenomenological analysis (IPA), this study explored the meanings and experiences of eight occupational therapists with moral distress in school-based occupational therapy in kindergarten through 12th grade public schools in the northwestern United States. IPA as a research design is well suited for investigating complicated, emotional, and nuanced topics that require in-depth understanding of participants’ perspectives. Data were gathered through participant-centered in-depth interviews, with a decontextualized photo-elicitation component, and a demographic questionnaire. Analysis included the six steps of IPA to generate personal experiential themes, resulting in group experiential themes across all participants. Participants attributed their moral distress to three overarching themes: (a) professional ethos versus educational culture, (b) professional identity versus educational identity, and (c) professional autonomy versus perceived compliance. The meaning of these themes to the participants included a lack of value for occupational therapy services and knowledge among stakeholders, a lack of shared decision-making and unequal power in school-based practice, and the value of moral distress as a catalyst for action. These findings contribute to the understanding and meaning of moral distress in school-based occupational therapy as issues of incongruence of professional values, diminished professional identity, and compromised professional autonomy in school-based practice that lead to disillusionment and loss of meaning in their profession and school positions. Proposed future practices for addressing moral distress in this group include implementing peer mentoring programs, establishing community of practice groups, advocating for a broader scope of practice, and setting up multitiered systems of support. This study proposed the need for further investigation to effectively identify and define moral distress, explore the impact of moral distress on occupational therapy practitioners and consumers, and subsequently design targeted interventions to foster adaptive capacity and resilience.